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pacu, home health, hemodialysis
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dialyzern specializes in pacu, home health, hemodialysis.

dialyzern's Latest Activity

  1. dialyzern

    epo managers

    I am a clinic manager in a 24 station Fresenius clinic with 125 pts. My anemia manager needs 2 separate days approx. 5 hours to review the labs, make the monthly changes allowed by our physician generated protocol, update the computer and write the orders. We created an order with blanks that can be filled in with the dose change and date, but have the standard order with icd-9 code, Mds name/nurses name. We arranged this in multiples like address labels that can be printed onto peel 'n stick labels. She writes the changes, peels and sticks it onto the order sheet and signs it off. It helps decrease the writer's cramp. Hope this helps. :typing
  2. dialyzern

    cannulation advice

    Develop the art of listening. Get a stethoscope before you stick and listen to the sound of the blood flowing through the graft. I listen across the access from left to right to hear the strongest sound of the bruit. You do not have to see it or feel it to be able to cannulate it. Femoral grafts tend to have higher pressures. Grafts can be so deep that the angle of insertion may need to be increased, so you feel the needle's hub is standing straight up coming from the graft. That's ok, as long as you have a good flow. I use a "pillow" 2x2's (folded x 4) to prop the hub so it is more stable before taping across and then butterfly per your unit's policy. Diablo's point of tightening the end cap before you cannulate is invaluable, it is a second nature thing I do now without even realizing. Sadly, nurses tend to have less cannulation skill and expertise than techs, as they are doing the many catheters and other duties during changeover when you need someone. Sometimes, backing up a hair and reangling the bevel inside the graft by moving the hub that you are holding is the trick. It takes time and practice to develop this skill. Patience is the key. Take a deep breath and don't give up. You're spunky....you can do it!
  3. dialyzern

    What helped you learn HD?

    I agree with all of the above. I would also say to remember that even though it is a great challenge to learn the machine and procedures, never forget that you are still nursing a patient. After 6 months the machine will be second nature. There will be trying times with machine problems, turnovers, bleeding patients to name a few. Stop and take a deep breath and remember that you will get through it. Also, try to be on the scene when problems occur to watch how situations are handled. There are many things that can happen during dialysis that you can read about or review in training the will make more sense when you see it happening. Speed is not a consideration in the beginning as I was the slowest to catch on in my orientation class but I made it! Understanding and accuracy are what carry you through. I love dialysis and have spent 20 of my 28 years of nursing in this challenging and rewarding area. Best of luck and keep us posted on your progress. :redpinkhe