Nursing intervention?

[nursedandy]

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

[DeLana_RN, BSN, RN]

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

I'm an RN who worked in an outpatient dialysis clinic for 5+ years; our standing orders/protocols included giving Vancomycin 1 gram for up to 3 doses while culture results were pending for presumed catheter infections as evidenced by purulent drainage at the exit site; this protocol was of course approved by our nephrologists, but was suggested by RNs and RN managers. (Note that culture results were to be called to the MD as soon as available.)

The protocol was very specific; in the case of suspected infection (redness at the exit site, but no drainage) we were not allowed to initiate Vancomycin unless the MD was called and approved it based on VS and other assessment data.

DeLana :)

[penem10]

Work them up for infection. Draw blood cultures, look for s/s of infection ie: respiratory, kidney, catheter, assess access. No s/s? Rule out this first then consider the flu? Did they get a flu shot?

If they do exhibit s/s of infection or sepsis, consider an antibiotic for the source of infection.

Are you using a lower temperature for your dialslate solution? This can make them chilly also.

Hope this helps.

Robin A. Clark, RN, CDN

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