Is Dialysis considered Critical Care?

nurseontheway · Jan 30, 2012

Do you do dialysis at hospitals? This sounds interesting instead of being stuck at a clinic all day. I imagine the pay is better too?

MJB2010 · Jan 30, 2012

Nurseontheway - have you considered pediatric dialysis?

nurseontheway · Jan 30, 2012

Yes, but for the hospital you need your BSN.

gollybabbler · Feb 1, 2012

I worked ICU bedside forever, now I'm doing dialysis in the ICU/hospital. I can say for certain that dialysis is not considered ICU. Also, you can do dialysis in hospitals and not work for the hospital if the dialysis is contracted out to another company, in which case you may be okay without the BSN. Not sure what is the case in your area- good luck!

Chisca, RN · Feb 4, 2012

According to the AACN acute dialysis does involve directly caring for critcally ill patients and those hours count towards certification. It doesn't make any reference to "total" care and you would be a pi$$ poor dialysis nurse if you felt your only responsibilties were for the dialysis treatment.

aandrae · Feb 25, 2016

I seriously appreciate this. As an acute dialysis nurse who is in the icu every day I do way more than just run the machine and hook the patient up to it.

chare · Feb 25, 2016

I seriously appreciate this. As an acute dialysis nurse who is in the icu every day I do way more than just run the machine and hook the patient up to it.

I'm curious. Exactly what do you do for the patient in the ICU?

Guttercat, ASN, RN · Feb 25, 2016

I'm curious. Exactly what do you do for the patient in the ICU?

To treat the patient effectively as an HD RN in ICU, one really needs to know at least the basics of hemodynamics in relation to vasoactive drips and concurrent hemodialysis, vent settings, CVP's, and a solid foundation in reading and interpreting cardiac rhythms.

What we do as dialysis RN's in the critically ill patient affects whatever the ICU RN is trying to do, and vice versa. It's a delicate dance sometimes just to keep the patient alive during dialysis, and the dialysis RN needs to be able to communicate effectively with the ICU RN and docs.

Chisca, RN · Feb 26, 2016

I disagree with you Rocknurse: dialysis in the ICU only covers the dialysis, not the total care of the patient.
So, the dialysis nurse is more task-oriented whereas the ICU nurse oversees the total care.

And sometimes my task is to get the ICU nurse to take care of their patient.

aandrae · Feb 26, 2016

To treat the patient effectively as an HD RN in ICU, one really needs to know at least the basics of hemodynamics in relation to vasoactive drips and concurrent hemodialysis, vent settings, CVP's, and a solid foundation in reading and interpreting cardiac rhythms.
What we do as dialysis RN's in the critically ill patient affects whatever the ICU RN is trying to do, and vice versa. It's a delicate dance sometimes just to keep the patient alive during dialysis, and the dialysis RN needs to be able to communicate effectively with the ICU RN and docs.

Yes. Perfectly said. If we had just the knowledge of dialysis and were completely task oriented then I would look at the dialysis orders and if the doctor said to remove 3 liters, then I would try to remove 3 liters regardless if I walked into the room and saw that the BP was 80/40 and the patient was on 50 mcg of norepinephrine.....yea right! I don't even turn on the machine. I'm calling the nephrologist immediately and he'll tell me not to do dialysis in most cases.

I use this real life example because in situations like this I've had the ICU nurse then come to me confused/worried saying "But the patient NEEDS dialysis, because he has +4 pitting edema, crackles in his lungs and a K of 5" Me "Yes, but he either has no fluid in the vascular system for me to remove because it's all third spacing or he is so septic that he is unable to maintain an adequate blood pressure. Perhaps get an order for Albumin 25G IV to help with the fluid shift or we'll need to see if the antibiotics can get the sepsis under control. This patient is so unstable he will proabaly crash the moment I start to pull his blood out of him at 250 ml per minute..." and that's running him slow but what do I know I'm just here to run the machine.

I am also thinking of the total care of the patient before I walk into the room. First I'm finding the ICU nurse and asking questions like "Can I start dialysis now or do they have another treatment/procedure coming up that takes priority (i.e. bronchoscopy, intubation/extubation), does the patient need to be re-positioned soon? This treatment will be 3.5 hours and it's easier/safer to move and clean them now while they are not hooked up to yet another machine. What medications will be due while they are on the machine? Some of them maybe dialyzed out and should be held until after treatment. His output is 2,000 ml in the last 24 hrs? Thank you for telling me I may not be able to get 2 L off if he's putting out that much."

I understand that it may seem like we don't do much, but when I'm sitting there for 4 hours just monitoring thats a GOOD thing. That means the treatment is running smoothly and the patient is tolerating dialysis. Just because I am not constantly running doesn't mean my mind isn't. There's a reason why we are not allowed to leave the room while the patient is on the machine. As you ICU nurses know things can change within seconds for those patients and when you're not in the room the dialysis nurse needs to know how to recognize those small changes in order to react before things go completely bad.

However, as I stand up for my specialty I will say this I still think ICU nurses are the cream of the crop of nursing, have the highest respect for them and love working with them. I searched this topic because I wanted to know if I could apply for my CCRN, which I found out I can from the AACN themselves. Since I'm working with ICU patient's all the time I think going for this certifiation specialty would be a benefit for myself, the patients, the ICU nurses and hospital. Patient's are getting sicker and all health profressions are getting more complex as time goes on.

nutella, MSN, RN · Feb 28, 2016

I seriously appreciate this. As an acute dialysis nurse who is in the icu every day I do way more than just run the machine and hook the patient up to it.

I agree!

I worked critical care and acute dialysis.

The great thing about acute dialysis is that you focus on your treatment and everything related to it but once your tx is done - you leave....

I did work closely with the critical care nurses, there is a lot of collaboration if you do a good job. In addition to HD I also set up CVVHD and did trouble shooting for the nurses in critical care. It was a great job - I loved the whole shebang. The reason I left was frequent on call (several times a week), too much overtime, crazy weekends...

NurseRies, BSN, RN · Mar 3, 2016

I do a lot more then dialysis also. I always reposition the patient, make them comfortable, assess their foley, write down all their drips. If I don't know something I will look it up. Check their vent settings, check neuro status, interpret rhythms, suction trachs, read the critical care notes... It goes on. I'm not an ICU nurse by any means but I wouldn't be a stranger if I ever switched to ICU. It's a good introduction to critical care, but it's not critical care experience that you put on a resume. I've been trying to learn from respiratory therapists lately, there's so much to learn about our ARDs patients, and other vented patients. I also have learned how to use many different types of IV pumps, I always put blood, calcium gluconate, antibiotics, on IV pump because it's so much safer then hanging by gravity like some HD nurses do.