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????
As stated before, I have 15 years of nursing experience with 12 of them being med-surg and I'm sure you know where they admit HD patients? I also worked one year on a dedicated renal failure floor. I'm not sure why you would ask that as it's not really germane to the discussion.
As for the guy with the broken hip, I'm not really following you there. Would you be unable to clean someone up with dropping them and breaking their hip?
Finally, why the defensive tone? I haven't criticized anyone, I merely stated what my experience has been and I am quite surprised to read about others' experiences with this. Why should that upset you?
If you'd read all the posts you'd see that a nurse alone MIGHT have difficulty standing a patient and pivoting them WITHOUT legs onto a bedside commode. What I said was which would be worse a poopy butt or a broken hip?
I never said you critized anyone did I? I am dialysis nurse. The OP was looking for information from a dialysis perspective. I worked M/S for years but I rarely give advice on it anymore. I walked through the ER a couple of times. I'd be hard pressed to tell you how that department runs either.
Dialysis a rather new discipline in medicine and as such is ever, constantly, and frequently changing. Things change on a daily basis almost. So what was "right" a week ago, could be totally thrown out this week.
It takes approximately one year to feel comfortable in this discipline let alone confident and that's working in it on a day-to-day basis. A dedicated renal floor is not a dialysis unit.
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.
I guess if I got someone back from cath lab or radiology special procedures full of poop and a nurse and brought them back knowing they'd been in it for four hours, I'd be asking the same questions. Maybe if I worked in cath lab, dialysis or radiology I'd be able to deliver a patient back to the unit "the groin site is dry and intact, no bleeding, good pedal pulses, and he's been sitting in feces for 4 hours"........maybe.
I fully understand that incontinent patients need to lie in it sometimes. During a cath, you're not going to move a patient to clean them up. During dialysis while in a dialysis chair, you're not going to clean them up either. I understand that.
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.
This is exactly what I did. I picked up my poopy patient out of his dialysis chair, sat him back down in the wheelchair full of feces, put his stinky poopy self in the elevator, wheeled his stinky poopy self down the hall, and brought him back to his room and cleaned him up, scrubbing dried 4 hour old poop off of him, trying to salvage some semblence of dignity that he had left after this humilating experience.
What I'm not understanding about the cross-contamination thing, is that it's o.k. for them to sit in the poop. But after the dialysis is over and I want to clean him up (yes, I know about hypotention after dialysis and orthostasis and the risk of breaking the poor patients hips) prior to putting him in the wheelchair, I, the non-dialysis nurse can't do that in the dialysis unit? Remember it's an inpatient unit, well-staffed, curtained, full of incontinence supplies nearby and I could have carried the dirty stuff to the laundry shoot. I don't get it.
Thanks for your input. We don't have to go around and around. Please understand I'm not being judgemental of HD nurses as I'm now enlighted.
This is exactly what I did. I picked up my poopy patient out of his dialysis chair, sat him back down in the wheelchair full of feces, put his stinky poopy self in the elevator, wheeled his stinky poopy self down the hall, and brought him back to his room and cleaned him up, scrubbing dried 4 hour old poop off of him, trying to salvage some semblence of dignity that he had left after this humilating experience.
What I'm not understanding about the cross-contamination thing, is that it's o.k. for them to sit in the poop. But after the dialysis is over and I want to clean him up (yes, I know about hypotention after dialysis and orthostasis and the risk of breaking the poor patients hips) prior to putting him in the wheelchair, I, the non-dialysis nurse can't do that in the dialysis unit? Remember it's an inpatient unit, well-staffed, curtained, full of incontinence supplies nearby and I could have carried the dirty stuff to the laundry shoot. I don't get it.
Thanks for your input. We don't have to go around and around. Please understand I'm not being judgemental of HD nurses as I'm now enlighted.
On the surface I agree with you Tweety. My even bigger concern is the patient sitting in a w/c for 4 hours. NOW that is unacceptable.
Hope we've given you some insight and good suggestions for the next time.
I never said you critized anyone did I? I am dialysis nurse. The OP was looking for information from a dialysis perspective.
I just couldn't understand the snarky reply, it seemed rather unnecessary to me. You can give advice from your perspective but I am certainly allowed to respond from mine.
Look, I don't want to fight with you. I have always had a good relationship with dialysis nurses because I worked so closely with them(daily). We all work hard, okay? So let's just back away and move on.
On the surface I agree with you Tweety. My even bigger concern is the patient sitting in a w/c for 4 hours. NOW that is unacceptable.
Hope we've given you some insight and good suggestions for the next time.
I appreciate the insight.
Just to clarify, the patient wasn't in the w/c for four hours. I took him in the w/c and put him in the dialysis chair where he had the incontinent episode. He could stand and ambulate short distances which is why I didn't bother taking him to dialysis in the bed. Later I arrived with the w/c to take him back down to the unit I work. He wasn't in a w/c for four hours.
Just to clarify, the patient wasn't in the w/c for four hours. I took him in the w/c and put him in the dialysis chair where he had the incontinent episode. He could stand and ambulate short distances which is why I didn't bother taking him to dialysis in the bed. Later I arrived with the w/c to take him back down to the unit I work. He wasn't in a w/c for four hours.
Ok that's a clarification. But I'll tell you from experience, it's almost impossible to clean someone up in a lounge chair. They can turn in those darn things. With the arm rests in the way. About breaks the care givers back.
Been there done that. Got the T-shirt.
Thanks for being patient and trying to understand both sides of the fence.
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 thought this was funny for some reason. If you have a even a 2 year degree in some aspect of healthcare, I think being able to clean BM or help someone in the bathroom is pretty basic. CNA's clean BM and take people to the bathroom and most of them don't have anything beyond a HS diploma and four weeks of CNA classes. Sometimes it seems like nothing can make a healthcare provider more incompetent than a brush with an incontinent individual.
I thought this was funny for some reason. If you have a even a 2 year degree in some aspect of healthcare, I think being able to clean BM or help someone in the bathroom is pretty basic. CNA's clean BM and take people to the bathroom and most of them don't have anything beyond a HS diploma and four weeks of CNA classes. Sometimes it seems like nothing can make a healthcare provider more incompetent than a brush with an incontinent individual.
It does seem pretty basic, and it's not that I don't think rad techs and resp. therapists are incapable of incontinence care. I just don't think they learn it in their programs of study and it's not normally part of their daily job description, so I'm not going to expect them to do in the time they have the patient, which is usally counted in minutes, not hours. Funny how incontinence care is the domain of nursing isn't it?
Of course they get cleaned up! I worked in dialysis for 23 years. We have bedpans, screens, diapers and water! I'd call the dialysis unit and ask to speak to charge nurse and or the nurse manager. That's negligence.
Of course they get cleaned up! I worked in dialysis for 23 years. We have bedpans, screens, diapers and water! I'd call the dialysis unit and ask to speak to charge nurse and or the nurse manager. That's negligence.
27 years in dialysis here. I agree totally. We also keep all of the above plus clean clothing and always did.
1940Nurse
78 Posts
If you'd read all the posts you'd see that a nurse alone MIGHT have difficulty standing a patient and pivoting them WITHOUT legs onto a bedside commode. What I said was which would be worse a poopy butt or a broken hip?
I never said you critized anyone did I? I am dialysis nurse. The OP was looking for information from a dialysis perspective. I worked M/S for years but I rarely give advice on it anymore. I walked through the ER a couple of times. I'd be hard pressed to tell you how that department runs either.
Dialysis a rather new discipline in medicine and as such is ever, constantly, and frequently changing. Things change on a daily basis almost. So what was "right" a week ago, could be totally thrown out this week.
It takes approximately one year to feel comfortable in this discipline let alone confident and that's working in it on a day-to-day basis. A dedicated renal floor is not a dialysis unit.
FWIW