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Dialysis (acute & chronic)
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Tish88 specializes in Dialysis (acute & chronic).

Tish88's Latest Activity

  1. Is there any update on this program for the CE requirement on child abuse?
  2. Tish88

    Dialysis At Sea--hard to get a spot as an RN?

    I know when I cruised with Dialysis at Sea, I would sign up about 9 months ahead. They will send you a calendar of all the cruises for 2013. I would pick in January for an October cruise and June for a February/March date.
  3. Tish88

    Ideas to help my pt

    What is his starting BP? To me, it sounds like his dry weight needs to be adjusted. When was the last time it was adjusted. If he does have a cardiac history, 4kg sounds like a lot for him. There are so many variables it could be and is hard to tell without a full history of the patient and about his treatments.
  4. There are a few questions I would ask first before answering. 1. Is the catheter infected prior to the exchange? Is there a tunnel track infection present and/or positive blood cultures? 2. Are you exchanging over a wire? 3. How is the radiologist placing a catheter if he does not touch the original catheter? If there is a tunnel infection present, you will need to change the tunnel and not go over a wire. It will be like a newly placed catheter. You don't want to place a new line into an area that already has an infection. Secondly, if the patient has positive blood cultures, you should have the patient receive dialysis then pull the catheter. Give the patient at least 48 hours on antibiotics and be catheter free. If this is impossible, place a temporary femoral line during that time and then on the 3rd day place a tunneled catheter. This is what we do if there is no signs of infection and will be exchanging over a wire. 1. The catheter dressing is removed and the skin and catheter are cleaned with adhesive remover and all adhesive is removed. 2. The heparin is removed. 3. The patient is then taken to the procedure room. 4. The scrub tech puts on sterile gloves. The entire skin, neck, chest area and the catheter itself is chlora-prepped. The caps are then removed. The hubs are then chlora-prepped, since you will be putting a guidewire down one of your lumens. We use a minimum of 2 chlora-prep scrubs and more if needed. 5. Once this area is prepped, a sterile towel is laid on the patient's chest and the catheter lays on this. Then the patient is covered with a sterile drap and we are ready to do the exchange. 6. Both the doctor and scrub nurse don 2 sets of sterile gloves. Once the wire is in position and the old catheter is removed, the one set of gloves are removed (the dirty ones that touch the old catheter). Now you still have clean sterile gloves on. The wire is then cleaned with betadine. Now you can place the new catheter over the wire. I hope this helps. By using this technique, our outcomes are infection free!
  5. Tish88

    Pediatric Dialysis

    I am not a PEDS dialysis nurse, but I know the children's hospital in our area uses the Fresenius K machines. I have used the Phoenix and the K's and I HATE the phoenix machines!!!!
  6. Tish88

    Davita vs Fresenius RN - big question

    I agree with the previous poster. Definitely find out how your time will be divided.
  7. Dialysis catheters are packed with a higher dose of heparin than a normal CVC line. Heparin 1:1000units /ml up to 1:10,000units/ml is used for dialysis catheters. Normal line flushed are 1:100 units. Only dialysis staff should be accessing these catheters. These are off limits to hospital staff because this is the patients "lifeline".
  8. Tish88

    Nephrology Nursing Certification

    ANNA does not require you to have "their" CE's to sit for their exam. The majority of PCT's who take an exam do not have any CE's prior to taking the exam.
  9. The lumen of a Groshong is around 9F where as a dialysis catheter is around 13.5 - 14F. The Groshong would not support the required large volume of blood that is needed for dialysis. As for the length, they both reach into the superior vena cava and into the right atrium, so lengths are about the same. The groshong has a 2 way valve on the catheter tip that prevents backflow into the catheter, this valve would impede the needed flow for dialysis. As for not needing to flush the catheters, the dialysis catheter can use Tego Caps that when flushed with normal saline, provides a positive pressure at the tip to prevent backflow and no heparin dwell is needed.
  10. Are you out on FMLA? If so read up on FMLA regulations. U.S. Department of Labor - Wage and Hour Division (WHD) - The Family and Medical Leave Act This is from the website about returning to your job: Job Restoration Upon return from FMLA leave, an employee must be restored to his or her original job, or to an "equivalent" job, which means virtually identical to the original job in terms of pay, benefits, and other employment terms and conditions. I was out on FMLA for the birth of my son and my employer tried to replace me and I found out about this. They tried to move me to a different position. So I contacted a government official, who supplied me with an attorney for free to handle this matter. The attorney contacted my employer and asked them 1 question - "does her job still exist?" My employer answered "yes, but she was replaced and the attorney told them this is illegal to do under the FMLA." Within 1 hour my employer called me up to tell me that I was returning to my normal position upon my return to work. Good Luck to you.
  11. Tish88

    Acute Dialysis: Do they want you to live close by?

    I have worked for the 2 largest dialysis companies and never had to live in the city where the position was for. Since I did acutes, I was expected to travel to the hospitals were they provided dialysis treatments for. The one company would make acutes travel up to 60 miles one way from their home to cover hospital treatments. Anything more than 60 miles, they could not force you to go and would find someone that lives closer. The companies do have policies that indicate how long you have to respond to a page and be at the hospital and have the patient connected to the dialysis machine. One company gives you 2 hours and the other is 4 hours.
  12. Tish88

    Overwhelmed within 2 weeks!

    I always tell my new staff that it will take you 6 months to feel comfortable and a year before you truly understand dialysis completely. I am sure that if you need more time on orientation, that could be possible to extend your time. It can be overwhelming at times, but you will do fine!
  13. Tish88

    Water supply?

    I don't understand how using the shower could hurt "the physical plant"? Don't patients use the showers? All you are doing is running the water If the unit does not have water supply to the rooms, how do you wash your hands?
  14. Tish88

    Nephrology Nursing Certification

    Check first to see if you would even qualify to sit for the exam. There are restrictions as to how many hours you need to have worked in dialysis before you can take the exam. Since you don't do hemodialysis, I don't think you would qualify. The website you checked before has all the requirements. I personally know dialysis nurses who has been doing hemo for many many years that still can't pass the exam. I took the exam about 18 years ago and I had been in dialysis for 3 years at that time. It was not easy and I studied alot for it.
  15. Tish88

    Water supply?

    They would hook the shower hose up to the R/O machine (reverse osmosis water machine), that filters the water before it goes to the dialysis machines. I have hooked up this way in the past. I also had to run a garden hose to get water supply to a patient that was on ECMO and could not me moved. More and more hospitals are designing patient rooms with dialysis in mind and placing water supply lines in more convenient places. I can remember having to place a filled trash can on the foot pedals of sinks to get water to go to my R/O. You just had to make sure housekeeping didn't empty the trash, because the cans themselves was not heavy enough to activate the water. One fellow male nurse used to carry a brick in his backpack to place on those pedals. (That is a bit extreme for me).
  16. Acutedialysis - thanks for sharing those links