Jug Bleaching protocol?

Just wondering....how do you bleach the bicarb jugs at your facility? It just seems like there's an easier way than how we do it by us...two days...rinsing...etc. Any thoughts?

Once per week (for us Wednesdays) we use bleach water, then rinse with RO water...allow to air dry...we are a 3 day per week facility (MWF) so I guess I don't know what you are asking...

We also bleach the entire system monthly...THAT is a chore!

Once per week (for us Wednesdays) we use bleach water, then rinse with RO water...allow to air dry...we are a 3 day per week facility (MWF) so I guess I don't know what you are asking...

We also bleach the entire system monthly...THAT is a chore!

I am curious about the Neutralyte that some units use. Please correct me, at any time, as I am trying to learn all I can about this field of dialysis. Thx.

Question: For those units using Neutrlyte (spelling?) do the jugs that only state "3" also have Ca in them. I know some jugs have on the outside "K 3.0 Ca 2.5" while I note others might have only a "3". Thanks.

Question: Do your units perform buttonhole technique on patients?

Thanks.

I am curious about the Neutralyte that some units use. Please correct me, at any time, as I am trying to learn all I can about this field of dialysis. Thx.

Question: For those units using Neutrlyte (spelling?) do the jugs that only state "3" also have Ca in them. I know some jugs have on the outside "K 3.0 Ca 2.5" while I note others might have only a "3". Thanks.

Question: Do your units perform buttonhole technique on patients?

Thanks.

Never heard of a buttonhole technique. Can you explain?

Just wondering....how do you bleach the bicarb jugs at your facility? It just seems like there's an easier way than how we do it by us...two days...rinsing...etc. Any thoughts?

We bleach at the end of the day everyday. We let the part bleach and part RO set for 10 minutes and then rinse with RO and check with Chlorine strips to make sure jug is free of bleach.

Never heard of a buttonhole technique. Can you explain?

Buttonhole is where cannulation is performed in the same insertion site. If you go to Medisystems.com site you can find detailed information on this. Buttonhole has been around since the 70's however not used alot in the United States. The patient has the same cannulator for at least 6 sticks, with sharp needle. It must be the same cannulator as there is the same angle of insertion of needle, as well as pressure, etc. There forms a tunnel whereby a dull needle can be inserted and is not painful, less infiltrations and less infections. Medisystems is the company that makes the dull needle. They are great for education of staff and you can order videos on this technique. They have the best nurse educators around.

At our facility we try to rotate sites each cannulation, the buttonhole is new for me!

We bleach at the end of the day everyday. We let the part bleach and part RO set for 10 minutes and then rinse with RO and check with Chlorine strips to make sure jug is free of bleach.

We used do do this daily as well.. with the exception of letting it sit for ten minutes.

But now we were told to do this only once a week. We are a 6 day facility.

As for the buttonhole technique.. our docs won't use this method at ALL.

Curious, as to why the docs won't use the buttonhole. There is proven justification with this technique, although if staff are 'not' educated and trained sufficiently in this process there is no need to do it. One needs to be really trained with rationale. Actually, if you are familiar with DOQI as well as Initiatives i.e. "Fistual First" project this is going to be something units will have to address.

Curious, as to why the docs won't use the buttonhole. There is proven justification with this technique, although if staff are 'not' educated and trained sufficiently in this process there is no need to do it. One needs to be really trained with rationale. Actually, if you are familiar with DOQI as well as Initiatives i.e. "Fistual First" project this is going to be something units will have to address.

I've been to the "buttonhole" website some time ago and read up on it.

From what I hear, this technique has some major drawbacks, and if not mistaken, infection being one of them. The site really drums it up as being superior, but I do know that many docs absolutely refuse to use it. I think this has been discussed here a year of so ago.. will have to go look at the archives and see if I can find more on it.

As far as "fistula first".. absolutely agree. A fistula is definately better, but sadly not always possible for some patients. For that matter, SOME patients are not candidates for a fistula OR graft, and are stuck with a cath permanently.

On the contrary, the buttonhole, if done correctly, will present for less opportunity for infection and infiltration. There is well documented information from Dr Twardowski who is world reknown and at a university in the US, can't remember which one. ALso, Medisystems will send you, free of charge, videos and writiten information, on the buttonhole. However, if staff are not trained adequately, then there can be problems.

I hate to even make this next statement, but will, without hopefully offending anyone reading...........Many staff, be it nursing or techs, often become defen

sive when questioned about what they are doing, or ask questions. I am aware of several situations, whereby patients brought information, of an educational nature, to staff in order to ensure their care be improved and it was taken with much distaste. These patients became to feel that they were put in a position where they could NOT speak out any further. Some staff even went so far as to say that staff were stressed and asking questions made them more stressed. I have seen too many situations whereby patients are placed in a situation where they are not part of the team. ANother thread, for sure.. btw, nice to meet ya. :)

On the contrary, the buttonhole, if done correctly, will present for less opportunity for infection and infiltration. There is well documented information from Dr Twardowski who is world reknown and at a university in the US, can't remember which one. ALso, Medisystems will send you, free of charge, videos and writiten information, on the buttonhole. However, if staff are not trained adequately, then there can be problems.

I hate to even make this next statement, but will, without hopefully offending anyone reading...........Many staff, be it nursing or techs, often become defen

sive when questioned about what they are doing, or ask questions. I am aware of several situations, whereby patients brought information, of an educational nature, to staff in order to ensure their care be improved and it was taken with much distaste. These patients became to feel that they were put in a position where they could NOT speak out any further. Some staff even went so far as to say that staff were stressed and asking questions made them more stressed. I have seen too many situations whereby patients are placed in a situation where they are not part of the team. ANother thread, for sure.. btw, nice to meet ya. :)

Like I said.. the buttonhole has been around for awhile, and many docs don't care for it, even refuse to use this system. I'm sure they have done the research, even tried it in many cases. Bad word HAS gotten out about this method.

As far as the patient being a part of the team.. I have only worked in my facility and no others, so I can't speak for them. I do know that in MY facility this simply is not the case at all. We encourage patient participation, and welcome their input.. ALWAYS. Actually, we wish there WAS more interest and input on their part.

But there ARE some clinics out there which leave much to be desired. And I can guarantee you that as long as they refuse to staff appropriately, there is a LONG road ahead to improving much of anything out there. :stone

Staffing has alot to do with the uuttonhole, particularly. The same staff must stick until the tunnel is formed. There is also a 'lifesite', I believe that is similar but not, if that makes sense.

As far as states and individual staffing I guess each licensing agency in each state would have that information. What state are u in?