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????
PS... we HAVE done it, and were called on it. There are 12-14 OTHER patients to consider here as well... and THEY complained.. loudly. And rightly so.
I, personally would not want to be exposed to any more nastiness than is already found in any dialysis unit if I were a patient there. We must have everyone's interest at heart, not just the one.
We are taking fluid OFF not putting in on. Many units have a policy ( a very lax one at that) of not eating during HD treatments.
Reasons not to eat on HD:
# 1. A patient can drop their b/p VERY quickly on HD. They don't even know it's happening. IF they have something in their mouths they can easily aspirate it. I go around and take all the gum I see early on in the treatment. I've had to fish out gum before It's not a fun process
#2. As Hello nurse has said the patient has a fair amount of blood out side of their system. Many are diabetics. The human body is smart when there is blood volume depletion the blood is routed to the most vital organ, the brain, and away from the stomach. Thus the digestive system is not at it's peak of performance resulting in vomiting at times even without food in the gut. Bicarb helped that some by buffering the blood
# 3 HepB and C are real concerns in an HD unit. As we all know it really is easier for someone to get Hep B than it is to get AIDS. There are blood spatters you don't even see. Eating in a dialysis unit is NASTY.. The staff are not allowed to chew gum or fiddle with their contact lens in the unit. And those are common sense issues and adhered to quite well. We have to protect our patients as much as we protect ourselves.
Dialysis isn't like your local hospital. Where there is one place to go and that's it. Dialysis is a very competitive business with very tight financial margins..If a patient doesn't like it there they can go to a competitor. Are we to cater to one patient over 20-30 others? You'd probably "hack up a hair ball" if you knew what you and I are paying for dialysis every week. The population increases by about 9-10% every year.
Again there is just so much money in the pot.
As for insight please read all the posts.
I agree this wasn't handled well in the acute inpatient HD unit. I've given my opinions on how to remedy it in the future. Tweety doesn't sound like a whimp to me.. It will be handled better the next time.
Just a question for ya'll. Does X-ray or MRI clean a poopy patient when they bring them back to you.. Does RT clean a poopy patient after they give an albuterol treatment.
:redlight:
Xrays and MRI's can hardly be compared to dialysis. If a patient soils themselves in x-ray they are not going to have to sit in it for four hours!
Hate it, Diva, but I'm standing firm and will have to disagree with you on this one... no cleanups on the unit floor. BR, yes.. not on the floor. For all the reasons given above, and then some.
Jnette: Re-read my post. I said I *did not* condone cleanups on the floor.
I am opposing the patient not being cleaned up at all. One unit I was at even had a shower in one of the patient BR's (chronic outpt unit). How great was that? Hand held shower. It was rarely used but nice to have anyway.
These kinds of things happen infrequently in outpt units, but it does happen.Thankfully it is not an every day thing.
Hate it, Diva, but I'm standing firm and will have to disagree with you on this one... no cleanups on the unit floor. BR, yes.. not on the floor. For all the reasons given above, and then some.
Jnette: Re-read my post. I said I *did not* condone cleanups on the floor.
I am opposing the patient not being cleaned up at all. One unit I was at even had a shower in one of the patient BR's (chronic outpt unit). How great was that? Hand held shower. It was rarely used but nice to have anyway.
These kinds of things happen infrequently in outpt units, but it does happen.Thankfully it is not an every day thing.
ooops. :imbar
Sorry, Diva... you did mention that, and I overlooked it. My apologies. :)
Yes, I have heard of units with showers, too. That would be soooooo nice to have. Unfortunately, units are equipped for better or worse depending on the location.. and sadly, the wealth of that geographic population. I found that out when I went out to AZ. to visit my mom. Very ritzy area. Same Company but oh boy, did they ever have the staffing, and all kind of marvelous "exras" that my home unit did NOT. You'd think all units in one company would be entitled to the same, but I found it not to be so.
I work in LTC and we had a resident who always came back from dialysis and as soon as she was back to the floor she said she was messy and needed cleaned up. She herself complained about the inability of the dialysis personnel to not clean her up and leave her setting in it until she came back to us......She even went as far as taking extra depends or clothes with her when she went, and still no clean up while at dialysis.
Yes, I have heard of units with showers, too. That would be soooooo nice to have. Unfortunately, units are equipped for better or worse depending on the location.. and sadly, the wealth of that geographic population. I found that out when I went out to AZ. to visit my mom. Very ritzy area. Same Company but oh boy, did they ever have the staffing, and all kind of marvelous "exras" that my home unit did NOT. You'd think all units in one company would be entitled to the same, but I found it not to be so.
I have found, with the chains, that it is local management, (regional and/or FA's) that can push for the niceties. One thing, though, is that the unit has to be performing financially to afford them. Don't forget the chains have to please the shareholders. Oh, don't get me started:o
Just a question for ya'll. Does X-ray or MRI clean a poopy patient when they bring them back to you.. Does RT clean a poopy patient after they give an albuterol treatment.
Not a fair question. They aren't trained in their degrees to do this, and they don't have the patient for four hours.
Hellllllo Nurse and 1940 are right on the money here. As far as Hospital Floor HD, that's a whole 'nuther matter... I'm sure this could have been handled differently, at least helping cleaning the patient up before returning to his own floor.
Jnette, I'm totally understanding of the concerns and drawbacks of clinic setting. I had no idea.
My patient was inpatient and his dialysis was over, so many of those concerns are invalid and that is where I'm having trouble with this situation. I'm not in no way shape or form judging the professional dialysis nurse.
All of this has been a very interesting lesson on the in and outs of clinic dialysis. I know that in Canada we do things differently but it had never occured to me that it would be that big a difference.
Not a fair question. They aren't trained in their degrees to do this, and they don't have the patient for four hours.
I worked M/S before I went back into dialysis. The cath lab had an RN and yes the patient could be gone for 4 hours if they called them early. And many times the X-ray department kept patients for a long time. And had an RN in that department.
Is there a time limit on poopies?
Dialysis is a treatment. Just as an X-ray is or an albuterol treatment. Maybe if you look at it that way. As I said before in an acute unit a dialysis nurse won't even medicate your patient. They will give blood, or albumin for you though. I think that's a nice gesture.
Jnette, I'm totally understanding of the concerns and drawbacks of clinic setting. I had no idea.
My patient was inpatient and his dialysis was over, so many of those concerns are invalid and that is where I'm having trouble with this situation. I'm not in no way shape or form judging the professional dialysis nurse.
BUT not in the dialysis unit itself. So why not hustle him back to his room and clean him up.. I'd be just as concerned though that he sat bolt upright during his whole treatment in a w/c. They have very little support for that type of process and for that long.
jnette, ASN, EMT-I
4,388 Posts
PS... we HAVE done it, and were called on it. There are 12-14 OTHER patients to consider here as well... and THEY complained.. loudly. And rightly so.
I, personally would not want to be exposed to any more nastiness than is already found in any dialysis unit if I were a patient there. We must have everyone's interest at heart, not just the one.