penem10

Thank you everyone for your very informative responses. Does'nt there have to be a separate log/documentation to record the specifics of the dialyzer use rather than a paper label that can be lost? Does this label become a part of the permanent record? I have heard of a patient getting the wrong dialyzer and contacting MRSA from it. The patient was told when he got the wrong dialyzer. He then died. Thanks again, you are all great!

In some states the department of health will put forth standards of nurse/patient ratio for dialysis. In others, it is the state board of nursing.

I would not recomend going to a dermatologist to soften the areas. The scarring, if minimal is protective to an extent. The scar tissue will decrease the pain sensation to some degree. I would recomend a fistulagram also, this way you know what you are dealing with. She may have a stenois of some sort.

Hi! our facility is looking into reuse, and I have read that the AAMI standards require a log to be kept. Do any of you have experience with this log? Is so, what has to be kept on the log? Have you ever had a patient get the wrong dialyzer? Thanks for your help.

I would recomend at the minimum 6 months of med-surg experience. There is nothing like on the job experience when your a new RN. Most units I know of like this minimu also, ICU or ER experience would be even better.

The description of LPN's vary from state to state and unit to unit. But the majority cannulate the fistulas and grafts, initiate dialysis, terminate dialysis. In our state, NY, they cannot access caths unless they have proper competency. They adminster meds and do the nursing care plans.

We have used this in a desperate situation. When multiple attempts at cannulation have been made and no success. When the interventional radiologist is not available to do a fistulagram, or when the vascular surgeon is not available to place a cath. I have been told that they just do not as good a treatment. It is not something I'd do regulary, but at least the patient gets the fluid off to keep them out of the ER and out of trouble, temporarily. We always give a call to the MD or NP to let them know the trouble we had and what is going on. This patient needs a fistulagram and the stenosis opened up to keep this graft working properly.

I have heard of this situation, although I have never dealt with it before. The solution was to approach your co-workers with the attitude that you are all there for the patients. It is not a competition between tech and nurse. Bottom line, the patients suffer when this ocurrs. Approach the techs with this and you hopefully will see things change. More and more unlicensed personnel are taking over the units nationwide. This is not an attack on techs, there are awesome ones out there. I just believe a RN needs to be assessing the patients, accessing their grafts/fistulas and really knowing what is going with that patient on a daily basis. This is not possible when your 1 RN is struggling to keep informed on 10-15 patients at a time. IMHO Penem10

I would just like to add a comment to "make it work" You need to remind that doc that his KT/V's are probably bad and that is all documented nationally. At least in our facility, that is the motivator to get those caths out or to get them functioning. Robin A. Clark, RN, CDN

As far as I know, their is no limit to using TPA, however, In my experience, it is best to try to understand why it is not working and then fix the problem. For instance, how long has it been in? The longer the Cath has been in, the more apt it is to develop a fibrin tail and, the tpa cannot get to that, so the option would be to replace that cath. Is the problem mechanical? Kinked? Wrong placement? Migrated up against the wall? All these things would be problematic and the cath would need replaced. We will instill tpa and send the patient home dwelling until their next treatment, we have found that this works better than allowing it to dwell for 1 hour and then trying their treatment again. When they replaced that Cath, did they try the other side of the chest? Sometimes the patient is anatomically a problem too. If able, please try to get an access placed in an arm. It sounds like that patient's KT/V is low after many bad BFR days. Hope this helps. Robin A. Clark, RN, CDN

Assess the situation, a blood leak is a serious issue and do not rinse the patient's blood back. Restring and initiate dialysis again. In any other situations, try to rinse the patients blood back, dialysis patients need every once of blood they have. This can be done manually by hand if need be. If the machine malfunction is jepordizing their prescribed treatment, then you need to pull that machine and give the patient another one. You must follow the prescribed treatment by the MD. If the machine is operating in bypass, the patient is not getting their prescribed treatment. Every situation is different and needs to be assessed on that basis. Your unit should have back up machines available stand at the ready and have already gone through test mode. Hope this helps Robin A Clark RN, CDN

I agree it is good to orient with the tech to learn the machines and what their job is. But you need to orient with a RN (preferrablY) or and LPN if a RN is not available. Especially if you do not have any experience in Dailysis. I remember back years ago when I started new to Dialysis and the first time I had to deal with a patient that went unconscious, SCARED to DEATH! You have to learn how to deal with these patients and even the most experience tech cannot do that for you. I would go to your nurse manager and talk to her about your concerns and if she does not go along, move to another facility if that is possible. Your license is on the line. The responsibility falls with you. Does your unit have competency sign offs? In our facility the RN and nurse manager has to sign off on a new RN's competency. Good luck. Robin A. Clark ,RN, CDN join dialysis nurses nephrology group at yahoo. com

Work them up for infection. Draw blood cultures, look for s/s of infection ie: respiratory, kidney, catheter, assess access. No s/s? Rule out this first then consider the flu? Did they get a flu shot? If they do exhibit s/s of infection or sepsis, consider an antibiotic for the source of infection. Are you using a lower temperature for your dialslate solution? This can make them chilly also. Hope this helps. Robin A. Clark, RN, CDN Join Dialysis Nephrology Nurses at Yahoo groups.com

This link will get you a big list of books available for ICD 9 codes. http://tinyurl.com/yj3feg Have a great day Robin A. Clark, RN, CDN

Cannulation Camp: Basic Needle Cannulation Training For Dialysis Staff by Deborah J. Brouwer, RN, CNN I highly recomend this inservice, she does cannulation training around the country. In her education materials she states "The needle should be held by the wings, with the bevel of the needle facing upward for the cannulation. This places the cutting edge of the needle on the skin, which facilitates cannulation through the skin, subcutaneous tissue, and the graft wall or fistula vessel wall." I would like to add that increasing evidence from Europe has substantiated that the buttonhole technique is a better technique because it creates a track in the vessel (for fistulas only) and cuts down on infiltrations. This can be done inhouse or for home based patients. Our facility does not use this, but I am thinking about pushing the issue. Robin A. Clark, RN, CDN