ED RN considerations for ESRD pts

[WonderRN]

Hello.

I am a new RN and I work in the ED at a city hospital in which many of our pts have comorbidities, including ESRD on dialysis. I am trying to educate myself more about this very complicated disease process in hopes to improve my care of these pts and improve pt teaching (as I have the opportunity in a very hectic ER).

I am looking for any general advice/recommendations in the care of these pts. Is there anything you would like me to know, as a new nurse, or as a ED nurse? Any common problems you see caused to these pts by an uneducated RN?

of course I know no needlesticks/BPS in fistula arm, be careful with fluid rehydration, many pts don't make urine, many have chronic anemia, have to watch their phosphorus and potassium intake and general fluid intake, and watch BP after dialysis.

One specific question I have- when a pt has a AV fistula in use in the left arm and an old one in the right arm- Can I still use the right arm for BP? (the two instances I have had this happen I used a leg, just to be sure- no one could give me a definitive answer) How accurate is this BP? Where can I stick for an IV- below the site? above it? does it matter?

Thanks in advance for your replies. I am trying to be the best nurse I can to the patient demographic I serve!

[GeauxNursing]

we take BPs in the "old access" arm, as long as they are not being worked up for a new access, in case another part of the same arm might be used. You stay away from the access arm all together with needles. But in emergency situations you do what you have to do. We've had pts come back to us and tell us how their CVC was used for something, their fistula was used for blood draw. We just cringe and shake our heads.