Dialysis RN1

According to V-tag 686 and 687 if LPN's are allowed to function as a charge nurse in your state then "technically" they can do this. It just does not sound like a great plan that puts the patient first. What if you didn't show up, would they have to close the clinic? As for your trailing comment about Epogen being given even though the patients blood pressure was elevated; this is a correct action as it is given to maintain Hgb/Hct at a safe level over time and does not have an acute action that is contraindicated in this situation. It is hard being a new employee raising questions about the inner workings of the facility, you may want to request to talk with the area director since the FA is not available, after all the LPN is working under your supervision and your license.

In my opinion the Systolic is probably the most important as that is the pressure in the vasculature while your heart is contracting. the diastolic is when the heart is at rest (laymens terminology) If the Systolic is elevated the posibility for stroke exists and uncotroled reaks havoc on the kidneys. Of course the diastolic is very important as well but neither are indicators for the need to start dialysis. Other labs will indicate the need to start dialysis.

oooo, 15 degree canulation??? It is more typical to do the 45 -90 degree as rnbob mentioned. a 15-30 degree canulation is more designed for an IV insertions. usually fistulas and grafts are just a bit deeper and a clean introduction of a large bore needle will give longjevity to the access. canulating at 15 degrees can sheer and also not alow you to get fully into the access.

are you currently with a for profit company? If so I wouldn't expect many changes. if you are a non profit the staffing situation may change depending on how your set up is already. really anything anyone would answer here would just be shots in the dark and guesses because any take over is different based on the needs of the particular clinic.

First off welcome to the world of dialysis. as you continue to learn and grow in your new position I am sure you will find it rewarding and satisfying. This will only come when you ask questions such as these for if you don't know the basics it can be frustrating and dawnting so good for you for reaching out. and remember the only stupid question is an unasked question. So here goes.... 1. as for tourniquet use on a graft: first and foremost follow your unit policy. grafts are already large bored and placing a tourniquet wont tend to inflate them any more than they already are. Also they are not very elastic such as a fistula and any increase in pressure can actually cause a tear at the anastomosis. 2. Changing Na concentration does help with blood pressure but we tend to use Na to assist with shifting of fluids from the tissue to the vascular space. the draw back to the use of Na is that it will cause a patient to become thirsty and they will tend to drink much more fluid especially immediatly post dialysis treatment. I have used a hypertonic Na (23.4%) in 10ml doses to increase the movement of fluid from tissue to vasculature and have seen it very effective. the reason of course for the increase in B/P is due in part to the fact that the vascular volume is increased. 3. Yes dialysate temperature does a great deal for a blood pressure and for the reasons you listed above. 4. Trans Membrane Pressure (TMP) is effected by clotting, viscosity of blood traveling thru the membrane and the effort applied to removing fluid. If you have to remove 6Liters of fluid from a person who is hemoconcentrated meaning vascularly dry your TMP is going to move more towards 0 or even postive. remember you want a negative TMP. if you have to remove 6 liters from a patient who has the fluid to give up then the TMP shouldn't be to affected. Now if you have to remove 6 liters from a patient that has 4 liters to give up then you will notice towards the end of your run that the TMP starts to rise. and if you are using a dialyzer for the 25th time and it is only passing with a 92% you can assume that 8% of the fibers are clotted before you even get started so more blood has to travel thru less fibers and more fluid has to be removed at a higer rate at the dialyzer level causing a hemoconcentration at the dialyzer level thus an increased TMP. If your patient is septic..... well thats a whole nother conversation. as for a malfunctioning sensor... you should NOT use equipment that has a malfunction period. I hope this answers some of your questions and that you have a long and fruitfull employment in the dialysis world. God Bless

you have to take a certification examination. You should apply anyways and get your foot in the door even though the ad says the prefer certified nurses. It isnt an easy test to just go and take if you have no background in nephrology nursing. When you get an interview just let them know that you are very interested in a longterm career in the field and that you would be more than willing to become certified after obtaining some experience. Good Luck

I find it interesting that they havent told you or offered support in the matter. I would think that a more reliable sorce for that information would be your HR department or administrator.

Well it doesn't really matter which you do first.... You feel the thrill meaning when you palpate over the area of the fistula or graft where there should be a palpable buzzing sensation. If decreased or more pulsating than buzzing then there may be a problem. Take into considertion the depth of tissue you are having to feel thru the buzzing may be somewhat muted on a heavy person. The bruit is as described above something that you listen for. A nice wooshing sound is healthy, a high pitched squeal or a barking would be indicitive of a stenosis and may require intervention such as ballooning or revision. The importance of your assessment is that it be done before the dialysis nurse comes along so you can identify any problem and have it solved or in the works of being solved so the patient is able to receive treatment in a timely fashion.

Wow, we cover 8 hospitals. The nurses are scheduled 4 days a week and start at 7AM. the day ends when the day ends, there is no predicting when a patient is going to need our services. The hours we put in run very similar to NatKat above. if its dead we go home if its slammed we stay late. call is scheduled 1-2 days a week with an every 8 week weekend call rotation. out of the 8 campuses we have two hospitals that have a unit. one is a 4 bed unit the other is a six station unit everything else is done bedside. we have 12 full time RN's 3 Full time and 1 part time tech and do about 350 treatments a month. It works well for us but to be an acute dialysis nurse is unlike many nursing positions. the hours can be long, there is a great deal of autonomy and the satisfaction of the position is one of the most gratifying that I know. It certainly is not for everyone and I would suggest that if it isn't working for you that you get out before you burn out. Acute dialysis nurses take care of the sickest of the sick and you always need your A game.

Harrison, I am a die hard DCI employee. As long as they will have me I will continue to give them my best. I have not worked at a DaVita but I am sure there are some great Davitas as well as not so great programs but I think the same can be true about DCI. DCI has a great mission and I really like the fact that it is nonprofit so more money is freed up to be injected into research and not pushed into the pockets of hire ups. As for atmosphere, training and the likes..... I know that the atmosphere here where I am is fun loving, professional and patient first in attitude. Training is a 12 week program and has evolved over the years into a very structured and organized program. As for cost cutting, I am sure especially now with the new bundling package that cost cutting will be around for a long time no matter if you are in a for profit or nonprofit organization. Just because one says they are non profit doesn't mean that they are for no profit. It is important to turn a profit in order to stay in business. The things that are done with the profit are what make that difference. Reuse vs. non-reuse: we currently are a non-reuse program but it is up to the clinic as to whether they are reuse or non. With reuse there are guidelines that indicate if the dialyzer can be used again and how many times it can be used so it is not surprising to me to hear you say that as long as they pass test that the dialyzer can be used. The test indicates how much percent of the dialyzer fibers are open and will continue to function. The last time I used reuse we were able to use the dialyzer up to 99 times if it passed test but they rarely got that many passes usually more like 25-50 times kind of like what you are saying. So I guess in short DCI is a great company to work for. They have probably the best benefits package that I have ever had the opportunity to receive from an employer. There are good McDonalds and bad McDonalds out there just as is true about any other business including DCI. If you have a desire to be back in dialysis I would say at least give DCI a chance Dr Johnson who founded the company still lives today and is an active part of the direction in which the company is steered. Good luck with your relocation.

There was a great article that was published in the Nephrology Nursing Journal September-October 2005-Vol.32, No.4. Titled: “Should Patients Eat During Hemodialysis Treatments?” by Katina Kinnel. You can do a Google search on the title and find the article. We too have a no eating policy and I have used this article to back my position on multiple occasions.

I am in my 9th year with DCI and think that they are a great company. I think the pay scale is regional and in my area it is exceptional and very competitive. The health benefit has come a long way and is now the best I know of around. The retirement is awesome and like none I have ever seen. The company is not for profit and really puts back into the community for research. The founder, Dr Johnson, is all about the patient and their needs it is really nice to see and feel the care and dedication to patient care rather than how we can cut corners all the time in order to pad a pocket. I would highly suggest DCI as an employer. Good Luck

Put in your application Training will be provided. and remember, confidence comes with experience. good luck

Great points. In our hospitals I have helped them formulate policy on accessing the cathater so it is in line with how we provide care. we review it anually and certainly it is not accessed without the order of a Nephrologist and as a last resort.

Im from the acute side of life, but we have one 4 bed unit and 7 hospitals. we mostly do bedside treatments