patients coding in dialysis

schnookimz · Feb 16, 2014

I guess you got the job!!!

I don't think people are going to code as a "sure thing" if you're closely watching them and anticipating what may happen. Remember, "when in doubt, bail out!" Meaning, when things don't look good, return the blood and stop the treatment!!!! You can always restart if you need to do that.

schnookimz · Feb 16, 2014

Oh and they sign a consent for the dialysis tx soooo I'm sure anyone could sue, but I doubt it's any different than any other medical lawsuit. I'm not sure it would have much basis.

ffliper27 · Feb 16, 2014

hi schnookimz,

yes I got the job, but not in Acutes...Long story short, when I got to the 3rd interview for acutes, the FA said she had some qualms about me being in acutes because I didn't have ICU experience. But she did say she saw potential in me, so she said she'd be glad to recommend me for a chronics position. So she did. And so I'm going to do chronics instead of acutes.

Chisca, RN · Feb 17, 2014

More codes on Monday than any other day of the week. At some point every pt has to go two days without dialysis and some can't make it. Try to include that in patient teaching so that if patients are going to choose be noncompliant don't do it during that two day stretch.

Chisca, RN · Feb 17, 2014

Don't confuse crashing with coding. 1 out of 3 patients are going to significantly drop their blood pressure during treatment. This is related to where fluids are in the body( out in the tissue, not in the bloodstream) and the rate at which that fluid is replaced as it is removed from the blood by dialysis. Careful management by the dialysis nurse (turning UF off, elevating feet, infusing some saline) prevents a crash from coding. But if you are trying to pull 5 liters from a heart with an EF of 20% it can be a challenge.

Trauma Columnist · Feb 19, 2014

Sudden cardiac death does occur in pts on hemodialysis is actually quite common:

Patients with ESRD on long-term dialysis therapy have a very high risk of SCD. The incidence of SCD in dialysis is much higher than the incidence of myocardial infarction and severe LVSD, which are the current indications for ICDs. It is likely that ESRD and its consequent influence on the heart, both directly and by virtue of the sudden shifts in volume and electrolytes associated with dialysis therapy, could be the cause for such high risk of SCD.

Risk Assessment for Sudden Cardiac Death in Dialysis Patients