Open visitation during acute dialysis

[Chisca, RN]

What is the policy of the hospital you dialyze in towards visitors during the treatment in the ICU? Is it whatever the ICU unit policy is or something different?

My hospital is open vistitation and the only times visitors cannot be present at the bedside is during initiation and take off. I'm in favor of open visitation in theory and have seen it work but my main objection is architectural as few ICU's are built to accomodate all the machinery that a patient might need in addition to family that may or may not be camping in the room. Our computers are mounted on the wall so my line of sight for the patient/monitor/dialysis machine is compromised when more than one person is present. But hospital policy is any number can be present. Becomes real fun on Sunday after church services.

[NurseRies, BSN, RN]

I have worked in a lot of hospitals, over 20, doing acute dialysis. I think most places don't have strict policies in place. Some dialysis nurse managers put the policy into place, but I have only ever seen one place really enforce this policy. Some bigger hospitals limit the amount of visitors to 2 at a time, then they just shuffle in and out. Of course, they must go during take off and put on. It is my personal belief that these people are in the ICU, and I'm going to be in there all day, it is kind of cruel to ask someone who just drove an hour to get there to come back after lunch. I just explain that they are welcome to come on in, if there are any complications, I will ask them to step out for 10-15 minutes. If it were my loved one in there, I would want to be in the room. So, I almost always let the visitors come in. Some of them ask a million questions sure, what is that fluid, what is that stuff for, and then questions get more personal, how long have you been doing this, where do you live, are you married, etc etc. Some days it bothers me, but most days I could use the entertainment out of boredom! Being in the ICU is all about talking to families, I think that is one of the ICU nurse's biggest complaints!

But, yeah no policy. We actually have much more strict policy about visitors in the dialysis suite or room, because there's multiple patients and it violates HIPPA. We are also much busier in there and it is not really safe to talk to a family member for 20 minutes when we have numerous patients to monitor. I usually only let visitors in the suite if I'm only running one patient at a time. Otherwise, I ask them to please only stay 15 minutes and I try to make things private so they can't see the other patients.

[Ruby Vee, BSN]

Visitors shouldn't be present when you're starting or ending dialysis, but otherwise it's the policy of the specific ICU you're in. (Each of the 9 ICUs has a different policy for visitation.) If they're impeding your view of your machine, you have every right to ask them to move -- or leave. You aren't monopolizing the computer so that the ICU nurse cannot get into it to chart vital signs or medications are you?

In some of our ICU rooms, there just isn't enough room for a visitor after we get all the machines they require -- ECMO, a Thoratec, dialysis machine, RO, and a perfusionist in his lounge chair next to the ECMO. Sometimes we have to tell visitors they cannot stay. As for someone who drove an hour to visit -- usually there are other family members present somewhere in the ICU they can visit with. Yes, you feel bad about it, but patient care comes first.

[NurseRies, BSN, RN]

Visitors shouldn't be present when you're starting or ending dialysis but otherwise it's the policy of the specific ICU you're in. (Each of the 9 ICUs has a different policy for visitation.) If they're impeding your view of your machine, you have every right to ask them to move -- or leave. You aren't monopolizing the computer so that the ICU nurse cannot get into it to chart vital signs or medications are you? In some of our ICU rooms, there just isn't enough room for a visitor after we get all the machines they require -- ECMO, a Thoratec, dialysis machine, RO, and a perfusionist in his lounge chair next to the ECMO. Sometimes we have to tell visitors they cannot stay. As for someone who drove an hour to visit -- usually there are other family members present somewhere in the ICU they can visit with. Yes, you feel bad about it, but patient care comes first.[/quote']

There have only been a few instances where I thought patient care was compromised based on visitors. Most patients are not on ECMO etc, prob in this case it's not safe to visit for more then a few minutes. In most cases, there is plenty of room in the icu. Obviously I have enough nursing judgement to decide if patient care is compromised, and would not let guilt or obligation get in the way. In most cases, I really don't think patient care is compromised. Visitors who drove an hour shouldn't have to sit on the waiting room for 5 hours. But I will follow icu policy, most places I've worked aren't that strict.

[Erikadawn RN]

Theres no policy at my hospital besides, putting on and taking off. So I just base it on how annoying the family is, on if I put them out. Generally, the floor nurses don't know the policy and they know us, the dialysis nurses. So they will back us on whatever we say. I one had family members keep touching the tubes n lines and moving them during my tx. So they had to go!

[westieluv]

I've had to ask a couple of family members to please wait outside of the ICU when they began making ignorant comments about dialysis that were distressing to the patient. "Eww...all his blood is in those tubes!", or, "Oh, that's so sad that you have to be on dialysis, Grandma. I knew someone who had to have dialysis and it was really awful...", or, "Eww...what's that thing sticking out of his chest?" I mean, many of the ICU patients who receive HD are new acutes and are already very upset about the prospect of having to have HD, what with the stigma that is attached to it and all, without their family members coming in and making it worse when they don't even know what they're talking about. I never feel guilty asking people like that to leave, and I try to educate them a bit along the way.