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Chisca RN

Dialysis
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Chisca has 36 years experience as a RN and specializes in Dialysis.

Chisca's Latest Activity

  1. Chisca

    Dialysis and Diabetics

    Dialysis solutions used to have 200 mg/dl sugar in the dialysate bath that would somewhat protect the patient but now it is 100 mg/dl. For some patients that is not enough to protect them during a treatment. Tell me you gave insulin before a treatment and i will be checking their blood sugars hourly.
  2. Chisca

    Dialysis and Diabetics

    Glucose molecule slightly bigger than water molecule so sugar is easily removed during dialysis treatment. I would recommend NEVER give a patient insulin before a dialysis treatment.
  3. It is a blessing you were fired because it sounds toxic where you were working. I am quite aware of my patients lab work and this dialysis knew the labs. I am also aware of any IV access or lack thereof. What happens where i work is the dialysis nurse calls the nephrologist to extend the treatment time so the blood can be given. You were left holding the bag that the dialysis nurse created by their negligence. Handoff from dialysis nurse should have covered lack of transfusion and you should have called whoever ordered the transfusion and informed them of no IV access. Not your fault and if anyone should have been fired it was the dialysis nurse. Hang in there, it will get better. One door closes and another will open.
  4. Chisca

    productivity

    How else can you run a factory if you don't measure productivity?
  5. So in your facility only dialysis units can give blood? No IV access is a MD problem and should have been dealt with earlier in course of stay. Don't see how you are at fault.
  6. 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?
  7. Chisca

    Tube feeding and hemodialysis

    Not specified in the standard orderset.
  8. 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.
  9. 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?
  10. Chisca

    ‘Hemodialysis Access 101

    Nice little interactive tool designed by Dr Namrata Krishnan to teach nephrology fellows about dialysis access. Enjoy. Hemodialysis Access 101
  11. 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
  12. 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."
  13. 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.
  14. Chisca

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

    [ATTACH=CONFIG]27046[/ATTACH]
  15. Chisca

    Which nurse do you want for your Little Johnny?

    Awaiting to be replaced by a robot.
  16. Chisca

    ANNA membership?

    Dialysis news alone is worth the price of admission. ANNA News Service - Dec. 7, 2017
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