ValWai

One more reason to stay healthy.

How about completely blocked catheter? Sometime the clotting is so bad that nothing can go in or out. It's impossible to instill anti-coagulant into the catheter without dislodging the clot. I used to draw the catheter until it collapses with a 20 syringe. Then I clamp the catheter when it's flat and fill the catheter with diluted heparin when I release the clamp. Though I know that heparin prevents clot formation instead of dissolving them. But it works and it will not dislodge the clot into patient's cirulation. The only thing that worries me is whether the suction I exert will damage the vessel wall. Do you think it's safe?

Why nurses? Do we impress them that we kill everyday just because we face death everyday. Or do they think that we have no emotions towards people's death, or we are supermen and women who can do what ever is left undone. It's nothing to do with whether you are pros or cons against death penalty, or anything to do with who is capable of doing it. We are there to take care of the sick and promote public health. It's back to the history again when nurses were paid to handle dead bodies. It's is disgusting and insulting.

It was >10 years ago when I was working in an acute medical ward. It was government hospital. There was 50 beds but accomodating 50->100 patients. Thanks to the magical canvas beds. There were more than 20 admissions every shift. Tons of work for the newly admitted and endless daily routine for the rest. Things that were beyond any one's imagination happened there. It's fun but busy and stressful. I decided to leave and signed up for whatever courses available. This is the etiology. I was not one of the favourite prodigy in the center. But the charge nurse taught me a lot through scolding of course. I learned bit by bit from the tank to the drain, screw-driver and hammer and..... . I like the job very much. The patient-nurse relationship is much closer here in dialysis center. We know their husbands, wives, children, their jobs and their problems well. Most of us become friends. Code blue is not common amongst chronic patients. They are usually sent to hospitals if we sensed any problem. But things just happen. Nurses are given much autonomy to decide what to do when the physian is not available. So staff with ICU experience will handled the situation more efficiently and confidently. In fact many renal nurses are formerly ICU nurses.

What we do is exactly what you are doing in your hospital. But there is always conflicts between ICU staff and dialysis nurses when it comes to this question. Some nurses will be very happy to take up the responsibility while some nurses don't. We all know that it is impossible for us to stay in ICU and monitor the patient and the machine round the clock. ICU staff has to do it. A clear hospital policies on who does what will help to prevent conflicts.