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  1. Chisca

    Tube feeding and hemodialysis

    Thank you to KeepinitrealCCRN and MunoRN for voting, for the rest of the 311 slugs who viewed this question and didn't respond, why not?
  2. Chisca

    Tube feeding and hemodialysis

    Not specified in the standard orderset.
  3. Chisca

    Tube feeding and hemodialysis

    Postprandial hypotension is a drop in blood pressure after eating a meal. Stomach distension is the trigger as the body shunts blood to digest the food based on this signal. No distension and there isn't a signal. Bolus feeding would trigger the response but trickle feeding does not. If you do hold the feeds during dialysis the risk is a dramatic drop in blood sugar as you are depriving the patient of glucose as the dialysis machine is removing glucose. The glucose molecule is slightly bigger than a water molecule and during a 3-4 hour treatment I have seen sugars fall up to 200 points. If your patient has any liver issues and can't convert fat to glucose the fall in serum glucose levels will be more rapid. European and asian countries routinely feed patients while on dialysis while the US and Canada do not.
  4. Chisca

    Tube feeding and hemodialysis

    Trying to determine what ICU nurses are doing with tube feeds when dialysis occurs. Hold feeds or keep them running?
  5. Chisca

    ‘Hemodialysis Access 101

    Nice little interactive tool designed by Dr Namrata Krishnan to teach nephrology fellows about dialysis access. Enjoy. Hemodialysis Access 101
  6. Chisca

    CRRT vs. CVVHD

    Simplest explanation? CRRT is "slow dialysis" and is for those who cannot tolerate conventional dialysis. CCRT involves slower blood flow rates, slower fluid removal, and can be either diffusion based or convection based. Diffusion will involve passing dialysate through a filter and allowing toxins to diffuse out. Water removal is determined by hydrostatic pressure. This is how conventional hemodialysis works. Convection will involve passing water across the filter which will drag toxins across he filter and out of the body. Removal rates are driven by the amount of fluid you can pass across the filter. Either therapy can set up to just remove water, just remove toxins, or remove both. Hemodynamic stability will determine which therapy will be chosen. CVVHDF What?! Renal Replacement Therapy Simplified… – Blogging For Your Noggin: Nursing Education Made Easy
  7. Chisca

    Tell me about your week in Acute dialysis.

    6 minutes. I can restring a machine and have it ready for reconnection in less than 6 minutes. Sort of like the movie Uforia where the main character describes how well he can drive an 18 wheel tractor trailer. " I can drive that rig up a goats ass, make a u-turn and come out smelling like a rose."
  8. Chisca

    Fresenius -- Granuflo-- were patients harmed?

    And yet we still want to claim it's perfectly safe to check a patient's lab just once a month. And base our clinical decisions on that snapshot in time.
  9. Chisca


    The ICU is wherever the patient is at. As others have pointed out busy ERs frequently have ICU level patients waiting on a bed so why wouldn't that experience qualify? Even my acute dialysis experience counts. Option 1: Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill patients during the previous 2 years, with 875 of those hours accrued in the most recent year preceding application. https://www.aacn.org/certification/get-certified/ccrn-frequently-asked-questions
  10. Chisca

    Tell me about your week in Acute dialysis.

    You won't require training so acutes will hire you in a heartbeat. What they won't emphasize, as Anna S pointed out, is what happens when you work all day and take call that night? My current personal record is 22 hours straight. No, I didn't volunteer for it. Call will kill you.
  11. Chisca

    Blood leak

    " If there is a blood leak alarm, WHERE on the dialysis machine do you check the dialysate with the test strip" Red hansen. Or the drain port for the machine. "Once you have tested positive for blood, what are the actions one should take?" If positive DO NOT RINSE BACK. The blood is contaminated and you will be rinsing back contaminated blood. I usually see blood leak alarms when the filter goes from being dry to being wet. If for example you set a machine up for sequential UF (ie no dialysate flow) and as you pull fluid the filter becomes wet the machine thinks there is a blood leak. It's really a change in TMP and the machine thinks the worst scenario which is a blood leak. It's a false alarm.
  12. Chisca

    D50 vial via venous fistula needle

    D50W can be safely given through venous line. Glucose is highly dialyzable as it's molecular size is 180 daltons. (very small molecule) Diabetics make me very nervous if they are on the machine and haven't eaten. You can give D50W before the filter but some will be removed.
  13. Just judging by staff turnover it is worse than it used to be. If you stay in my unit longer than a year you are on old timer. Not sure where the grass is greener, though.
  14. Chisca

    Can someone who knows PA cath's dumb this down for me?

  15. Chisca

    Which nurse do you want for your Little Johnny?

    Awaiting to be replaced by a robot.