Zeek

We have had patients with a peritoneal dialysis catheter that can be drained as well. They don't necessarily have to be on dialysis to have this type of catheter as a long term access. It is double cuffed - one cuff under the skin and one further down the catheter to prevent infection entering the peritoneum. That way there is no poking them for access when they need to be drained. It is true that they tend to fill right back up, but with a catheter you can also instill antibiotics directly into the peritoneum to fight an infection.

I had a "devastating" fracture of my femur almost 2 years ago. Then had the screw at the base of the rod break when I started walking on it which shortened my leg by 2 cm. I am in pain every day as well. I really can't do much of anything including walking at this point and it is very frustrating. I am fortunate that I have wonderful friends who have supported me through all this. I do meditation, relaxation exercises, have an awesome Chiropractor who does NUCCA therapy and am working with an MD at a pain clinic to address my issues. The one thing that keeps me moving is that I ride horses and I cannot sit in the saddle at all due to pain. I keep looking and finding medical professionals to help me so I can get back to riding. I feel like you need an answer to why you are having this pain. Try to see a Physiatrist if you can find one. They are physical medicine MD's who will look for and help you with this pain. I have chronic back pain after 3 surgeries as well. The Physiatrist I had years ago was a huge help for me. Best of luck to you!

Although I have limited experience with CRRT, part of the anticoag issue is whatever the MD is comfortable with. We tend to use more citrate, but it needs to be reversed before the blood goes back to the patient which requires additional pumps, meds and lab draws. We have an MD who is more comfortable with heparin solely because it does not have to be reversed. But he uses citrate now as they have a protocol in the ICU for it with CRRT and he has gotten comfortable with the protocol.

You can go to the ANNA (American Nephrology Nurses Assoc.) website to find information about hemodialysis. I am not aware of anything that DaVita has for CE credits, but I know that Fresenius does offer courses as well. I work for DCI and you will receive your initial education as a dialysis nurse from an educator and your preceptor. They will teach you the basics of dialysis - toxin removal, fluid removal, electrolyte shifts etc. You should learn how the machine works and how to put the blood lines on, prime and hook up a patient, return blood and disconnect all during your initial education. There really is a lot to learn and you can take this as far as you want! Good luck to you.

I am in the dialysis field and we look at primarily secondary HPT. PTH secretion is tied to serum calcium levels but magnesium can exert a similar effect. Low levels (hypomagnesemia) can cause an increase in PTH secretion leading to low calcium levels especially in our population because their kidneys don't convert Vitamin D2 to D3 which is the active form (simplified version!) and they cannot absorb CA from the gut.. If a patient has an extremely low magnesium level PTH secretion slows and the patient can become even more hypocalcemic. So for someone with severely low magnesium levels, the pt. would most likely have a normal to low level of PTH secretion. With just low levels, the PTH rises. For secondary HPT, it is calcium and phosphorus that are the major drivers of increased PTH levels. If phosphorus is too high, the parathyroids increase production to bring calcium levels in line with phosphorus. The body looks for calcium in the easiest place to find it - the bones. Thus, our patients can have osteopenia and risk calciphylaxis if uncontrolled.

When I started in dialysis in 1985 we wore street clothes and did not use gloves. We held bleeding needle sites with just gauze and frequently had blood on our hands. Even when using a face shield, I have been splashed up under it by a wayward fistula needle - Hep C patient to boot. Never thought a thing about it. Now gloves rip many times putting them on and sometimes have obvious holes or even fingers missing. We've had some fun with that!!

I have heard that the blood flow only goes to 250 or 300 which is not high enough for conventional dialysis. I guess it would be OK in a hospital setting or maybe a daily home unit though.

Others that have posted here are correct about the venous pressure staying the same or similar. Here is why: TMP (Transmembrane Pressure) is calculated by using the current venous pressure and the dialysate pressure (which, if pulling fluid should always be less than the venous pressure). This creates the hydraulic pressure difference to remove fluid. When your dialyzer (filter) is clotting, the resistance of the blood moving through the tubing into the venous drip chamber doesn't change. The pressure in the DIALYZER changes which affects TMP. If your venous pressure changes then look at the drip chamber and line as others have noted. Note that your dialysate pressure will fluctuate based on current UF rate. If you use a profile (start high, end lower, etc.) watch the TMP throughout the run. It should decrease as well. If you have a negative TMP, verify your venous pressure is correct for that patient (no clotting, transducers OK, Pods OK on the Streamline tubing etc). At least on the machines I have used, TMP is never negative without clotting, BUT I have not used all the machines out there. All of the same things above will apply. Also remember that TMP is what helps us remove fluid. It only affects solutes (waste) with convection or solute drag which enhances the dialysis process. Chisca RN above is correct if she means that by the clotting in the dialyzer we are removing fewer solutes. Mostly the solutes are removed through diffusion. Sorry for the long post, but TMP is something people don't teach enough about in my opinion!!

The last time I lost it with a Nurse Manager was when she insisted I was the one responsible for all the infections in our unit. She was yelling at me and had her finger in my face at which time I told her politely to remove the finger or it would be broken. This was after dealing with her tantrums for over 7 years and I swore that I would no longer Kowtow to her. I also told her I would no longer deal with her yelling at me and if she spoke to me as a professional I would be happy to have a conversation. I left her standing in the breakroom and went home - feeling good about myself for standing up to her. I never let her yell at me again and she left for another position shortly after.

I know that they have in the past used a lot of travel people, so you may be able to find a job in that market. I wish you luck over there!!

I live in Montana and have horses. They are my sanity! I can trailer 15 - 30 minutes from my house and be lost in the woods for a day! The only thing that relaxes me and makes me feel free of life's encumbrances...

I have found you will either love it or hate it. I love it because you get to know your patients and can pick up on subtle clues that you may not be able to see on the floor. I use all my assessment skills and then some for these patients. I've been in the industry for 35 years! Be aware that it does take some technical expertise which you will learn on the job. The machines alarm and you need to know what to do. Some nurses don't like setting up machines because there is so much tubing. But get yourself a system and do it the same way each time and that will make it easier. Best to start in-center and then go to inpatient if that is where you want to be. You learn so much dealing with a group of patients at one time rather than 1:1 that you do sometimes in acute dialysis. It is always hard to find dialysis staff as it is so specialized so I would say go for it!! Keep us posted on how you are doing.

Welcome to the family! But seriously - this company is really great to work for. I have worked in independent out patient hemo; for profit centers and hospital based units and have really been able to see a difference. I love that DCI puts profits back into the company in the form of transplant resources and research for kidney disease. During Covid we have had weekly updates and Webex meetings with the heads of the company. When I have issues with patients they are there to help address them. I truly hope you are happy in dialysis. I have found that I use all my assessment skills and I have appreciated the technical aspects of it as well. Good Luck!!

At most units the patients are given an ESA (Erythropoesis Stimulating Agent) which helps them to build red blood cells as their kidney no longer produces erythropoetin; IV iron products to help them make the red cells; the activated form of Vitamin D called Calcitriol (there are other trade names for this, but again, with damaged kidneys the body can't convert D2 to D3) and some Calcimimetics which help with PTH levels and Ca lcium balance. We do give antibiotics for infections and use heparin and lidocaine for treatments as well. Some units have meds for high BP like Clonadine or for low BP like Midodrine; nausea meds, benadryl, tylenol etc. Most of the meds are oral except for the ESA and iron. We give some of these meds in center because they are tied to the bundle of services which is how we get paid to do a treatment. I think many people think of dialysis nursing as an assembly line - put them on- take them off. There is so much more to it! You use all your assessment skills and can head bad outcomes off at the pass - I have caught DVT's in a patient who just returned from the hospital and one nurse at our unit caught a pericardial friction rub from pericarditis! It is technical on one side and in our unit nurses do everything a tech can do so we all work together as a team. A good basic book is "Review of Hemodialysis for Nurses and Dialysis Personnel" by Judith Kallenbach. It is a very basic book that you can find on Amazon. I would encourage you to try it. Not everyone likes it, but it can be a fun and rewarding job!

And you forgot to add One upper Opal - the nurse that has had whatever you or her patients have, but so much worse! This thread is awesome!!

I have an awesome Chiropractor who I have worked with for 7 years now. I have had 3 prior back surgeries from lifting and general life. Those helped with the acute pain, but not the chronic pain I have endured since then. 2 different people told me about this practitioner and how wonderful he was, so I thought - why not? The first day he worked on me I had no more leg pain!! That was huge for me. He practices NUCCA therapy which only works on the atlas and axis. I don't really understand how this works, but I am back riding my horse after years out of the saddle and doing other things I love. The initial phase was intense (2 times/wk), but I go only about every 6 weeks to 3 months to maintain. No claiming to heal the sick or raise the dead!

Most places of employment have a policy that covers you as long as you work in that facility. If you choose to leave for any reason or get fired, you no longer work there and the hospital no longer insures you. What if, the following year, someone decides that Aunt Jane was harmed by "a nurse" while she was there and you get selected to be the fall guy. You no longer have insurance, have to hire an attorney out of pocket and try to defend yourself. That is the reason you should always have your own policy. I heard a great presentation by an RN who was a part of a lawsuit. She was eventually dismissed from the suit, but the hospital lawyer was all about the hospital not having to pay - not so much FOR the nurses and technicians he should have been protecting as well. When you have your own insurance, you have your attorney who is there to help YOU - not the hospital/clinic, etc. get out from under this lawsuit. Another reason to have your own policy. I have been in nursing for over 40 years and always carried insurance - for my piece of mind. It is not expensive either so that is another plus.

Most companies have a "claims made" policy that only covers you if you still work for the company. Should you change jobs, you are no longer covered, but can still be sued. Check and see what type of malpractice insurance they carry. I always have carried my own insurance because their lawyers look out for the company not you. I would advise you to get your own insurance.

Your manager is trying to bully you into staying per HER guidelines. You have done nothing wrong. I have worked with people like that as well and was at my wits end before they left. Things are better now. I agree with kp2016 to look into the guidelines for transfers or notices and make sure you need to stay a month. CONGRATS on getting the new position. I love acute dialysis - you will learn so much! I traveled for a bit doing acutes and got to do so many amazing things. Now I am an educator and feel like I can really speak to many of the tasks that acute nurses do (plasma, CRRT etc ) because I have already done them.

I have worked for 2 non-profit stand alone clinics and then Fresenius and now DCI. I have also travelled and worked with Fresenius as well. I have not worked for Davita at all. I do really like DCI the best. The company's founder is still around, but his son really does much of the day to day running of the company. I like that I can walk up to Dr. Doug Johnson (VP of the board) at the annual meeting and talk to him about experiences in my unit. I like that they don't expect you to count every bandaid and test strip in the building. I really like the fact that they are truly patient centered and that "the care of the patient is our reason for existence". We have had calls every week with Doug and his team to help and guide us through this Covid-19 mess. I feel like the company actually listens to the people who are on the front lines. Don't get me wrong, life is not all roses here either. We still have to follow the same CMS guidelines and reimbursement isn't any better for us than the other clincs I don't think. But I like the philosophy of the company and respect the founders.

The machines haven't changed that much in my opinion. I think you will be fine. You are right, your skills will need to be fine tuned, but you will start remembering once you start working. If they are kind to you, they'll give you a preceptor for a month or so to make sure you are doing OK before throwing you to the wolves. I would much rather have someone who has done dialysis in the past rather than trying to train a brand new nurse to do in-patient dialysis. Good Luck!

I have been in the field of dialysis for 35 years so I did not do a practice test. From my perspective, the NNCC does not care about where you get your CEU's from as long as they meet the guidelines and are from an accredited organization. My current employer has a meeting every year that we receive CE's for which I submit to NNCC for credit. They are approved by the California Board of Registered Nursing and have a provider number. I would go ahead and get that certification!!

We have a counter off the main floor that we set our drinks on. You don't say, but I am assuming that this is outpatient hemodialysis. I would talk with your manager and see if there is somewhere you can leave a drink that won't make you be off the floor for too long each time you need a drink. Your history of UTI's should encourage them to help you in some way.

I would like to add that being a dialysis nurse is stressful as well. You may be in charge of 12 patients and the technicians that do the actual care. It seems that some people have the idea is that you just put them on and take them off and it's no big deal. Except it is. Just like you are seeing more critical patients on your floor (and I agree that 10 - 12 is too many), we are seeing sicker patients released from the hospital to dialysis and it seems like we are an outpatient hospital ward LOL! I don't want to dissuade anyone from trying dialysis - I love it and have stayed for 35 years in this field. But just be aware that other types of nursing are stressful too but in a different way. I wish you the best of luck in whatever you decide. By the way - it is not true that you cannot get a job in the hospital after being a dialysis nurse. We have had 3 new grads start here and then transition to the hospital for acute care. You have to be able to sell yourself!!

Beachbabe86 - I am currently in Montana. Have practiced in Washington state, done some travel nursing in Indiana, N. Carolina and Kentucky then came back and settled here. I really love it! And I have been doing this a few years so I guess that qualifies me as a pro!! Thanks!!