How much do your PCT's do?

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Since I am new and have no idea regarding Dialysis, I have many questions.

So here are a few regarding PCT's and me as the soon to be LVN that will be liable. I am very nervous about my license being at stake and I am not sure what is normal and what is not.

In your Facility what do your PCT's do?

Are they accessing everything but Catheters?

Are they drawing up the Heparin, Lidocaine and Saline then labeling it? If so how are we supposed to know that what they drew up is really what they say it is?

The PCT's in ours set up the packs, meening they draw up the Heparin and label it. Then they put it in the packs for the Catheter pt's. so the packs are ready even before they pt. gets there. It makes things flow nicely, yes, but I am just wondering how we are guaranteed that this is what the label actually says it is. They also draw up lidocaine if pt's need it. My concern is, the lidocaine sits next to the Heparin and in the 4 days I worked this week. I found the lidocaine in the Heparin box twice. I also say several predrawn Heparins that weren't the amount the needed to be, say like the pt was supposed to have 8000 Units, the tech would pull back to where they thought 8ML's were and that was it, but when I would look at it, it would actually be under or over by as much as 1ML. So being the nice, sweet person that I am, I wouldn't say anything, but fix what they did wrong.

Since I dont' start theory part of the orientation till next week, but have been drilled to death in school about exact amounts, I am thinking that if the Dr. ordered. 8000 units, shouldn't it be exact rather then almost?

And my other thought is, when it is me that is responsible for the heparin on the catheters, shouldn't something be said about, unless you are giving it, don't draw it up?

Oh, one other thing, Say the RN in Charge does an access, because it is a tricky one, shouldn't that Nurse be responsible for documenting the Bruit and accessment rather then the PCT. I was told yesterday by the PCT, "here, go ahead and check that the Bruit was good, and his resp's were OK." I said, "I didn't feel the Bruit, I watched the Nurses technigue, I didn't touch that pt." She said back to me, "That is OK, we always do this section of the sheets." I gave the pen to her and said, here show me what you mark. And left it at that.

It makes me nervous about these kind of practices, I don't want to step on toes, but feel this is my license I need to protect. Am I being overprotective?

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Specializes in Dialysis, neuro, surgical, M/S,tele.

I have found that PCT's make me nervous too. I worked as one for several months before sitting for boards, but it wasn't until I had that license that I realized how precious it is. Techs just don't relize that. In our facility they go through approximately 2 weeks of class work and 10 weeks of being with a preceptor and that's all the training they get. It's kinda scary.

Thank God we do have good techs in our facility, but everyone makes mistakes. As far as "how do you know this is heparin?" NOTHING is drawn up until the nurse gets there, and then they have to show the nurse the bottle and say "i'm drawing up heparin.." and likewise with lidocaine. Luckily our bottles and volumes are vastly dif. of each so they do not get confused.

Our assessments are on the computer and the nurse has to fill it out before the pt. can begin tx. In this the nurse answers several questions such as resp, lung sounds, HR,... and the last 2 are normal presentation of access (this includes bruit, thrill, appearance..) and site care done. I always listen to the access whether i stick it or not, but whether it's a nurse or a tech that actually does stick they are supposed to listen too. I don't care if the manager listened to it and then told me to stick it, i would not until i heard for myself. People who do not do that are putting thier pt.'s at a HUGE risk.

Our techs can access caths, which I am thankful for. All in all you are not being too overprotective, whether you are a LVN, RN, or BSN an unlicensed staff member can make you lose that license before you can blink. It's important that you trust your techs b/c they can make or break you at times. But if there are serious problems (such as frequently wrong amt. of hep. or sticking w/o listening) you need to pull them aside and talk to them. They may just not have enough training or not understand the importance of it. If after that you still feel uncomfortable i'd take it to your CN or manager. Hope I could help a little. Sorry so long.

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I have found that PCT's make me nervous too. I worked as one for several months before sitting for boards, but it wasn't until I had that license that I realized how precious it is. Techs just don't relize that. In our facility they go through approximately 2 weeks of class work and 10 weeks of being with a preceptor and that's all the training they get. It's kinda scary.

Thank God we do have good techs in our facility, but everyone makes mistakes. As far as "how do you know this is heparin?" NOTHING is drawn up until the nurse gets there, and then they have to show the nurse the bottle and say "i'm drawing up heparin.." and likewise with lidocaine. Luckily our bottles and volumes are vastly dif. of each so they do not get confused.

Our assessments are on the computer and the nurse has to fill it out before the pt. can begin tx. In this the nurse answers several questions such as resp, lung sounds, HR,... and the last 2 are normal presentation of access (this includes bruit, thrill, appearance..) and site care done. I always listen to the access whether i stick it or not, but whether it's a nurse or a tech that actually does stick they are supposed to listen too. I don't care if the manager listened to it and then told me to stick it, i would not until i heard for myself. People who do not do that are putting thier pt.'s at a HUGE risk.

Our techs can access caths, which I am thankful for. All in all you are not being too overprotective, whether you are a LVN, RN, or BSN an unlicensed staff member can make you lose that license before you can blink. It's important that you trust your techs b/c they can make or break you at times. But if there are serious problems (such as frequently wrong amt. of hep. or sticking w/o listening) you need to pull them aside and talk to them. They may just not have enough training or not understand the importance of it. If after that you still feel uncomfortable i'd take it to your CN or manager. Hope I could help a little. Sorry so long.

Ok, now I am really concerened. Listening to an access? Not one person has ever done that, I have not even seen a nurse listen to lung sounds, which I thought was very strange.

Not one person on that floor has a stethescope. I am assuming that is how you would listen and what am I supposed to hear? The nurses do feel but there is no listening at all, and none of the PCT's have said anything about feeling at all. They just stick and move on. Granted right now all I am supposed to be focusing on is the machines. BUT...I am seriously scoping this place out. Once I take and pass the NCLEX, I can't feel like I am risking my license. I have to know that all is good.

Everyone has been so awesome and have really made me feel welcome. The other good thing about this place is the new PCT and myself are the only ones that have been there for less then 2 years. They all seem to be very happy there, that is a huge bonus, but I am wondering if there is some lack in training. Or maybe they have forgotten. Alot of them have been there for 8 or more years.

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Specializes in Hemodialysis, Home Health.

It all depends on your particular facility's procedures and policies.

Every facility and every "company" has different policies.

Some listen to the bruits, some do not have this as a requirement. We used to listen to lung sounds before and after tx., two years ago this was changed to only BEFORE tx. In our facility only licensed staff do lung sounds and assessments.

Our techs DO draw up the heparin, and we don't use lidocaine. Out techs DO catheters and dressing changes.

All facilities differ in their policies.

The best advice I can give you is to familiarize yourself with YOUR facility's policies and go from there. Ask you clinical manager about your concerns nad ask to review the policies for your own reassurance.

We, too, have excellent, and dedicated techs. They are conscientious and well trained.

Only you can know if yours need more of a careful eye. Give them room to grow, but know that you must also be aware and dilligent.....

Wish you the best. :)

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All of a sudden "fill the thrill and hear the Bruit" is coming back to me, I heard that once in school and I think it was while I was in my Dialysis rotation.

So if you are feeling is that the same as listening?

I haven't gotten a P&P Manual yet, maybe that will come after theory class.

2 weeks of theory, then back on the floor. I cannot wait to get back on the floor. So far I have loved it. The patients are so awesome.

I am just a little concerned about ANYONE drawing up anything I am supposed to be giving.

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Specializes in Hemodialysis, Home Health.
All of a sudden "fill the thrill and hear the Bruit" is coming back to me, I heard that once in school and I think it was while I was in my Dialysis rotation.

So if you are feeling is that the same as listening?

I haven't gotten a P&P Manual yet, maybe that will come after theory class.

2 weeks of theory, then back on the floor. I cannot wait to get back on the floor. So far I have loved it. The patients are so awesome.

I am just a little concerned about ANYONE drawing up anything I am supposed to be giving.

The "thrill" is what you FEEL... it's actually feeling the rushing/pumping of the blood in the fistula or graft. The "bruit" is what you hear.

We never actually listen UNLESS we can't FEEL the thrill... if I don't feel anything, I grab my scope and listen.. if still nothing, I can' pretty much know the patient's access is clotted off.

As far as drawing up heparin, etc.... the techs are trained just as you are in this. It is their job, just as it is yours. Hopefully your techs are conscientious, and most of them truly are. The amount occasionally being off just a tiny bit is no major concern.. of course they should attempt to be careful, but it will not truly harm the patients unless they have real issues with internal bleeding, occult bleeding, etc.

The heparin is used to keep the dialyzer from clotting, so we don't use enough to do any real damage. Tha'ts not to justify carelessness or apathy... but I wouldn't be OVERLY concerned about a fraction of an ml, ... even an ml is not going to do any real harm. Might cause the patient to bleed a tad longer when holding his/her sites, but that's about it.

You have to get to "know" your techs and have a good working relationship with them.. gain thier respect and confidence, and vice versa. Just let them know to be sure to come to you if in doubt about ANYTHING relating to the patients.

You'll get there... I've never had a problem with any of our techs.. but we're very picky about whom we hire, too. :D

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Since I am new and have no idea regarding Dialysis, I have many questions.

So here are a few regarding PCT's and me as the soon to be LVN that will be liable. I am very nervous about my license being at stake and I am not sure what is normal and what is not.

In your Facility what do your PCT's do?

Are they accessing everything but Catheters?

Are they drawing up the Heparin, Lidocaine and Saline then labeling it? If so how are we supposed to know that what they drew up is really what they say it is?

The PCT's in ours set up the packs, meening they draw up the Heparin and label it. Then they put it in the packs for the Catheter pt's. so the packs are ready even before they pt. gets there. It makes things flow nicely, yes, but I am just wondering how we are guaranteed that this is what the label actually says it is. They also draw up lidocaine if pt's need it. My concern is, the lidocaine sits next to the Heparin and in the 4 days I worked this week. I found the lidocaine in the Heparin box twice. I also say several predrawn Heparins that weren't the amount the needed to be, say like the pt was supposed to have 8000 Units, the tech would pull back to where they thought 8ML's were and that was it, but when I would look at it, it would actually be under or over by as much as 1ML. So being the nice, sweet person that I am, I wouldn't say anything, but fix what they did wrong.

Since I dont' start theory part of the orientation till next week, but have been drilled to death in school about exact amounts, I am thinking that if the Dr. ordered. 8000 units, shouldn't it be exact rather then almost?

And my other thought is, when it is me that is responsible for the heparin on the catheters, shouldn't something be said about, unless you are giving it, don't draw it up?

Oh, one other thing, Say the RN in Charge does an access, because it is a tricky one, shouldn't that Nurse be responsible for documenting the Bruit and accessment rather then the PCT. I was told yesterday by the PCT, "here, go ahead and check that the Bruit was good, and his resp's were OK." I said, "I didn't feel the Bruit, I watched the Nurses technigue, I didn't touch that pt." She said back to me, "That is OK, we always do this section of the sheets." I gave the pen to her and said, here show me what you mark. And left it at that.

It makes me nervous about these kind of practices, I don't want to step on toes, but feel this is my license I need to protect. Am I being overprotective?

You've said a couple of things that concern me. First, NEVER give a med that you did not draw up and label yourself. That is just putting yourself at too much risk. Even if the PCT label's it heparin; what if he/she actually drew up Lidocaine instead.....you do NOT want this to happen. Second, NEVER document something you did not do, and do not have someone else document something for you. This is not safe; there could be miscommunications etc...especially with an unlicensed employee. Our PCTs can give, Heparin, Lidocaine (1% ID only), NS, and O2. They can stick, put on, and take off. They cannot access catheters or perform dressing changes. They can initiate tx on catheters, but they cannot connect or disconnect bloodlines with catheters. Again, if they are giving the med, they have to draw it up, if you give it, you draw it up. Never put yourself, your license, or the patient's wellfare at risk by giving a med drawn up by another person, nurse, PCT, whatever. People make mistakes; they may have meant to draw up heparin, but drew up Lidocaine instead. Make your OWN mistakes, not someone else's.

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You've said a couple of things that concern me. First, NEVER give a med that you did not draw up and label yourself. That is just putting yourself at too much risk. Even if the PCT label's it heparin; what if he/she actually drew up Lidocaine instead.....you do NOT want this to happen. Second, NEVER document something you did not do, and do not have someone else document something for you. This is not safe; there could be miscommunications etc...especially with an unlicensed employee. Our PCTs can give, Heparin, Lidocaine (1% ID only), NS, and O2. They can stick, put on, and take off. They cannot access catheters or perform dressing changes. They can initiate tx on catheters, but they cannot connect or disconnect bloodlines with catheters. Again, if they are giving the med, they have to draw it up, if you give it, you draw it up. Never put yourself, your license, or the patient's wellfare at risk by giving a med drawn up by another person, nurse, PCT, whatever. People make mistakes; they may have meant to draw up heparin, but drew up Lidocaine instead. Make your OWN mistakes, not someone else's.

See that is exactly how I feel. I don't want to give a med that someone else has drawn up and that is why I came here to ask. It looks as though that same places do this and this is common for them. But I have decided that once I am put in the position of doing the catheters and pushing meds that I didn't draw, I am not going to do it. If it becomes a big deal and they don't like the fact that I can't trust the PCT's then I will have to find another job. I worked hard for this license and people make mistakes, we are human and I can't take a chance like that. It's not a matter of trusting the PCT's it is a matter of the patient safety. I have to ensure myself that what I am putting in the line is what it is supposed to be. There is no way to guarantee that unless I do it myself.

We wouldn't do it in the hospital so why would we do it here,

Thanks so much for your response it makes me feel better knowing that I knew what was right, but felt like I was being pressured to do what was wrong.

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1. If you don't know (therefore can't trust) your PCT... YOU draw up all meds you give. Period. Just say this.. "I need to learn this..can you show me how to do it?" AND say..."To make your life easier..I will just draw up all the meds my patients need... :)" with a smile.. let them know you are making THEIR job easier!

2. B&T.. As Jnette said what bruit and thrill are. HOWEVER, we listen regardless no matter what. And guess what? When you listen EVERY time...when they begin to get a stricture...you HEAR it before it clots off! YEP! You hear this high pitched swishing sound vs. the regular sound... and when YOU get to know the patients access...you will know what is going on with them!

Prevention is a HUGE aspect to ALL nursing...not just dialysis! :)

Read your P&P's...even if you have to do it on your breaks...take them home, etc. READ THEM! Make copies of those most pertinent to you and read them often!

YOUR license is on the line!

NEVER document ANYTHING YOU PERSONALLY DID NOT DO! That is against your own nursing rules. Read your own state's licensing info... I guarantee that is considered falsifying documentation and you CAN lose your license doing that! Your company doesn't want you to do it! Those you work with just find it the easiest way to do it! UH..NO!

Do you have a stethoscope? Do they provide one for you? I suggest you BUY a good one for yourself for around 100.00. At tax time, write that off as a work expense (keep your receipt!).

Keep the questions coming... Good luck! Geez... I should pm you my phone #! If you want to talk, pm me...I will call you!

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The theory class has been an excellant source of information for me. It is long and drawn out, but I am so glad we have to do this. Not only for my own knowledge but also because it has been an excellant review for Boards.

Things that didn't click in school make total sense to me.

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Hi,

This is my very first post

I am currently in my first semester of Renal Dialysis Tech training. Although we have yet to start the clinical portion of the program our instructor (Dialysis RN) has made it quite clear that we Will be listening and feeling the access site in our clinical training.

In the state of Wisconsin, RDTs can do dress changes, give the Heparin and also place and remove the blood lines. I am very exicted about this opportunity as I can gain good experience before starting my LPN or RN clinicals. (which ever comes first, the wait lists for nursing are quite long)

Unless I'm missing something, we learned in Certified Nursing Assistant training that the nursing staff, licensed or unlicensed should only sign off on tasks that they performed ??????????????????????

I still have a long ways to goin my studies, and I sure that I will have questions along the way. Im learning a lot here, and I really like this site.

MKE247

Since I am new and have no idea regarding Dialysis, I have many questions.

So here are a few regarding PCT's and me as the soon to be LVN that will be liable. I am very nervous about my license being at stake and I am not sure what is normal and what is not.

In your Facility what do your PCT's do?

Are they accessing everything but Catheters?

Are they drawing up the Heparin, Lidocaine and Saline then labeling it? If so how are we supposed to know that what they drew up is really what they say it is?

The PCT's in ours set up the packs, meening they draw up the Heparin and label it. Then they put it in the packs for the Catheter pt's. so the packs are ready even before they pt. gets there. It makes things flow nicely, yes, but I am just wondering how we are guaranteed that this is what the label actually says it is. They also draw up lidocaine if pt's need it. My concern is, the lidocaine sits next to the Heparin and in the 4 days I worked this week. I found the lidocaine in the Heparin box twice. I also say several predrawn Heparins that weren't the amount the needed to be, say like the pt was supposed to have 8000 Units, the tech would pull back to where they thought 8ML's were and that was it, but when I would look at it, it would actually be under or over by as much as 1ML. So being the nice, sweet person that I am, I wouldn't say anything, but fix what they did wrong.

Since I dont' start theory part of the orientation till next week, but have been drilled to death in school about exact amounts, I am thinking that if the Dr. ordered. 8000 units, shouldn't it be exact rather then almost?

And my other thought is, when it is me that is responsible for the heparin on the catheters, shouldn't something be said about, unless you are giving it, don't draw it up?

Oh, one other thing, Say the RN in Charge does an access, because it is a tricky one, shouldn't that Nurse be responsible for documenting the Bruit and accessment rather then the PCT. I was told yesterday by the PCT, "here, go ahead and check that the Bruit was good, and his resp's were OK." I said, "I didn't feel the Bruit, I watched the Nurses technigue, I didn't touch that pt." She said back to me, "That is OK, we always do this section of the sheets." I gave the pen to her and said, here show me what you mark. And left it at that.

It makes me nervous about these kind of practices, I don't want to step on toes, but feel this is my license I need to protect. Am I being overprotective?

Up Vote Up Vote ×
Hi,

This is my very first post

I am currently in my first semester of Renal Dialysis Tech training. Although we have yet to start the clinical portion of the program our instructor (Dialysis RN) has made it quite clear that we Will be listening and feeling the access site in our clinical training.

In the state of Wisconsin, RDTs can do dress changes, give the Heparin and also place and remove the blood lines. I am very exicted about this opportunity as I can gain good experience before starting my LPN or RN clinicals. (which ever comes first, the wait lists for nursing are quite long)

Unless I'm missing something, we learned in Certified Nursing Assistant training that the nursing staff, licensed or unlicensed should only sign off on tasks that they performed ??????????????????????

I still have a long ways to goin my studies, and I sure that I will have questions along the way. Im learning a lot here, and I really like this site.

MKE247

Welcome to AllNurses.

This is what I have found out regarding my facility. First of all, if I don't want my PCT's to draw my heparin I will be administering, they won't. I decided that this bothered me so bad, that I had to bring it up. Oddly enough even our charge nurses never thought about incidents happening by mixing up the Lidocaine and the heparin. I am not sure if they didn't think about it or not, but in our facility it is just standard for them to do it and when you are in the middle of rush hour, it is easier to have all that ready to go. BUT, I will draw my own and no one is upset about that. Our Head nurse even said that if I pushed a med that was not the right med, they wouldn't back me, just because this is standard in our facility. Duh, that right there told me that, they all know it isn't the right thing to do, therefore count me out.

Secondly, alot of the techs that work at our facility pull other shifts at Fracenius. They have all said, that this facility I am at, is not as strict as Fresenius. Shortcuts are done, maybe not with approval but they are done. Fracenius is very strict and if you are caught cutting any shortcuts you will be reprimanded.

When I say shortcuts, I meen things like only cleaning the site with alcohol and not betadine as well. We are not supposed to put the machine in test mode until the other patients line is completely off the pole, but the techs do it because of time issues. They are supposed to listen and feel, but they only feel because of time. I am still shocked about that one, because if you are doing both you can catch a change in the bruit early and possibley catch it before it is completely gone.

We have the MasterGuards on the Access needles and only one person uses those. That bothers me, I really wish they would do like a "retrain" on that because we have lots of bare needles being slung around and someone IS going to get stuck.

I just went through the theory class and I can vouge on the fact that they have be trained correctly, they just don't do it and they are not corrected when doing shortcuts.

I will probably make an idiot out of myself because all of this does bother me, but I just think maybe the charge nurses and head nurse and DON, have to much on their plates to really see what is going on.

There are definately some issues between the Tech's and Management. Respect being one of them, but for now, I just keep telling myself, this is excellant training for me, don't create any bad habits, do it the right way and just ride it out as long as I can.

I still have not gotten my ATT, I am sooooooooooo ready to take my Boards. I want to get that off my to do list.

Good luck with your training. We don't have a Dialysis Tech program here, they hire CNA's and then train them.

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