Juanay

Our nephrologist is now encouraging our pt to use OTC Vitamin E 400u bid and OTC Carnitine as directed daily especially pre HD

The tape goes under the needle then criss cross over the top. I, then, always add a piece over the top of the criss cross.

I am a travel dialysis nurse and have worked in units where 3K was standard and other units where 2K was standard. Most of the units standard have been 2K.

You should also protect the arm (if it is in the arm). No tight sleeves, no watch, bracelet, nothing to hinder circulaiton. Pt should not sleep on that arm. Assess for bruising /infiltration. If infiltration had occured from tx, extremity should be elevated and cold applied that day and evening, alternate heat and cold the following day and continue to keep elevated to reduce swelling/bruising. Signs of infection could be pain, swelling, draining, warmer than other extremity.

shannon8232 Sounds like this pt needs to be on a behavior contract. If he refuses to comply with the contract he should be discharged as a pt from your facility. Unfortunately in the times we live in we should take all verbal abuse as assault and not allow these behaviors to continue. You never know when one will snap. Maybe all the staff should sign a complaint and send it up the chain of command until something is done. This type of behavior should not be tolerated.

Here's the web address: http://foundationenterprises.com/ I've been traveling with them for 2 1/2 years. Juanay

I graduated from JCJC in 2001 and started out making 14/hr. I worked 18 months at that wage before I got a 4 dollar/hr raise. Worked another year while going to USM for my BSN then decided to travel. I'm making twice that now. Kinda hard to go back to those low wages, but I know if I decide to go back home that is what I will have to settle for. It's a shame! Juanay

Yeah, Lots of colors, some have holes ( not for use in clinic ) Around $30.00 here and @ home. I have actually had a N ask me what I think I should do in a situation and they reply "Sounds good to me, lets do it." The N's here are all very approachable. One of they great +'s here. Juanay

What a difference the 2 of us could make in a unit!!! Too much for most places to handle I'm sure! I have been asked to extend here again. Since this is the closest thing to home I probably will unless this THING that WILL go down this week backfires. I'll PM you later. Juanay

The toe's fine. Still aches occassionally when the weather changes or when I've been on it all day in tight shoes. Got some Crocks and absolutely LOVE them. Best shoe I've ever worked in is a garden shoe. Imagine that! As far as 14's... This is the only place I've been that has used them. All using them have 500 - 550 BFR.

We have had greater success in decreasing time with N's orders fro larger dialyzers and larger needles for well established accesses. 14 Gauge on several clients now. Labs are positively reflecting! The pts are sooo proud to have their times cut! Juanay

We are 24.7 miles from the nearest hosp and have no courier service for labs or blood. We (the staff) have to physically go pick up the blood and take any labs ie...BC's for fever, culture swabs, 24 hour urines. If we have a code we have to run it with all measures even if the pt is a no code per protocol because pts cannot be pronounced dead in our facilities. Never a dull moment! Juanay

Sometimes you gotta wonder about these N's and what they are thinking!!! HHHHMMMMMMM!

Being a traveler "When in Rome" Protocols are different in every unit. Every state. Vanc 2 G over 2 hours, burp bag through arterial. Same situation through venous with pump. I've seen Gent given with RB and shudder since it is ototoxic. I've seen Ancef and Fortaz given post tx and allowed to run through. Protocols where I currently practice are all per pump: Vanc 1 g over last hour 2 G over 2 hours through venous port. Gent, Ancef, Fortaz post tx over 20 min. We are also allowed to give blood faster. 1 Unit PRBC's over 20 min through the arterial to allow the dialyzer to filter. Juanay

When I started in dialysis our units used only NS or Min UF, Decreased UF goal for Cramps. (Pushing on the foot, allowing the STABLE pt to stand as well) The facilities I am in currently DO use hypertonic, Bicarb, D50 as well as Na modeling and UF profiles. These pts also gain excessively b/t tx and the cycle continues. I have found here that with assessment (no edema, Lungs CTA (B) no SOB, statements of good appetitie, gaining weight, less active) many of these pt need increase DW. We as nurses are pt advocates and should (if protocols allow RN to increase DW)increase the DW and continue to monitor. DW's can change weekly. I have seen many pt's stabilize with an increase in DW and no more cramps, no symptomatic hypotension. JMHO;) Juanay