what to know about dialysis

NurseRies, BSN, RN · Feb 18, 2013

Pls give me more information in dialysis area.
Is it ok to reprocess dialyzer for 40 times?
What is the right direction on canulation of AVF access.

At the clinic I worked for, some dialyzers were reprocessed over 80 times. I don't remember exact cut off point to throw them away. For an AVF, you want to ALWAYS point the venous needle towards the heart or "up", the arterial needle for a fistula can be faced "up" or "down", meaning towards the heart or away from the heart. On an AVG or graft, both needles should always point "up", or towards the heart. You never place a needle down on a GRAFT. Also, never use a tourniquet on a graft because it could cause rupture. Always use a tourniquet on a fistula. One other thing to remember is that AVGs often clot a lot easier. Do not put too much pressure on them and do not let the patient's blood pressure drop too low, which could encourage clots.

stavros_rn · Feb 20, 2013

Why needle for AVG should always be point up? I saw it in the clinic that AVG and AVF needle point down for Artery and Up for venous.

Another question is that when will be the best time to give Iron sucrose for dialysis px.? One time in our clinic when the patient is hypertensive they didnt give encifer bec. BP will rise. Then when the patient is Hypotensive they didnt give also the encifer bec. They say BP may drop? I cant get it. Am confused..

maura2013 · Feb 20, 2013

Why needle for AVG should always be point up? I saw it in the clinic that AVG and AVF needle point down for Artery and Up for venous.
Another question is that when will be the best time to give Iron sucrose for dialysis px.? One time in our clinic when the patient is hypertensive they didnt give encifer bec. BP will rise. Then when the patient is Hypotensive they didnt give also the encifer bec. They say BP may drop? I cant get it. Am confused..

Up for venous and down for arterial for good circulation. Iron sucrose can b given any time during tx....I've never heard any diff...

NurseRies, BSN, RN · Feb 20, 2013

At my company, which was pretty Large, they said you never point either needle down in a graft. I don't know the reasoning, but I looked up the guidelines and it says that arterial needle can be faced up or down on an AVF and an AVG. I am not sure why I was taught differently. Here is the link with some guidelines about dialysis accesses. http://www.bcrenalagency.ca/NR/rdonlyres/AC0BB28B-00A9-41A6-BD76-55F441559B03/59055/FINALFullGuidelineCannulation1.pdf

Whatever iron medication you use, could also be Venofer or Ferrlicit, among others, it is important to push this medication very slow. We used to dilute it in a bag of saline and give over one hour. After budget cuts were made, they did away with the small saline bags and we just had to hook up the medication and push one ml at a time. I didn't like that practice. This drug is known to do funny things to blood pressure, both drop it and make it higher, depending on the persons body chemistry. Epogen is contraindicated in people with chronic hypertension, however, you will rarely see it held. Supposedly, it increases the risk of strokes. I think most doctors say that the risk of stroke is very low and not worth making someone chronically anemic and feeling awful. We never held iron meds for blood pressure though. I floated to many different clinics. Maybe it is your doctors preference to be more careful with this med. Can you ask the charge nurse?