Do you use 2 Bags of NS or 1?

diabo, RN · Aug 27, 2005

I am interested in knowing if there are other places that are doing what we just switched to.
We were originally priming our machines with a full bag of NS, and then hanging the second for the dialysis and take off, we generally used almost 2/3 to 3/4 of the 2nd bag. We were told that we need to back it down to one bag, prime it with half a bag then take off with the other half.
Are there risks to this. I vaguely remember reading something in the past about 1st use syndrome, is this where this could come into play and if so what are the S&S of this? SOB, and is it flank pain or chest pain, they are diaphoretic to aren't they?
Are there other risks?

Always go by the manufactures guideines sent in every box of kidneys. Many say 1/2 bag heparinized, then dump the prime, or one full bag plain NS.

jnette, ASN, EMT-I · Aug 27, 2005

We use the first bag of NS in our set up, prime, and recirculation.. access the second bag when the patient is hooked up and off and running.

We don't heparinize our NS.

Again.. it depends on your dialyzers (as mentioned above) and your facility policies and procedures. Don't be afraid to ask your DON about your concerns and questions... that's what she is there for ! (or your instructor)

First use syndrome can cause a multitude of s/s.... confusion being most prominent.

Nurseinthemaking · Aug 27, 2005

We use the first bag of NS in our set up, prime, and recirculation.. access the second bag when the patient is hooked up and off and running.
We don't heparinize our NS.
Again.. it depends on your dialyzers (as mentioned above) and your facility policies and procedures. Don't be afraid to ask your DON about your concerns and questions... that's what she is there for ! (or your instructor)
First use syndrome can cause a multitude of s/s.... confusion being most prominent.

The DON has been busy with some other things going on and the person I have been working with, speaks English, but it is very hard to understand her, when I ask her questions like that she looks at me like she has no idea, she will answer with, "we push this button". And that is OK, but for me, I want to know the why's and how's. There has been a definate language barrier. So, that is how my week went, but I do no that my preceptor I will be working with after the 2 week theory class is easier to understand, so I think alot of issues will be resolved with that.

As far as the 1st use syndrome does it happen pretty quick after starting the Dialysis or does it happen after an hour or so.

I will quit bothering ya'll with my crazy questions. Sorry.

jnette, ASN, EMT-I · Aug 27, 2005

The DON has been busy with some other things going on and the person I have been working with, speaks English, but it is very hard to understand her, when I ask her questions like that she looks at me like she has no idea, she will answer with, "we push this button". And that is OK, but for me, I want to know the why's and how's. There has been a definate language barrier. So, that is how my week went, but I do no that my preceptor I will be working with after the 2 week theory class is easier to understand, so I think alot of issues will be resolved with that.
As far as the 1st use syndrome does it happen pretty quick after starting the Dialysis or does it happen after an hour or so.
I will quit bothering ya'll with my crazy questions. Sorry.

That is terrible that you have a language barrier with your PRECEPTOR, of all people !!!

I would INSIST you get another, and soon ! It is wrong, no.. it is WRONG !!! :madface:

How long did you have to take classroom instruction? I had to have all this stuff DOWN, in classroom.. before I ever went to my unit. Then, there were only small variations I had to pick up on, but the basics were well ingrained. I KNEW how to set up a machine before I ever went to the floor in my unit.

Our classroom instruction is six weeks. Then, and only then, are we sent to our unit, where we are precepted ANOTHER six weeks.

Truly, get what you need from someone who can explain and show it to you step by step, and wirte yourself a good cheat sheet with all the steps involved, and don't hesitate to USE it !

I'm not quite sure about the timing of "first use" syndrome, we've never had anyone have it. But I THINK it is within the first half hour, but someone else please correct me if I'm wrong.

Hang in there... 6 weeks from now you'll be feeling a lot more confident ! And even then, you'll still be "learning"... for a long time to come yet !

Dialysis is NOT somwthing you learn overnight ! And I repeat, do NOT let anyone intimidate you into "rushing" to learn ! Stand your ground... pleasantly, tactfully, but FIRMLY. :)

Wish you the best.. and ask away... that's what WE are all here for, too ! :icon_hug:

Nurseinthemaking · Aug 27, 2005

That is terrible that you have a language barrier with your PRECEPTOR, of all people !!!
I would INSIST you get another, and soon ! It is wrong, no.. it is WRONG !!!
How long did you have to take classroom instruction? I had to have all this stuff DOWN, in classroom.. before I ever went to my unit. Then, there were only small variations I had to pick up on, but the basics were well ingrained. I KNEW how to set up a machine before I ever went to the floor in my unit.
Our classroom instruction is six weeks. Then, and only then, are we sent to our unit, where we are precepted ANOTHER six weeks.
Truly, get what you need from someone who can explain and show it to you step by step, and wirte yourself a good cheat sheet with all the steps involved, and don't hesitate to USE it !
I'm not quite sure about the timing of "first use" syndrome, we've never had anyone have it. But I THINK it is within the first half hour, but someone else please correct me if I'm wrong.
Hang in there... 6 weeks from now you'll be feeling a lot more confident ! And even then, you'll still be "learning"... for a long time to come yet !
Dialysis is NOT somwthing you learn overnight ! And I repeat, do NOT let anyone intimidate you into "rushing" to learn ! Stand your ground... pleasantly, tactfully, but FIRMLY. :)
Wish you the best.. and ask away... that's what WE are all here for, too ! :icon_hug:

Ya know, you made me feel better. I have been in tears all week, because the PCT that started the same day I did, is from India, her preceptor does too, she is understanding what is being said. Mine is from India too, and I have tried so hard, to not get frustrated or upset, but I have really struggled, she has had to repeat things, 4 and 5 times to me and I am standing there looking at her like, "What did you just say." I told her that if I look like a deer in headlights that's because I feel like a deer in headlights. In Nursing School, I never had to have things repeated to me more then once, I get things, I am very technical and very computer oriented, I have a Degree in Computer Science and build websites for goodness sake. But having this barrier has been the hardest thing ever. It makes me the GVN look stupid, because the PCT is getting it. I am able to set up the machines, but have yet been able to take one off, because it has taken so long to communicate with one another. The PCT was taking them off the machines already.

How they did our training is, put us on the floor for 4 days this week for 10 hours. The first day we just watched the LVN that is actually changing positions (she was great) I took tons of notes, but more about what to assess for rather then machine stuff. She is an awesome nurse and I am really hoping they reevaluate who my preceptor will be, because we jive real well with one another. She would be great for me, because she can help me with the machines, but also help me with what Nurses are responsible for on the unit.

Then for the next 2 weeks is theory class and from what I have been told, we don't have a teacher, we will be reading all day and taking tests. They don't have any machine set up training at all except for on the floor. The LVN I was with the other day said 20 years ago when she trained she spent days in a room with the machine, just setting it up and tearing it down all day long. That is what I need and I also think that is what the patients would rather too. They want to get in there and get set up so they can get started rather then waiting on two people with a language barrier try to figure one another out.

After the 2 weeks of theory we are on the floor with a preceptor for 6 weeks. They did tell me that they would not throw me to the wolves and for awhile will only be getting 2 patients and then once I am feeling OK with that they will give me 3 and then 4. What scares me the most is the accesses. But for now, I am going to focus on the machines. I had a wonderful Charge Nurse come up to me and tell me that when he started he felt just like I did, the one piece of advice he gave me was to just focus on the machines for now and then get to know the patients next. To remember they are people not just patients. That made me feel better too.

Trudging along.

I really want this and I am not quick to give up, so I will keep trudging along. I have had so many people tell me that even after a year that they were not 100% comfortable with all of it.

jnette, ASN, EMT-I · Aug 27, 2005

You'll be fine. :kiss

Give yourself all the time you need, and don't be in too much of a hurry yourself.

Get the machines down first, and get them down WELL. Machines are VERY important, mistakes can be deadly.

Whatever you do, be SURE to always check and doublecheck that your venous chamber line is IN the air detector beore yous start up any patient!

Don't fear the accesses... look at them as a challenge. They are SO much easier to stick than a regular IV. Very few pose a real problem. There are always going to be a few here and there, but for the most part, they are easy enough.

If I were you, before you stick someone youve never stuck before, ask the others if they are deep, or shallow, where the best place is to stick them, etc. Once you get to know the patients and thier sites, it will be routine... each site is individual, and you'll get to know each one.. where and how to best cannulate them.

A new fistula can be problematic while they are still immature.. but in a few weeks, even they are easier. You might try to avoid those for awhile.

Grafts are usually pretty easy, but you want to be sure to rotate stick sites on these, as they can and do wear out... you can only puincture a piece of tubing so many times, and if you continuously stick in the same spot, that place will wear out fast!

After awhile, you will get the "feel" in your fingertips.. it will be a natural !

There is no greater pleasure than having a good "stick". :)

Avoid cannulating in or near pseudoanyeurisms (the big "bump").. go below, above, or access from the side, never IN it.

All little things you'll learn as you go.

ALWAYS ASK if you have any doubts, fears, or questions! Don't be afraid or too shy or too proud to ask your coworkers! Save the patient's access by asking when in doubt. All staff had to learn just as you are now... nobody's better than anybody else, and it takes TIME.

Your patients will appreciate your hesitancy and deferring to someone else if you're not confident enough to stick them.

In time, you'll be as good as the rest ! Keep up the good attitude, and watch, watch, watch !!!

nosonew, BSN, RN · Sep 4, 2005

Our new procedure is 3 bags. One to prime, One to test, One to Run. Yep.

Nurseinthemaking · Sep 4, 2005

Our new procedure is 3 bags. One to prime, One to test, One to Run. Yep.

Wow, why is it that we are cutting back and ya'll are able to add to the expenses. Where are you located?

I am in Texas, and our clinic is located in a very low income area. The majority of the people we see, have no cars, all have to use the public transit system and heavily rely on us to help them get the meds, nutritional products and money for transportation to get to their tx's.

nosonew, BSN, RN · Sep 4, 2005

Wow, why is it that we are cutting back and ya'll are able to add to the expenses. Where are you located?
I am in Texas, and our clinic is located in a very low income area. The majority of the people we see, have no cars, all have to use the public transit system and heavily rely on us to help them get the meds, nutritional products and money for transportation to get to their tx's.

We are Davita...Kansas and we were told it is a new procedure for safety measures. Also helps to not run dry too!

TGIMN · Dec 12, 2005

We use 2 bags of NS.

DialysisTech76 · Nov 8, 2009

We prime and recirc with one bag and change bags before treatment is started. Unless a problem comes up we only use 2 bags.