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

hi nephrobsn! i totally agree concerning na profiles. i am traveler too and sure we know each other! the unit i am in currently has had 6 units on blanket modeling and uf profiles for years. i agree with you though that if a pt comes in with 220/111 pt i do not turn on the na and document bp too high. all pts are on na linear 148-135 and profile 4. our new don has been brave enough to challenge these arcaic orders and be pt specific. like no profiles on small gainers, profile 2 on large gainers with elevated bp who are stable. and so on.

Go to Delphi Forums at this addy http://forums.delphiforums.com/ICNurse/start Lots of great info on IC. Hope this helps Juanay

Hi Theresa, I am a dialysis travel nurse. I work with Foundation Medical Staffing. Joe Hill is my recruiter. He is great! No high pressure. I have recently started my 3rd contract with them. They work hard to place you where you want to go. Please feel free to PM me. There are 4 other companies that place primarily dialysis that I am aware of: Nursing Options, LLC Jeff Walthall Recruitment/Marketing Manager 877-687-7350 877-687-7360 Fax [email protected] http://www.nursingoptions.com Quick Travel Staffing, Inc. Belinda Pagliaro Vice President 150E. Olive Avenue, #308 Burbank, California 91502 Tel: 800-554-2230 Fax: 800-554-7501 http://www.qtstaffing.com Sagent Healthstaff http://sagenths.com/ Drenan McQuillan [email protected] 1.877.RN4HIRE I have only traveled with Foundation. They have always worked very hard to keep me within a 300 mile radius from home as this is important to me. The other companies contact me regularly to keep me informed of opportunities they have available. Good luck! Juanay

:chuckle Good ones! How about: "Well, I didn't drink a lot of water! I only had my pot of coffee and tea, that doesn't count does it?" 10 kg over! Recently had a pt complete scheduled tx and call back the same day to be hemo'd b/c sob. We worked him back in hemo'd for 30 min and his family brought him a 36oz mug overflowing with crushed ice! We were all flaberghasted! Took it away from him and he had the GALL to get mad at us! Juanay

Thanks Memphispanda, I wrote a term paper on the subject 2 years ago. This info is still pretty standard for the disease. Sugarbaker's, I believe, is formost in the tx. Very radical. We were told that chemo and radiation are ineffective treatments. However mom did have 6 weeks of chemo after her 2nd debulking surgery (13 hours) that left her with an iliostomy, on TPN and many other problems. We had never heard of this before her diagnosis, that's one reason we were shocked to hear of someone else within 15 miles of us with the same cancer. Thanks for the reply. Juanay

Hi, My mother-in-law died 3 years ago from this rare type of cancer. It's a gelatenous tumor that disentegrated most of her bowel, parts of her liver, bladder. Just wondering if anyone out there has heard of this and if any new treatments have developed for this cancer. She has a friend who was diagnosed with the same cancer who is still battling the disease. She has had several surgeries for debulking but they aren't giving her much hope. Life expectancy at time of diagnosis is 5 years. Mom lived 2. Her friend has lived 4. Juanay

Leslie, Thanks sooo much for the reply. She is being very closely monitored and is loved dearly by all the staff. She brightens any room and is always concerned about other children who are having a hard time. "Little mother hen" It's amazing to see how this little child has so much compassion and wisdom far beyond her years. All prayers are greatly appreciated. Juanay ...And a little child shall lead them....

I have a question about my small cousin with ALL on methotrexate. Her recent labs showed BUN of 47 and 50. I am not an oncology nurse but work in dialysis and concerned because I know these are very high numbers. Her parents are not familiar with these labs and were concerned that I was concerned. Her Creatnine was 0.2, slightly below normal. Should we be concerned about kidney function or is this a normal byproduct of chemo? She still has very good output. Thanks Juanay

jnette, Thanks for your reply. She came in today for her tx with 99.0 temp and her arm was a little warm. The ER doc did use the upper part (venous limb) of her graft but now it has a large bruise on it! By post tx though her temp was normal. "At our ER up the road from our clinic, if we have to send them one of our pts. for an emergency, of course we leave the lines in, attach a syringe on one to cap the end, and leave saline running in the other... well, when the patient has stabilized in ER, they always call one of US to drive up there and pull the needles and hold the sites... they say they don't know how.......???? So no matter how busy we are at the time, one of us has to go up there and perform this majorly difficult task.. Grrr." Yeah, we had one go to ER yesterday for SVT's and was sent with needles in place. After he was stable they sent him back for him to finish his tx with needles still in his arm but he refused to finish his tx. He says he told ER staff to pull them so he could go home but they said "we can't do that here." SO... they sent him back so we could pull his needles and go home. So... :stone Juanay