MJFRN

Hi all ! Thanks again for the replies. Just to answer some of the questions posed: Yes, I did use the albumin ordered and I also questioned why the patient was not in ICU in the first place. No, our machines do not have UF profiling and I agree that this patient would have been better off on CRRT. Unfortunatley our company does not provide this service and believe it or not the Hospital does not do it either ( Not sure why, I thought all critical care units had CRRT?!). As far as the nephrologist is concerned, Ya know, at this particular hospital they are all like that. For instance when I called in the morning to get the order for the albumin and Na modeling he was all annoyed that I called so early. But ya know, like someone else said, why wasn't it written in the first place , espeically because of the admitting diagnosis!! Knuckle head (thats me venting one last time. ) Anyway, good news is I dialyzed the patient yesterday with no incident and she is doing fine now. Thank you all so much for the support. It really helped alot. I am so happy that this board exists!! Thanks again! MJ

Thanks for the replies so far. As I said previously, she was admitted for hypotension and decreased LOC. Right before she crashed her pre HD labs came back and her WBC count was extremely high. She had a stage two decubti on her back which I am sure is what is causing her to be septic and contributing to her hypotension. She had a pre HD temp of 99. She was not fluid overloaded and I was only doing gentle fluid removal (as per MD order and nursing judgement). I guess what is so disturbing to me is that I believe I did the right thing but the attitude from the floor nursing staff and MD seemed to be that I came in and just reeked havoc on their unit. I keep going over how the MD responded to my giving her fluid and I just think what, should I have just stopped giving fluid and said Im sorry the patient is not responsive but she is a dialysis patient and I really can't give her anymore fluid?

Hi everyone, I had an awful day in the world of acute dialysis today and I hope you can give me some feed back. I went to dialyze a pt today who was admitted last night for hypotension and decreased LOC. THis morning before I started her treatment she had a bp of 91/56. I anticipated that there would be problems removing fluid so I called the doctor for permission to do Na modeling and have albumin on hand if needed. Anyway, pt got through most of tx then with 30 minutes left BP dropped to 55 systolic and went into A fib and went unresponsive. I immediatly terminated tx and gave fluid. Wound up giving 2 liters of fluid just to get a BP of 105/50, hr 116 and get her responsive again. When nephrologist heard she got 2 L he freaked ! I know it was alot of fluid, but WHAT ELSE COULD I HAVE DONE? She wasn't responding till then. I am a wreck and totally questioning that I should be in the acute environment. The nephrologist said "now we have to hook her back up to UF her" and I said well she needs to be in the ICU than and get on some pressors. SHe was then moved to ICU to be dialyzed tomorrow. I truly don't know what else I could have done, I mean I took every precaution to maintain her BP's while on the machine and she still crashed. I am a wreck over this and I hope some of you can advise me on how else I may have handled this situation. Thanks MJ

Thank you so much for responding ! Thats what I thought it was but I was not positive. I wanted to hear it from someone else. Thanks again!!:)

Hi all! Quick question.... On the Cobe C3 machine, If a patient has a heparin shut off after 3 hours of a 4 hour treatment do you enter 60 minutes or 180 minutes where it says Heparin shut off time? I have been out of dialysis for about a year and for the life of me I can't remember how I entered this. The person who is re-orienting me to the machine does not use the heparin pump so she dosen't know and I have still not received a procedural manual (I am doing acute mobile dialysis and there is not one readily available). Thanks so much MJ