What should EVERY nurse know about Dialysis - page 4

I am a dialysis nurse turned home care nurse...live in a rural area that recently has had a dialysis center open (I work there PRN). With this opening the local home care agency has seen an influx... Read More

  1. by   katherine100
    Plenty of patients eat during dialysis. Everything they eat builds up in their system. There could have been another reason why the pressure dropped since it is dialysis after all.
  2. by   NurseRies
    Things I wish every floor nurse knew about dialysis patients:

    1. Don't ever give these patients orange juice for their blood sugar- NEVER!! Potassium ! Also no oranges, bananas, and prob should avoid tomatoes. Diet is very restrictive in general, but these are very important restrictions.

    2. If you don't give the phosphorus binders WITH food, and I'm talking while they're actually eating, you may as well throw it away. The binders BIND to the food to remove phosphorus, once the good is being digested, no use. Examples are Phos-Lo, Tums, calcium acetate.

    3. A creatinine of 5 is not alarming. Heck, a creatinine of 8 is really not alarming either. This is baseline for some folks, sad but true.

    4. If your patient needs dialysis, and the blood sugar is 300 or above, dialysis should actually help. I've seen people try to hold dialysis and put them on an insulin drip and transfer to ICU. These patients that are heading to DKA, NEED dialysis more then anything. The bicarb that is given has a dextrose of 100, so the concentration gradient that occurs during dialysis will improve the acidosis and the hyperglycemia. It is amazing to check the blood sugars hourly during dialysis and watch them come down.

    5. We only give IV antibiotics post HD if your patient truly has no other access. In the hospital, we are working 12-18 hour days and we really need to move on to the next treatment.

    6. Don't ever call me in the middle of the night to tell me a dialysis patient will need treatment in the morning. Please don't call me after 10pm unless it is truly emergent and I need to put my clothes on and come in. Thank you!
  3. by   katherine100
    Reminds of how much people don't know. Good post.
  4. by   AtomicWoman
    OK -- dumb question time. What is the difference between the "arterial" and "venous" needle in an AV fistula, and which is which? I find this mighty confusing, because the two cannulation sites are both in the venous limb of the fistula, right? Sorry for the very basic question; I don't work in an area even remotely related to hemodialysis.
  5. by   Chisca
    Direction of flow. Important to know after the needles (2) are placed as the dialysis machine will pull blood from the arterial side and return to the venous side. Determined by applying pressure with fingers in the middle of the access and with your other hand palpating each side of the access. The stronger pulse is arterial which establishes which side the machine will pull from. It's like a river that you want to be drawing in dirty blood from upstream and returning the clean blood downstream.
  6. by   AtomicWoman
    Thank you!
  7. by   NDXUFan
    As a dialysis patient, 99 percent of this information is true, but, not always. I have very low potassium and calcium levels. Even when I was In-Center, I had to take potassium and calcium supplements. Yes, I took the horse pill and took 2,400 mgs of calcium per day, to get my calcium levels to the normal level. My renal diet includes at least one glass of low sugar orange juice. I was at a sleep apnea study, recently and they have you sleep without your mask for a few hours, which is stupid. Blood sugar levels are difficult to impossible to control without the correct amount of sleep(Indiana University Home Dialysis). I had to have 5 small glasses of OJ before the room would stop spinning. Then, I needed to have breakfast at McDonalds. I am a Nocturnal person. I hate going to the hospital because then I encounter the "Renal Diet Nazis." I have come to the hospital with a potassium score of 2. I love my Nocturnal treatments and I hate shorter treatments. Yes, it is true, 99.9 percent of dialysis patients cannot take OJ for their blood sugar, their system will freak out. Yes, I do my own sticking I love the IU Nursing staff, good, good people If you have individuals who have fluid issues, try to start a Nocturnal program. I do have alot of issues with coughing, because I have had asthma for 32 years, since high school, I use inhalers and a breathing machine. Right now, the allergies are really bad.
  8. by   NDXUFan
    Yes, Katherine, you are right, it is amazing at times.
  9. by   NDXUFan
    No, I do NOT call the on-call RN in the middle of night. I call them during the standard work day. Trust me, I know how much I hated that as a police officer.
  10. by   Chisca
    NDXUFan As a dialysis patient, 99 percent of this information is true, but, not always.
    I remember an attending who would tell the house staff, after they were dumbfounded by some clinically challenging situation, that the patient "didn't read the book". You, sir, didn't read the book.
  11. by   NDXUFan
    Yes, Chisca, not every dialysis patient follows the book. Now, it is time to set up my machine for my nightly Nocturnal dialysis and I need to go to the local grocery store for some low sugar Orange Juice.
  12. by   nurseontheway
    Dialysis patients are the most stubborn people that I have ever met. They know what they are supposed to do and the diet that they are supposed to follow but most of them could care less. I have found that you have to over look a lot of things in order to stay sane. Some patients love to be educated but most of them could care less.
  13. by   NDXUFan
    In every situation on this earth, there are costs and benefits. Clearly, you see the benefits but are unaware of the costs. In the 19th century, housing reformers were appalled by the housing conditions for most or the vast majority of immigrants. The reformers saw the benefits of higher quality housing. Yes, that higher quality housing was available for a higher price than the immigrant was willing to pay. Yet, the immigrant was saving to send money back to the Old World, for a better education for their children, or to save and start a business. This just did not happen in the United States, but in many other nations as well. However, to the housing reformers, the "benefits" that they proposed, were clearly superior to the goals of the immigrants who had risked their lives to come to the United States. In fact, more people died coming to United States from Ireland than did on the slave ships from Africa, 22 percent to 9 percent. One of the largest dangers in this world is the arrogance of the highly educated. They and the housing reformers believe that their choices because of their education is superior to the choices of the immigrants. Housing reformers asserted that better housing was available because of their actions. However, this is false, rising incomes produce a wider variety of choices in the world.

    Many people will tell you how the public schools are great for your children, while they send their children to Sidwell Friends(Clinton, Obama, Biden, and numerous other members of the Democratic elite). Bill Gates proclaims the greatness of the Common Core education push, yet, Common Core is not addressed in the school that his children attend at Lakeside School in Washington, where the tuition cost is in the neighborhood of $28,500 per year.

    I am curious, NurseonTheway, how you would respond to numerous lectures about not drinking as a diabetic with a raging thirst? If you are curious, the cause of diabetes is unknown(John Hopkins, Mayo, Cleveland Clinic, and numerous other academic medical institutions). Over 90 percent of individuals who work in dialysis have admitted that they could not follow the renal diet. The vast majority of dialysis personnel admit that they would choose home dialysis for themselves, while sticking other people in a dialysis center. The therapy that is being offered by Fresenius and Davita is very sub-par at best(Indiana University Home Dialysis). If you need or want a transplant and would like to buy a kidney, that is illegal. YET, the very same group of people who stated that buying kidneys with money or any other fiscal exchange, should be illegal, are the very first people to check and scan the wallet of someone who wants and needs a kidney transplant. A number of the Indiana University Home Dialysis Nursing Staff have admitted this is total and complete hypocrisy.

    The two people who have the most to benefit or lose from a transplant are donors and the individual who gets the kidney, not arrogant third parties. Why are third parties making these kind of decisions when they do not have anything to lose?

    If you are serious about eliminating the problems of kidney failure and dialysis, propose and push for reforms, so that these issues are eliminated. First, propose Nocturnal Dialysis programs. If you did this, problems with kidney failure will cease and desist. Second, greatly speed up the process for kidney transplants and drop the hypocrisy. This issue is between the person getting the kidney, the donor and the doctor, as it is repeated endlessly for abortion rights.

    You can stay sane by not treating dialysis patients as children or as ignorant fools. The IU program treats us as adults and they do not have any of the behavior problems of Davita and Fresenius. I worked as a police officer for a large metro county and I can tell you that dialysis personnel have some very serious control issues. Most of my family is in Nursing and they would be appalled by the treatment of dialysis patients. What about discharging dialysis patients for nothing more than asking about their treatment plans? Criminals have more rights than dialysis patients, yes, I do know what I am talking about....... With some of the abuses that dialysis patients have told me, I would making sure that I would call the local prosecutor and those individuals would be going to jail. In domestic violence cases, in the majority of local jurisdictions, the charge results in automatic arrest. If some of the actions of dialysis personnel were in a DV case, they would be going to the slammer.

    My last question is, "Would you be willing to live the way that you dictate to others?"