Dialysis patients who are incontinent

1940Nurse · Jun 24, 2006

I sent a patient to the dialysis unit in a w/c. He sits in the chair and gets dialysis. Four hours later I get him. "He's sitting in feces". Me: Let's clean him up then. Dialysis Nurse: "We don't clean them up in here, there are other patients getting dialysis, it's a sterile procedure.". Me: "So if he pooped 4 hours ago, he is to sit in it for four hours?". Dialysis Nurse: (with attitude) "You don't understand".
I'm willing to admit I don't understand.
What's the scoop? Dialysis patients who are incontinent don't get cleaned up????

We don't usually clean them up. Especially if she had another patient to watch in the room. Usually the dialysis nurse is alone with two patients. If she is up to her elbows ( sorry) in poop and the other patient crashes what should she do.

What she should have done was call you and tell you to bring some help with you to clean up the patient.

In outpatient units we rarely clean them up either. We have no depends etc. It's hard to roll a patient over in a lounge chair and properly clean them. We don't have rooms or curtains. We do have those screens for what they are worth but we don't put them behind the patient so the patients across the way can see everthing that's going on. I've seen many a LTC facility give the dialysis patient laxatives or supps just before dialysis to avod the problem at their end. Doesn't work in outpatient HD.

I'd ask her to page me the next time that happens and tell her you would be right over with help to clean the patient.

Hellllllo Nurse, BSN, RN · Jun 24, 2006

It is against policy, and I'm told, state regs for dialysis personnel to clean up after incont pts at every HD unit I've worked at. I've actually been reprimanded for doing it.

Cross contamination is a big issue in dialysis. Lots of docs and nursing homes don't understand why we can't do their dressing changes, either.

Also, dialysis units do not have the staff, equipment, or supplies to do incont care.

If it's an occasional accident, I try to sneak in a clean up. If it's something that happens all the time, a family member can sit w/ a pt, or a family member has to be on standby in case incont care is needed. If such arrangments can't be made, all the nsg home/hospital staff can do is make sure the pt is toileted, has on a lot of barrier cream, and an absorbent brief w/ a pad underneath before going to dialysis.

Tweety, BSN, RN · Jun 24, 2006

Thanks for the response. I seriously wanted to understand.

It still sounds lame to me to let a patient sit in poop for hours. But I don't know enough about dialysis, so I'll be a little less judgemental. The nurse should have called me to clean them up. That's better than me having to get a brillo pad to scrub off four hours of dried poop. When I got there he wouldn't let me clean him up before putting him back in the w/c, saying I had to clean him up back on my unit.

jnette, ASN, EMT-I · Jun 24, 2006

It is against policy, and I'm told, state regs for dialysis personnel to clean up after incont pts at every HD unit I've worked at. I've actually been reprimanded for doing it.
Cross contamination is a big issue in dialysis. Lots of docs and nursing homes don't understand why we can't do their dressing changes, either.
Also, dialysis units do not have the staff, equipment, or supplies to do incont care.
If it's an occasional accident, I try to sneak in a clean up. If it's something that happens all the time, a family member can sit w/ a pt, or a family member has to be on standby in case incont care is needed. If such arrangments can't be made, all the nsg home/hospital staff can do is make sure the pt is toileted, has on a lot of barrier cream, and an absorbent brief w/ a pad underneath before going to dialysis.

Ditto............ Tweety all the above are absolutely correct. If we have a patient who is incontinent, and has family, we always ask the family to bring an extra set of clothes and some depends with them. If the patient has a BM while on dialysis, we will take that patient off the machine long enough for the family mbr. to take the pt. to the restroom, clean them up and change them. If they have no family, we make sure the NH or whoever knows to send them with a clean depends on. As hectic and chaotic as dilaysis is, there simply IS no time to stop in the middle of holding a patient's site or while taking a patient off and returning their blood, to deal with this as well.... serious cross contamination issues... not to mention that you have three other patients needing your attention all at the same time.

And as stated.. no privacy to offer bedpan, etc., although I have done that when absolutely neccessary once or twice, but it really is not protocol or desirable.

It's a shame, but these patients are in an outpatient clinic, and we don't keep or even HAVE regular "hospital supplies".

Trauma Columnist · Jun 24, 2006

I'm going to be starting a position in a dialysis unit (outpatient). I never considered that patients WOULDN'T be cleaned up. Thanks for the info.

Midwest4me · Jun 24, 2006

I recall being just as appalled as you Tweety at the lack of incontinent care when I first started in dialysis. Once I was there, with the fast "turn-around times" of taking pts off the machines and getting others on I realized there is NO time(that is sad) and it's because of cross-contamination issues!

Diva · Jun 24, 2006

Whoa! Against state regs? What about state regs regarding the respect and dignity of the patient? What about the other patients comfort if there is an odor? We not only keep depends but also cheap drawstring cotton pants (and tops). An incontinent patient is rinsed back and taken to the patient bathroom for clean up. We consider than an emergency. There is no way we could send a patient back out other than in the way they came in.

I can understand if there is one nurse with two patients, but what would he/she do if one patient crashed and the other's needle came out? There needs to be someone else nearby to help.

It is my understanding that while the patient is in our unit we take total care of the patient during that time. Anyone who asked a family member to clean up a patient (unless the family member offers AND insists) would be subject to a write up.

Hellllllo Nurse, BSN, RN · Jun 24, 2006

Whoa! Against state regs? What about state regs regarding the respect and dignity of the patient? What about the other patients comfort if there is an odor? We not only keep depends but also cheap drawstring cotton pants (and tops). An incontinent patient is rinsed back and taken to the patient bathroom for clean up. We consider than an emergency. There is no way we could send a patient back out other than in the way they came in.
I can understand if there is one nurse with two patients, but what would he/she do if one patient crashed and the other's needle came out? There needs to be someone else nearby to help.
It is my understanding that while the patient is in our unit we take total care of the patient during that time. Anyone who asked a family member to clean up a patient (unless the family member offers AND insists) would be subject to a write up.

Different states have far different regs for dialysis practice, just as different companies have different policies & procedures.

One nurse with two pts?

I'd be interested to know the staffing ratios where you are?

I imagine it is the lesser of two evils- An odor may bother other pts, but subjecting them to cross contamination could injure them.

The last two chronic units I worked, I was the only nurse in the building.

At one of the units, we dialyzed hospital inpts in our outpatient clinic. These pts were acute in a chronic setting, with chronic staffing. We had ill, unstable pts on certain drips, LIS, sealed wound vacs, and such. If I took the time to go against policy and change an incontinent pt in that environment, I would surely have my priorities mixed up.

jnette, ASN, EMT-I · Jun 24, 2006

Whoa! Against state regs? What about state regs regarding the respect and dignity of the patient? What about the other patients comfort if there is an odor? We not only keep depends but also cheap drawstring cotton pants (and tops). An incontinent patient is rinsed back and taken to the patient bathroom for clean up. We consider than an emergency. There is no way we could send a patient back out other than in the way they came in.
I can understand if there is one nurse with two patients, but what would he/she do if one patient crashed and the other's needle came out? There needs to be someone else nearby to help.
It is my understanding that while the patient is in our unit we take total care of the patient during that time. Anyone who asked a family member to clean up a patient (unless the family member offers AND insists) would be subject to a write up.

That is certainly wonderful if your unit is able to do that... and while we, too, would take the patient off the machine and interrupt tx. temporarily as you do, we did not have the time nor the staff to spare for such a clean-up. Nor did our medical director approve of such.

No, we did not let our patients sit in their pooh, but we were fortunate enough to have caregivers/family members who would stay during tx. time if they knew this was a problem, and assist the pt. with clean-up.

Thank goodness this was not a commom occurance, rather a rare one.

For those units who are fortunate enough to have adequate staffing, that is wonderful. Most, however simply are waaaaaaaaaaaay understaffed. And the families knew that and respected that. :)

TazziRN, RN · Jun 24, 2006

Whether or not it is dept policy to not clean incontinent pts, it is WRONG to let the pt sit in poop for that long. What about skin breakdown in a pt who's already compromised?? At the very least that nurse should have called you and asked you to come clean him up.

Diva · Jun 24, 2006

One nurse with two pts?
I'd be interested to know the staffing ratios where you are?

We would never have one nurse w/two patients. 1940nurse mentioned that above. I assume it was acutes and not in a chronic unit.

We are fortunate to have adequate staffing with a few bad days here and there. If there is only one nurse, nothing else can be done, but we are not allowed to run with only one licensed person in fact we usually have 4 and sometimes 5. I've been with a chain in the past, so I do know what goes on out there.