So, I have returned to Acute Dialysis after very heavy recruitment. I love it and got great hours...now for my problem.
Had a really unpleasant conversation with one of our nephrologists in regard to a specific patient. His basic complaint was that we (the Acute Dialysis Team) are stupid and incompetent. A patient' s BNP has continued to rise (except for a couple of days) despite daily dialysis. The patient came to us from a larger facility d/t problems with AVF. When pt arrived to our hospital, said patient coded, K was 6.6. Compressions and defibrillation were done and ROSC obtained in 3-4 minutes.
I have run this patient once...during treatment her SBPs were fine; however, her DBPs were in the toilet 24-32. Patient looked awful. The mean pressures didn't meet any criteria. I have just never seen such low DBPs before. The nephrologist very clearly stated DBPs did not matter, patient was in heart failure and diastolics were not an issue, that we were only to use SBP as our guide, since we were obviously pumping patient full of fluid. Again, another rant of our incompetence and need to find another job. I learned in nursing school that diastole allowed for perfusion of the coronary vasculature.
He did mention one person he wanted to run this patient. A review of treatment showed that a BP of 118/11 was recorded. The patient's BNP has climbed steadily even with his preferred nurse running the treatments.
In an effort to improve this patient's treatment, I asked some questions. I formerly worked in teaching hospital where questions were expected and welcome. Again, another unprofessional rant of the team's incompetence and stupidity.
I would love your input. BTW, the patient's BNP decreased a good bit after my one run. The patient needs CRRT, but we don't do that and I got the distinct impression the MD will not transfer patient to an appropriate facility.
