Quote from sueinga
The doc is aware and only said "make it work".
Any advice appreciated!
That is so typical of the docs and surgeons. Of course, they are not THERE listening to the alarms go off every two minutes because the darn thing won't run ! And at 200 BFR, the dialyzer is very likely to clot off, making things even worse.
The doc ( the clininc nephrologist/medical director) should have written standing orders for the TPA... I if I remember correctly, we used to be able to administer it twice during the tx. Once, let it sit half hour, then try to run... if unsuccessful, one more attempt (of course waiting the half hour each time for it to take effect). If still no success, we would send the pateint back to the surgeon.
Another thing, when the surgeons do get the patient and "run them", these patients are usually in a supine position in a hospital bed, unlike the sitting or semi-reclining position in the dialysis chair. So they always run "just fine" for the docs!
You might try lying the patient back.. have him/her raise the arm.. all those positional changes.. couching.. etc.
If the dialyzer is sluggish or clotting, do q half hour 100ml NS , be sure to add into your goal.
If all else fails, I would have your DON insist the doc do something, because the pt, cannot run properly this way and you have more patients to tend to than to be doing a one on one with this poor patient.. just to keep him running.. and poorly, at that!
Just one more reason I'm glad I'm no longer doing dialysis !