Nursing intervention?

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Specializes in Dialysis.

In your facility,what do you do when patient experience chills during HD treatment?:idea:

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

Give them a blanket...maybe ??

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Specializes in Nephrology, Cardiology, ER, ICU.

First, take their temperature. ESRD pts on HD can become septic VERY quickly. Then...if they do have a temp, obtain blood cultures x2 and treat for Vanco (for gram positive cocci) and tobra (for gram negative).

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Agree with pp, chills usually indicate an infection (often, the perm cath is the source). Call the MD, who will usually order blood cultures and antibx.

Of course, make sure the A/C isn't on deep freeze, but this is usually not the cause of intradialytic chills.

DeLana :)

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Specializes in Critical Care, Cardiothoracics, VADs.
First, take their temperature. ESRD pts on HD can become septic VERY quickly. Then...if they do have a temp, obtain blood cultures x2 and treat for Vanco (for gram positive cocci) and tobra (for gram negative).

Call the doctor, don't treat with anything.

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Specializes in Nephrology, Cardiology, ER, ICU.

Augigi - in dialysis - RN's operate on protocols. It can be perfectly acceptable to do this from protocol. Please also understand as my signature indicates, I am an advanced practice RN and have no need to call the doctor for this scenario.

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I should have added to my reply (and almost did) that many clinics have standing orders or protocols for such a scenario; in this case, you might still call the doc as a courtesy, or mention it if s/he rounds.

DeLana :)

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Specializes in Critical Care, Cardiothoracics, VADs.
Augigi - in dialysis - RN's operate on protocols. It can be perfectly acceptable to do this from protocol. Please also understand as my signature indicates, I am an advanced practice RN and have no need to call the doctor for this scenario.

I know you are, but I don't think that's a "nursing intervention", so much as an advanced nursing intervention. IN addition, I don't know if the OP is an APN.

I've never seen a protocol which permits a non-APN to initiate something like vancomycin.

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Specializes in Nephrology, Cardiology, ER, ICU.

Maybe you need to not tread where you know not? Seriously, our nephrology practice is protocol-driven and this is well within the scope of practice in IL.

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Specializes in Critical Care, Cardiothoracics, VADs.

I'm not trying to tell you that you're not correct. I'm not sure how you would presume to know my level of knowledge in anything, apart from the fact that I am not in the US...?

I merely was pointing out to the OP that they may not be able to do this, since it's not apparent they are either an APN or in your state.

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Specializes in Nephrology, Cardiology, ER, ICU.

No problem - Just as I would not presume to know what is done in Australia, you certainly must realize that different countries do things differently. In the US overall, much of dialysis care is protocol-driven. I work in two dialysis units owned by a large for-profit company. They do protocol-driven care and this is common practice. These protocols are enacted by the staff RN's.

If you preface your comments with "in my experience" than that lets people know that there are many kinds of experience and your comments are based solely on your own experience.

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Specializes in Critical Care, Cardiothoracics, VADs.

Since the question said "in your facility what would you do" I presumed that is what was being asked. Point taken.

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