dialysisalice

We run our pump speeds base on the Venous and arterial pressures. Try not to go above 240 mmHg for venous or -240 for arterial, that is when the RBC destruction begins. We run our pump speeds up to 500, if the pressures allow and the patient doesn't c/o pain. Catheters can only run about 350 though due to recirc.

"You da Nurse"!! Great job, crit lines work great in this situation too, if you have them.

Hi, first of all "Ouch", we had a late 20's patient who was pregnant with TWINS, newly diagnosed ESRD and Hypertensive. We were doing daily CCPD and Hemo 3 times per week on this patient to keep her creat below 3 (very ambitious). We are a small hospital based clinic in Montana and were working VERY hard to ship her to Seattle for better neonatal care and renal care. Unfortunately, pregnancy in an established dialysis patient only has about a 30% success rate, our patient had a less than 10% chance of success. Realistically, and callously, the non-compliant pregnant dialysis patient doesn't stand a chance, and if she did carry the baby to close to term (will probably not carry anywhere near term), how healthy will the baby be and how good of a mother will she be? I have suffered 5 miscarriages and they are heart breaking. My suggestion is "Hope for the best and prepare for the worst" and develop a multi-disciplinary approach that includes her OB and Pediatric docs along with the dialysis MSW, Nephrologist, dietitian and nursing. May the force be with you!

Ditto on the "Love, love, love" them. We had Cobes prior the the Phoenix, which were fine but I feel it is like going from a "Yugo" to a "Cadillac". The Phoenix has some very nice features.

Hang in there Rosie nurse, I have been a dialysis RN for 9 yrs and a RN for 18. Don't beat yourself up too badly about the infiltration, that happens, I use humor and after apologizing to the patient profusely, offer to sign the bruise from the infiltrate. A suggestion to help the patients feel more comfortable with you is to just "be there" talk to them during the treatment, if you can (and this helps out with the workload issue) tear down the machine and set up for the next patient, making sure you visit with the patient while you do this. I think it helps the patient feel more comfortable if he/she sees that you are proficient at the many dialysis tasks. Approach another caregiver and ask him/her to pave the way for you, have him/her go up to the patient and say "Let Rosie put you on today okay, now Rosie Joe's graft is arterial thumb and you need to go in at this angle and watch out for this area..." If you don't like that person hovering while you put in the needles tell them they can go about their business and you will call them if you need them. Hope this helps... hang in there, we need all the dialysis nurses we can get!!

My personal favorite was written by a very prudish LPN that read "Oral peri-care given" I asked her if the patient enjoyed it and then suggested using a comma next time she documented hygiene.