ch10

I never left! Always worked in renal. Been in renal since 1978! Thanks for asking. ch10

Do you use volumetric machine? You need a certain amount of UF just to take washback. Also blood is more concentrated than dialysate so your patient could end up heavier post dialysis. ch10

Hi, There are acute cases that do recover their kidney functions. There are of course various tests done to ascertain their kidney function. GFR, bx, etc. Sometimes severe hypotension due to other co-morbid condition can precipitate acute kidney disease. ch10

What venous pressure do you get using 17g at that pump speed? Do you use rope ladder technique in cannulation? ch10

Acute treatment prescriptions are different to chronic. Chronic: Our staff ratio is 1:4 in the chronic area. They are dialised at lower temperature, OCM and BVM are often used, Na+ at 135-136, all used high flux dialyser, all are treated free including drugs and EPO. We do not re-use kidneys. QB at 300-350, QD at 800, Kt/V is aimed at 1.4 (single pool) 1.2 (double pool) and 1.5 for diabetics. Acute: Smaller dialyser, QB 200-220, QD 500, Temp is higher at 36-37, Na+137-140, bloods are always reviewed every dialysis and HDX prescription change, coagulation is also reviewed (?minimal heparin), fluid assessed every dialysis. Most patients are filtered in ICU/ITU and transferred to HDX when stable. CVVHD/CRRT is also used. Kt/V is aimed at 1.7 ch10

Issues: Check "bruit" post op Ensure dressing is firm but not tight Check every 30mins first 24 hours Avf arm must be elevated to stop swelling Check for increasing haematoma, hand temperature and hand sensation and colour Check for any signs of infection Stop asprin if on it or any anti-platelet drug Minimal heparin or stop for 2 hdx sessions then review. Saline flushes if no heparin use (ensure fluid assessment is correct you dont want to overload patient) Check HB Vascath could either be temporary or permanent. Tessio lines are permanent lines and in some units are not use very often. Always be careful with infection when using lines. Exit sites must be monitored for any redness and signs of infection. Cap off as with your unit's protocol.

Haemodialysis is a good specialty. I am a Senior Nurse in Haemodialysis in the UK. Part of my work is involved in patients transfers from the main unit to our satellite units. We have over 500 patients within the TRUST and still expanding. Also part of my brief is to ensure that access patency is monitored, dialysis adequacy is maintained, fluid assessment, referrals from various areas/pre dialysis clinics and acute sectors ie.failing transplant/CAPD and other "crash landers" within various hospitals. We are also involved in plasma exchange, CVVHD, CRRT etc. So within haemodialysis there are various areas covered so it is not boring. Hard work though but equally satisfying. ch10

Yes it is a grey area. However, if the DNR was made whilst the patient was an inpatient then it needs to be reviewed weekly by their consultant. Changes could happen and the patients condition might have improved. If for example there is a directive that the he/she dont want to be resusitated because of other co-morbid conditions then it must be upheld. If there are no other co-morbid conditions surely when he/she is discharged, DNR is no longer viable. I would have thought that DNR ruling is reviewed at all times unless indicated otherwise. ch10