Meds during dialysis

[RNWithAHeart]

Hi,

I am a hospice nurse and have a 50 year old end stage renal patient. My question is, she has alot of pain (from other co-morbidities) and has prescribed pain meds for Q4 hrs. She is usually at dialysis for her runs for around 6 hours, and she is not permitted to take a pain pill while she is there, she cannot have 1 sip of water. In fact, according to the patient, she had to fight with the dialysis nurses in order to be able to take her scheduled insulin. I have prior tele experience and when our patients went up to dialysis, we would send up their breakfast and they would eat while they were having their run. This patient says she has seen the nurses literally pull a piece of hard candy out of another pt's mouth.

Is this standard practice during dialysis, and if so, could you tell me the rationale so that I can explain it to my patient?

Thanks for your help!:redbeathe

[dialysisguy]

It's true that I cannot give the patient her home meds without an order. However, I can get an order from my nephro doc for pain meds at the unit or an order to give a home med while on dialysis.

I am surprized that a HD nurse let you take a breakfast tray in his or her space! This area should be clean to sterile. Lots of risk of infection, especially dealing with catheters. We always have D50 for low BS.

NO EATING IN MY UNIT!

Hope I helped,

I was Tele Nurse too... :redbeathe

Good Luck,

DG:smokin:

[traumaRUs, MSN, APRN]

In the outpt chronic units where I round, everyone eats, drinks and is merry!!! And yes, its gross and disgusting!!!

That said, I'm an APN and I always give orders to the nursing home, home care, etc., to ensure they provide the pt with adequate pain meds. To do otherwise isn't humane.

And...a hospice pt usually does have pain and has a high narcotic tolerance. As we dialyze them, we also dialyze off the narcotics. Absolutely nothing wrong with giving narcotics while on dialysis.

[pricklypear]

Is she alert? Can she take her own meds? If she can, make sure she takes them with her, and takes her dose as scheduled. Dialysis nurses are not permitted to dispense meds w/o a nephrologist's order, but pts can, and do take their own meds sometimes while on dialysis.

When I worked in the hospital, we would frequently send trays w/ patients to dialysis. It was never a problem. We will always give at least ice chips on request for thirsty pts. But, every unit has it's own policies - and those must be followed.

However - to answer your rationale question: Eating a large meal causes diversion of blood flow to the digestive tract. Since about 250-300cc of blood are circulating in the machine at any given time during dialysis, this abrupt diversion of blood out of the general circulation can cause hypotensive episodes. Some of our patients bring a sack lunch, snacks or nothing at all. It really isn't realistic to expect a diabetic to go for up to or over 4 hours w/o some food - especially if they have to travel. D50 really doesn't do the job adequately. It doesn't hang around long enough.