Need help in Checking Water, etc

westieluv · May 1, 2016

It sounds like you work acutes. These two procedures are something that you should definitely have been taught in your orientation, and they can vary from company to company and program to program within a company.

The best thing to do would be to ask the person who trained you or your manager. Just say something like, "I may have gotten this in orientation, but I can't remember exactly how to ______. Can you fill me in?"

Learning acute dialysis is a huge learning curve and not like any other type of nursing, so don't beat yourself up if you can't remember everything you learned in orientation, that's normal and your co-workers expect it from a new dialysis nurse.

nutella, MSN, RN · May 1, 2016

Hi Guys! I am new to HD. I just started last week. We have many policy and procedures to follow and I love that we do, and they are succinct. However, there is not a guide or "how to" from start to finish on how to complete a HD treatment. I am piecing policies together. I am getting stuck on two things and was hoping someone could help.
#1-I can't remember when to check the water, RO, etc and using what strips? I have gotten to the part where the RO has to run for 15 mins then you check the water. I am lost from there.
#2-When to throw my machine in heat or disinfect. Any help appreciated :-)

Ok - this is NOT good.

I hope you are not working by yourself already since this poses a significant safety risk.

You need to talk to your preceptor/manager/educator if you do not know how to check the water and when/how to desinfect the machines.

If you do not check the water / RO correctly the pat can die. Not only is the tap water a source of chloramine/chlor - there can be residue in machines from bleaching them. If you do not check everything correctly and the pat becomes into contact with chloramine/chlor the blood will hemolyze and the pat could die. And I am not saying that to make a wave - I am saying that because those things have happened.

You really need to 100% know what and how to do.

Unexpected things can happen as well. One time I was coming in to do tx in acutes and there had been a main break in the city water system somewhere. After that they put more "bleach" in because some kind of count was off. As a result, the city water had a higher level and exhausted the portable RO tanks rapidly. Another day I checked the machine and there still a tinge of bleach after bleaching the machine - it turned out that there was something wrong with the machine as I rinsed several times and it came back positive for bleach.

You need to learn exactly how long the strips are good for, when to test, how to test (machines and RO), what to do if it is positive, how often to test in the tx (portable RO) and such.

Desinfect/bleach : There are policies in all companies that provide acute tx as far as I know. You need to follow 100% ! Those policies are tight in with hepatitis B surveillance and hep B tx.

If you tx a Hep B pos or unknown pat and do not follow the right policy for cleaning and dialyze a susceptible or neg pat with that machine you can spread Hep B easily. If you use the machine on several pat you can actually have a situation where you further spread Hep B. .

You need to follow the protocol weekly desinfect /cleaning as well.

Please do not delay to get all the information. You need to know how to monitor pat hep status, what to do in unknown and pos cases, how to quarantine a machine. And you need to know when to heat or bleach the machines routine and special events.

westieluv · May 1, 2016

I was going to bring up the safety aspects as well, but I figured that she must not be running patients independently yet if she didn't know how to test water or bleach a machine, or I would at least hope not. You are definitely right, running a patient without knowing how to do these things could be deadly. That was hammered into me during my orientation and for good reason.

whydoidothisrn · May 1, 2016

I just started last week, doing computer work. Followed my preceptor 2 days only. I wouldn't go ahead and do anything that would harm my patients. There are specific policies, and like I said they are succinct but I am having trouble tying them together. Yes, I am hard on myself, I should learn to relax. I get 12 weeks of orientation. I'm just a perfectionist.

Chisca, RN · May 2, 2016

The Association for the Advancement of Medical Instrumentation (AAMI) governs water standards for dialysis and for a mere 205 dollars they will sell you the brochure that contains them. AAMI Publishes Dialysis User Guide - Association for the Advancement of Medical Instrumentation Your employers water standards are going to be verbatim what the AAMI standards are.