Re-entry into dialysis

[TIK]

I was a dialysis RN over 20 years ago and left to raise a family, etc. I have kept working in other areas of nursing, just not dialysis. I have been thinking of returning to hemodialysis and have some questions. Things have probably changed quite a bit over the past 20 years. Do RNs actually put patients on or are techs doing that now? What is the average nurse to patient ratio? With more efficient dialyzers, machines, different baths, etc are patients having more "stable" treatments these days? (When I worked, if it rained, the water would be altered and patients would have bad treatments, etc. I even used coil dialyzers!!!) Are they still using Mannitol for hypotensive episodes? What is used to help low HCT counts, etc? Are they still using formaldehyde for reuse? I loved hemodialysis nursing, but have recently heard horror stories and wondered what it is like now. Of course, what are the salaries now? (When I left 20 years ago I made $8.00 an hour:) Is there a big difference between the different organizations, such as BMA, etc? Any info would be greatly appreciated! Thank you!

[NephRN]

Hello,

You didn't mention what part of the country you are from, of course, this will have an impact on much money you will make. It has been my experience, in Florida, that inpatient and outpatient areas pay about the same. I won't even go into Florida nursing salaries as they are quite pathetic. Nonetheless, let me see if I can answer some of your questions...

Inpatient setting: usually all RN staff with a secretary or tech with clerical duties only. Rn to pt. ratio varies, 1:1, 1:2, 2:3. It often depends on acuity. The RN is responsible for every aspect of the treatment. Of course, when doing a critical care pt. or unstable pt., the ratio is always 1:1 The inpatient areas that I am familiar with do not do any re-use.

Outpatient setting: usually one RN and 3-4 techs to 13 or more patients. The techs cannulate AV fistula's and grafts and put those patients on the machine. The RN accesses all catheters and puts those patients on the machine. The techs do the majority of the monitoring with the nurse doing assessments and all meds. I don't know of any centers where cardiac monitoring is done. The Gambro's in my area do not re-use but some of the BMA's and CFKC's do re-use. (Re-use is under a lot of scrutiny these days.)

The K-DOQI goal is for all patients to have an AV fistula and strongly discourages the insertion of catheters.

Some facilities are using Reverse Osmosis water, some are using De-Ionized water, it varies.

Mannitol is used in the inpatient setting for the prevention of disequalibrium syndrome when a new acute patient has a high BUN/Creatinine. It is also used sometimes for hypotension but we use SPA more often for that. It's a judgement call where I work. Also, we use hypertonic saline for cramping and that works quite well.

For low HCT: Iron dextran, Ferrlecit (our drug of choice), Venofer. Along with these, we use Epogen.

For obstructed catheters: The outpatients centers send all of their occluded caths to the hospital since Urokinase left the market. The hospitals use TPA (1mg/1cc) in a volume that will fill the lumen of the cath. We allow it to dwell for 30 minutes and have had great success with it, better than when we used Urokinase. When TPA is unsuccessful, we send pt's. to angio for strippings or back to surgery.

Hope this answers some of your questions.