Please help me. I am a new RN who is working in an outpatient chronic care dialysis facility. I have so many questions that I really need answers to.
First, how do you maintain sterility when hooking up patients with subclavian catheters?? I can do it for the dressing change but when I am hooking up without assistance it is almost impossible without changing my gloves over and over. The nurses in my facility say "I don't know why they say its a sterile procedure, it is really just clean". Is this true?? If not how do you do it??
Next... What do you do when you have a catheter that you can not aspirate the dwell from?? In my facility as long as you can push a saline flush through you go ahead and hook up and give the treatment anyway. This scares me. Is this safe?? ALso if the arterial line on the catheter won't pull they just switch the line and make the venous the pull instead. How long can you do that for (in my facility I have seen them do this till the catheter is not functional anymore)? As a new RN such practice makes me very nervous...Am I just acting like the "super novice"?
Lastly (for now) many of our patients have very prolonged bleeding times (and they bleed alot). To compensate the nurses and the techs just cut the heparin dose. I feel uncomfotable consistently doing this without the MD offically changing the dose.
Am I being overly cautious? What do you do when this happens?
Please someone advise me . I think the staff is getting irritated by my constant questions but I really want to make sure I am being safe. In nursing school we really did not cover dialysis to a large extent so I am really in the dark here. The last thing I want to do is develop bad habits.
I appreatiate any comments, advice and tips you can give me!!
Thanks so much!!!