Dialysis patients who are incontinent

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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????

I've never been a dialysis nurse but my brother was unfortunate enough to be a dialysis patient. I've read thru some, not all of this thread--maybe I missed a few things. My overall impression of the 4 dialysis centers I have observed is that they are basically like factories. My brother was terrified of being even a few minutes late for treatment because he said the nurses would treat him poorly--I witnessed this first hand. He had intractible nausea/vomiting and it was sometimes very hard for him to get there on time--he did the best he could. I am almost positive that the policies regarding incontinent patients probably vary widely. The units that I observed would not have cleaned the patient--ANY variation of the planned dialysis was simply not in the equation--their days were absolutely packed. A good friend of mine from the ICU took a short stint in a dialysis unit (basically doing the director who was a friend a favor), she quickly resigned; she made it sound horrible; like a conveyor belt--anything out of the ordinary and that was IT your day was shot. My brother's life was a living hell primarily because of his disease--made worse by being chained to a dialysis machine 3 days a week. I wish there was some way to uninstitutionalize the whole process. This is a way of life for these poor patients, especially those people who cannot afford home dialysis, or who live in rural locations and must travel great distances for treatment. Healthcare should be a basic human right. Dialysis centers should not be set up so rigidly as to not account for the individuals needs.

Specializes in A myriad of specialties.

"My brother was terrified of being even a few minutes late for treatment because he said the nurses would treat him poorly--I witnessed this first hand........Dialysis centers should not be set up so rigidly as to not account for the individuals needs."

Hi 91CRN----I'm really sorry to hear that your brother had that kind of experience. Having worked in dialysis for 5 years, (and very kind clinics at that) we always made every effort to make our pts feel comfortable. BUT like any medical environment(i.e. MD office/treatment center) we had a patient schedule we had to follow. If Mr. X was late arriving for his treatment, thereby late getting off his treatment, then Mr. Y had to wait to begin his treatment. It isn't fair to Mr. Y to have to wait. If we allowed 30 mins or more leeway time for pts to get in due to a variety of personal issues, we'd be doing 16+ hrs a day instead of 12hrs. And those pts who wanted/expected to be "on the machine early" would be screaming. There is no way to please them all---there were alwyas the chronically late ones and always the ones who demanded to get their treatments done early. Yes, it's pretty rigid---it's unfortunate that it has to be that way. As far as personal hygiene goes for those who are incontinent, it was considered a "cross-contamination issue" and we as nurses and staff were disciplined if we violated that rule. It is the responsibility of the nursing home, etc to make sure the pts are toileted/clean prior to the treatment. Yes, we "took off" the pts for bathroom breaks but LTC pts who were usually incontinent were not cleaned up---I felt VERY BADLY about this since I initially came to dialysis after having worked in LTC and felt it was negligence but once I worked in the Hd field, I understood the reasons behind it.

Drifternurse,

Thank you for your sensitive reply. I really do understand the issues regarding time and getting all the patients treatments done while trying to honor their needs and preferences. It is precisely my point that something like dialysis that requires fragile/at risk persons with multiple morbidities to be 3-4 hours in a recliner should be set up in a different way. As I previously stated, this is a way of life. From the patients point of view I just don't think that trying to keep such rigid schedules etc. is the way to best serve. Having said that, I don't have any viable ideas on changing the way things are done at the present time. A personal dialysis machine for everyone who needs it and a home health nurse who specializes in the treatment--and or training for family members and patients who are able to manage this on there own and are candidates would be my first choice:) I know there are wonderful nurses and technicians out there who do their best with the broken system we are all serving in.

The units that I observed would not have cleaned the patient--ANY variation of the planned dialysis was simply not in the equation--their days were absolutely packed.

I am so sorry that your brother was treated that way. Please don't think all dialysis centers are like that. Yes, there is a schedule. We try very hard to stick to the schedule, but when dealing with chronically ill patients with many co-morbidities we all know what can happen to a schedule. That is why having "plan B" is important. There is always some room to manipulate the schedule. One cannot be rigid when dealing with sick people. Anything can happen, and believe me it does.

Chronic late comers are sat down and given some religion. Those that really try, well we adjust the schedule to allow them some leeway...like having them follow a 4.5 hr patient...so it is a late machine anyway.

I must say that reading all these messages has been an eye opening experience. With many years as a med surg nurse and some nursing home experience it is hard to imagine that "nurses" can be on such opposite ends of the spectrum regarding such basic care. After all these years that dialysis has been in existence it seems that someone would have figured a way out to handle this situation without a patient having to be dirty for four hours. Its such a shame and a problem that is destined to get worse with all the diabetic patients we see who get in worse and worse shapes. A sad state of affairs as far as I am concerned:madface:

Specializes in Med/Surg, Geriatrics.
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.

Thank you! I know I have never had a dialysis patient returned to me unclean. Apparently policies vary widely across the country.

I have worked in a few outpatient dialysis clinics doing everything from being a staff nurse to being the director of the clinic, and I feel that it is my duty to say, if the clinic is too short staffed to help a HUMAN BEING after they are incontinent, then maybe they should file a complaint against the company, contact the state licensening bureau, contact Medicare, or have the patient's family members do it. NO ONE SHOULD EVER BE MADE TO BE HUMILIATED SIMPLY BECAUSE THEY PERFORMED A BODILY FUNCTION! Also, if the clinic is that short staffed, then FIND ANOTHER JOB! That is why nurses are treated like second rate citizens at times, because we let THEM treat us that way. STAND UP, BE HEARD, MAKE A DIFFERENCE FOR YOUR PATIENTS!

Specializes in ER, Medsurg, LTAC.

I am a student in an LTAC/MedSurg setting. I am uncertain of the terminology and technical names so I'll do my best to describe the situation.

Just an example I witnessed of a true to life patient that could not be cleaned:

Male with old AVF in both arms, critically ill. Any movement dislodged the needles and tubing. He HD'd in his room in bed and if it occured during meal time he was fed. If he was incontinent during Tx, he had to wait because of his complications. It was not a situation that the Tx could just be stopped and restarted. I knew an approximate time that HD would begin so I could place extra pads and ointments before Tx to help my patient. At the end or close to the end of Tx, the dialysis nurse would call me to let me know the patient needed attention if needed.

Our HD nurses remind us or call us down to floor to take patient to bathroom before Tx get underway to avoid incontinence. If incontinence occurs, it can't be taken care of in the HD Tx center- no space, no personnel, no supplies.

Total patient care is what we do as nurses and I have worked with dialysis patients in many settings for over 20 years. I have never been told to withhold basic patient care in any setting. It is not only repugnant to leave a patient in that condition for 3-4 hours but would not be very pleasant for other patients in the area--and they have enough to deal with. I would venture to guess that you should review your "state regs" more closely. Cross contamination is an issue if proper technique is not observed when assisting patients with their needs during your watch. Most dialysis units require that the nurses/techs are provided with full cover lab coats as other protective gear that can be changed after a "clean up" of blood or other body fluids if necessary. Cross contamination is not an issue if handled appropriately and I hope if this has been a problem in your unit that you initiate discussion with your DON for clarification.

Specializes in Government.

Sort of out of left field here...but I think this thread should be required reading. I know that the general public as well as many nurses have no idea how sick people really are these days in HD. I work in a community health job and deal with the legislature on public health and safety policy. When I talk to legislators, they think the average HD patient is a young to middle aged adult with a surprising, catastrophic organ failure. They have no idea that common end of life care for older adults often includes HD.

I am seeing an explosion of diabetes in my state and know that a huge uptick in ESRD is right around the corner. I've been thinking a lot about HD these days. Thanks for the thread and the issues discussed.

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