sueinga

Do you apply and let dry prior to cannulation? Or have them wash their arm before they sit down? Either way I wil try it- thanks for the input!

Hi, I have a patient who develops extremely irritated, scally skin around her access- it has happened around a catheter dite and also over an AV access in both arms. The CVC area responded to a bactroban on gauze debridement ( of the scales) and vaseline gauze for a dressing. It took 2-3 weeks to get it to heal up- now the same skin condition exists overlaying her forearm graft. I suspect an allergic reaction to Chloraprep and alcohol- but what can I use to de- germ the skin prior to cannulation that is both antibacterial and hypoallergenic without drying? Anyone else seen this and and any advice appreciated Susan

Hello, I'm interested in travel nursing- but do I need to obtain a license in each state I'm interested in? How does that work? Thanks anyone Susan

Hello, We draw our monthly and midmonthly labs from the arterial lumen of CVC patients and normally first withdraw the indwelling heparin of course- at least 3ml- 5ml There has been a debate as to whether the P.T./INR would be accurate anyway if drawn the same way or if a peripheral stick should be done. My latest instructions are get the pt on the maching and draw from the arterial port on the blood tubing---any opinions? thanks anyone Susan

Georgia lets you license by endorsement. I applied to the state of Virginia to take state boards and then took them in Atlanta. Its all computerized so you do not have to physically go to another state to test. After I got my Virginia license - I got my GA license by endorsement- not a big deal

Focal segmental glomerulosclerosis is scar tissue that forms in areas of the kidney that filter certain things out of the body. These areas are called glomeruli. The help the body get rid of harmful or unnecessary substances. Each kidney has thousands of glomeruli. "Focal" means that some of the glomeruli become scarred, while others remain normal. "Segmental" means that only part of an individual glomerulus is damaged. The cause of focal segmental glomerulosclerosis is usually unknown. A small number of cases result from reflux nephropathy. The condition affects both children and adults. Males are affected slightly more often than females, and it also occurs more frequently in African Americans. Focal segmental glomerulosclerosis causes about 10 - 15% of all cases of nephrotic syndrome.

Hello, I worked as an LPN for almost 30 years and used Excelsior to get my ASN. I've been an RN for a year now working in Dialysis. In my opinion it was far less stressful and expensive to use Excelsior for this- you just need more motivation and discipline for self study. It was way more convenient as well doing it at your own pace and in your own home basically. I plan on trying for my BSN soon. I would recommend it only to LPNs with at least 2 or more years experience - having that base experience counts for alot especially when you go for the CPNE. There are alot of online yahoo groups for student support that also help a great deal. Good luck to you!

Hi, Everyone pretty much agrees that when accessing a new fistula to use 17g x 2 weeks then 16g x 2 weeks and ultimately 15g unless otherwise ordered..........but I've heard conflicting views on what size needle to use when accessing a new graft, what is your rule of thumb regarding needle size and also pump speed with a new access? Thanks anyone Sue in GA

What are tipstops? We used sureseal bandaids for awhile but they were cost prohibitive- now we use superstoppers and most pts and staff love them- and they're cost effective

Hello, I live in NW Georgia area and just finished my first year as an RN in dialysis. I was an LPN for 25 years and then got my RN thru Excelsior. Look forward to hearing about other areas of care as I'm not sure this is my forte. Sue

When a patient c/o cramps anywhere ( legs, hands, abdomen, back) I turn the UF off , give 100 to 250 of saline and see how they respond- then its a judgement call as to if and when to turn the UF back on. I know its a sin to send a pt out with fluid weight on but if they are cramping??? Thing is- most peoples weight fluctates on a daily basis so is this not also true- even moreso with dialysis patients so that there EDW fluctuates probably more than it is changed?

Hi, In Georgia it is supposedly mandated that 1 RN to 10 dialyis patients is the limit. We run 16 patients on first shift and 15 on second shift. There is supposed to be 2 RNs but one comes late chronically (agency). I have been the only nurse a few times with more than 10 on a machine- once an entire day. I feel my license is being put on the line when the ratio is higher than mandated. I can say no more patients on after the limit of 10 until another nurse is in the buidling or I can do whats really expected it seems and that is that I "play it cool" and just let all 16 on without saying anything to anyone----What do you do when this happens? Btw, I only have 8 months experience at this point, FM does not get involved much and when I say I am alone- I mean the only RN in the building at the time-

Hi, In Georgia it is supposedly mandated that 1 RN to 10 dialyis patients is the limit. We run 16 patients on first shift and 15 on second shift. There is supposed to be 2 RNs but one comes late chronically (agency). I have been the only nurse a few times with more than 10 on a machine- once an entire day. I feel my license is being put on the line when the ratio is higher than mandated. I can say no more patients on after the limit of 10 until another nurse is in the buidling or I can do whats really expected it seems and that is that I "play it cool" and just let all 16 on without saying anything to anyone----What do you do when this happens? Btw, I only have 8 months experience at this point-

Curious- what is "chevron tape" ?? I've not heard that term before

We all have pts who are hypotensive post treatment and we don't want to give back too much fluid. Of course sodium variation, profiling and adjusting EDW as first options but after that? One nurse has suggested that by experience- giving either some boullion to drink or pickles to eat (combo of sodium & vinegar) raises the bp - whatdaya think? any other suggestions?

Hi, We use The Fresenius 2008K machines. Usually we do not, but when would you dump the prime and why, please explain the rationale? Thanks anyone-

I too have felt and experienced the disrespect of PCTs being an RN new to dialysis. I've been so busy putting on catheter pts that I have not had time to practise sticking pts...and the PCTs know this and their attitude is one of looking down on me. MY question is that after only 6 monthes of training, should I be the only RN on the floor when starting the day? or should the "charge nurse" be there?? I'm being told I've been trained and should handle it- I also feel my license is on the line-

Here in GA its 1 RN to 10 pts and 1 PCT to 4 pts. I have 5 catheter pts that I must put on as only nurses connect catheter pts, tho the PCT monitors until time for me to take off. RN is to push all heparins and give all meds on 10 pts tho.

Being fairly new to dialysis, I wanted to ask how many times/how often can one pt receive TPA? We have one pt who received it beginning of treatment one day (nonfunctioning catheter) with moderate success- BFR 200 then another day beginning and end and yet another day beginning of treatment- about 4 times in one week. Pt was sent for new catheter and AV fistula , came back the next day and catheter still was non- functioning- catheter was rotated- pt gets 10,000 of heparin each tx, again we instilled TPA to one side (cause we ran out). Got it working to BFR 200 again. Since we have to wait for fistula to mature, what options are there beside TPA? The doc is aware and only said "make it work". Any advice appreciated!

THANK YOU SO MUCH! These are invaluable resources! Sue

Does anyone have any good short term careplans that would apply generallly to most patients? Being new to dialysis and the only staff nurse that is NOT agency and I am being asked to do monthly nurses notes and now quarterly short term careplans ( can long term be far behind?) due uhhh in a week on 30 pts.....and could you recommend a good book on them for the future ones? Thanks anyone drowning in paperwork sue ps- I'm supposed to do all this and not put any "overtime" in???

Hi, I'm 3 monthes into my training as a dialysis nurse and the facility manager is trying to get things such at pt charts up to snuff. She has asked that we start doing monthly progress notes. Since I have not done this before on dialysis pts (and I have none here that I can look at- new clinic behind on paperwork) -- Can anyone give me an example of what they write monthly? thanks anyone! Susan

I have seen them use all 3 in my facility. The other day I used Sodium CL 23% 10ml and it raised the BP in a minutes time...but half hour later it was low again. The on another pt I used a 250cc bolus of NS and he still did feel better or increase BP- I had to rinse him back at his insistance and then he felt better but he missed almost half his tx time. I've read that Mannitol is usually given for first dialysis tx to prevent symptoms and DDS. Since I'm still learning I am not sure what to use but guess at this stage that a bolus of NS would be first choice

Can anyone tell me their reasoning when deciding to use either a bolus of normal saline vs hypertonic saline vs mannitol vs dextrose to treat dialysis induced hypotension thanks

I made 14/hr at a nursing home one hour north of Atlanta as an LPN with 25 years experience- then I went thru the Excelsior program to get my RN- you cannot survive on an LPNs salary unless you do agency in a big city perhaps- The market changes constantly and many variables come into play such as your experience and the demand for it, good luck!