New Grad-Worried about Liability in Dialysis

NeosynephRN · May 3, 2007

Hello. I am not a nurse yet...though I do graduate in 10 days. I was a PCT in Dialysis. We were allowed to take patients on and off treatment, I am not sure you would call what we did as an "assessment" we took temp, B/P, asked basic questions, like any SOB, loose stools, increase in thirst. We did the HR and resps...but the RN or LPN had to listen to breath sounds and do the monthly head to toe assessments. We could give saline throughout tx if warented and obviously in rinseback. We were NOT allowed to do any IV fluids...in Dialysis the saline is not considered IV fluids...well not where I worked. We could not touch an IV pump. We were allowed to give heparin. This is a one time dose pushed through the blood tubing at the begining of the TX. We had to take a special class and pass testing in order to do this. At least in my unit it would have been difficult to mix up heparin and any other injectable, as the heparin was in 10cc syringes and everything else in lil 3cc. We did have a nurse give the lido sub-q once thinking it was epogen, but that could happen to anyone that is not carefully checking their labels. I am sure people that have worked as an RN/LPN may have a different view, however none of the nurses I worked with had an issue with us doing these things, as it helped the whole team work better together.

Lacie, BSN, RN · May 4, 2007

Thier roles are generally set according to your particular state laws. Some states allow PCT's to give heparin and others dont. I dont see the possibility of one giving Lidocaine in lieu of heparin as most chronic dialysis clinics dont even stock such meds due to the liability. Most dont even have cardiac monitors or crash carts anymore. Ours has an AED and the very basics until 911 shows up. Yes you are ultimately responsible but it is up to you to follow through to ensure your PCT's are setting the machines properly such as the right dialysate, etc. Meds are generally drawn up and given by the LPN or the RN only. In my state only licensed may draw and administer Heparin. The only thing given by pct's are the NS bolus if needed and they must tell you they did it and why. They can also collect data for you but you are the one responsible for performing the overall assessment.

BoredLPN · May 6, 2007

I would never work as an RN in dialysis chronic unit. Not worth it IMHO.

In my state HI and facility I work in...the techs give hep, NS, pretty much do everything except meds.

suzanne4, RN · May 6, 2007

heparin is not a medication? it most definitely is and is considered so by any board of nursing, as well as board of pharmacy. and even requires verification by two nurses in most states before being given iv.

i would be very leary of a pct administering a medication that has a red flag on it per jcaho. that is a medication, pure and simple. it should be administered only by a licensed nurse. and in most states, an lpn/lvn cannot administer it iv either, and that is what is being done in the dialysis center. i would rely on your board of nursing, not what your center tells you to do in these cases. in a court of law, you would be the fall guy if there even were any issues that came up because of it. and the rn is legally responsible for any medication that is given during her time there on duty.

Trauma Columnist · May 6, 2007

I work as an APN in two dialysis units and the nurses draw up heparin, label it, then the nurse, PCT or pt give it. Much poor nursing practices evident in dialysis.

BoredLPN · May 6, 2007

Thats why I scratched my head when I started in dailysis. Techs draws up heparin, puts it in the pump, and also give the initial bolus when they canulate!!! It gets better...they prep "packs" for the next few shifts and draw up heparin, label it and put it in the pt's pack. My trainer says its okay cause they are under the supervision of RNs. Thats 4 RNs for 48 stations and alteast 14 techs..a few of the techs are LPNs including me but are considered techs...but LPNs get paid a little more. Again I wouldn't want to be a RN in chronic unit at this facility.

Lacie, BSN, RN · May 6, 2007

Check with your state boards nurse practice act. In some states it is legal for pct's to push heparin. Fortunately not so in my state as I dont feel anyone not licensed should be pushing anything "medication". Our LPN's do in our facility but they are also IV Certified and also give other IV meds. Facility procedures or protocal will never overrule state law. Simple as that. If it's not legal in your state dont put your license on the line.

Trauma Columnist · May 7, 2007

The thing that gets me is that JCAHO has mandated that IV heparin is a dangerous med and easy to give more or less than ordered. At the hospital where I worked, it was a two-RN med!

MSLNT1.1 · May 10, 2007

I am also a dialysis RN and work for a company that allows PCT's to put and take patients on and off the machines. However in the state of Illinois PCTS are not allowed to pass medications and while some nurses may feel like they wish they could, it is better to me in the long run. Although your nurse practice act may allow them to pass medication ultimately the charge nurse and clinical manager will be responsible. My suggestion is to get additional malpractice insurance. Try http://www.nso.com they offer malpratice insurance to healthcare professionals. I always make sure that I check the PCT's assessments and calculations because I know it will be my responsibility if something does happen.

MSLNT1.1 · May 10, 2007

I would say coming out as a brand new nurse that acquiring some med-surg skills would be beneficial to you. I would say that dialysis is definetly not technical type of nursing. As healthcare continues to decline, you still have to deal with the patient holistically. Most patients have either diabetes or hypertension and eventually end up with cardiac complications. While it may not be the setting of and ER it can go from being a quiet environment to one of critical nature in a matter of minutes. Most people think that being in dialysis is easy but it is not. Although your primary goal is to attend to the issues of the kidney once again you end up dealing with all the patients issues. And we know that there are plenty on nurses no matter what area they are in can be risk. It can be very a enjoyable field but it will mainly have to do with your knowledge and skills and what you bring and want out of the position.