km5v6r EdD, RN

How does your facility handle training for CRRT? Who is responsible for the set up, take off and hourly balances? Do you ever change the rates? Do you have parameters? Who provides the training? Are all staff trained for CRRT? Right now what w...

I agree in an ideal world the room temp would be high enough that the pt is comfortable without additional blankets etc. Unfortunately I have to work in the room with the pt. I have to wear a full paper lab coat with long sleeves, gloves, and mask ...

Big Gulps and dialysis equals cramping. You skip your outpt dialysis appointment and then have the ER call me in at 0400 for an emergency treatment and you will have a new dry wt. All the money you just spent to get high and or drunk before dialysi...

Keep in mind that an Art line has a continuous flow of fluid INTO it from a pressure bag. A dialysis needle has to have the ability to withstand the continuous PULL of blood through the needle at a rate of 400-500 ml/min and maintain the pressure of...

CRRT is continous renal replacement therapy. It is a long slow dialysis. Pt's in renal failure, either acute or chronic, who are to unstable to tolerate hemodialysis may be started on CRRT. Instead of being done in 3-4 hours the treatment ideally ...

Do you ever give Albumen as a prime for unstable pts or pediatric pts?

You should check the package insert that comes in the box of dialyzers to see manufacturers instructions. I know that the Optiflux dialyzers insert specifies that the prime be dumped prior to HD to prevent 'fibers' from going into pt blood stream. Th...

I have seen both adult and pediatric pt's survive CRRT. Granted the ones that don't far out number the ones that do but some do survive; especailly with the adults. We currently have several peds liver/sm bowel transplant pts that have required CRR...

All of the hospitals in this area have the CNA's do the accu-checks. They report the results to the nurse who then act on the results. The hospital provides the training for the specific machine used.

Your MIL probably developed a heptaorenal syndrome pre-op and it is continueing post-op. When the kidney's are "shocked" or stressed they may quit function for a time and take a while to recover. Even though urine is present it may not be "quality"...

Check with your local American Red Cross about a class. The AHA does do initial classes also; you may have to check with some of the local schools or the local ARC office. The only difference I found between the two is that the ARC expires in 1 yr ...

Almost 90 on Tuesday and snow today. Typical. This type of weather in March though is scary. Probably means the summer will be hiddously hot and long. The CPR class was short and good. I am actually glad to take the class with all the changes b...

Good Grief!!! Makes me even happier to be where I'm at. We are slowly converting over to computer charting and things like the Braden are already on the computer. We just don't have enough computer terminals between the med students, nursing studen...

Interesting. The rational behind nasal intubation makes sense but the sinusitis would be a major deterent. We rarely have an incident of VAP. Many times our kids do have an NGT in one nares and an NJT in the other. These tubes are usually place d...

Sorry to be so slow responding. I have been bogged down working. Where would replacement solutions be running? We generally run replacement both into the arterial chamber prefilter and into the venous chamber post fluid. The theory being that th...

Sorry I can't help with the heart surgery aspect as we don't do any heart's. We do the major bowel and liver transplants. Some of our kids will be on the vent for months; one for neary a year before finally trached. Rarely will our docs nasally in...

I have done SLED with both the K machine and the older H machines with the additional CRRT chip. What kind of details are you trying to sort out? At this facility the Nephrologist orders the amount of fluid to be net UFed and the UFR set. It isn't...

I work in a transplant facility. The cardinal rule around here is NEVER hold the transplant meds. They have to be given as ordered at the times they are ordered no matter what. There is no safe IV alternative for FK506. Common sense should be th...

The local Shopko's and casino's have well secured sharps containers in the restroom's around here. I does make sense. What struck me recently is that many malls and stores have "family" style restroom facilities but the large teaching hospital with...

My daughter is expecting her first child next month. EDC is March 25 or there abouts. Dates aren't terribly accurate because she was switching between the pill and Depo Provera for birth control. She called yesterday and said the military docs are "p...

Would your daughter allow you to go to an appointment with her to discuss the risks/benefits of this induction? My daughter and son-in-law live over 4 hours away and I still work full time. I may see if one of her appointments can be scheduled on my...

Then when one of them asked her to check for a radial pulse, she blanked out and said, "what's a pulse?". Poor thing, she made it through school fine though:chuckle . I worked with a nurse once who was also a minister's wife. Very nice person, rare...

I was working in CCU and it was our turn to have the code pager. We had just finished report when it went off for the PCU and I took off. Arrived in PCU to find both shifts still giving report asking "Where's the code?" They knew the call was for ...

All the companies I have worked for required "peeing" the lines before hooking up the pt. Even those with a dry pack dialyzer. "Peeing" the line consisted of dumping about 500 ml of saline through the lines immediately before hooking the pt up. We...

In the acute unit we would dump the prime on someone in massive pul edema that we were dialyzing to keep off the vent. If the pt was frothing that extra 250 ml of fluid could be to much. We would also sometimes dump the prime if we were resetting u...