kdunurse

How are you more likely to give the patient air with a med during rinse back than at any other time? My concern about giving a med during rinse back is that the patient wouldn't receive the full dose. Some of it will be left in the saline unless you give it at the very beginning of rinse back.

What the others have said. Often ADN or diploma nurses aren't eligible for non-acute nursing roles. The BSN is designed to prepare you for those. I'm surprised your counselor wasn't able to explain this to you clearly.

I'm not with Davita or Fresenius; our dialysis clinic is hospital basis (our hospital is part of CHI). I think the orientation is 6 weeks because that's the standard orientation time in our hospital. And most of the first week is taken up by general nursing orientation stuff, not dialysis related orientation. So it's only a 5.4 week orientation. Our unit is in a world of hurt right now. We've had a number of staff resign, so we will be orienting 4 staff members at once. This, while being extremely short staffed. I have no idea how to make the orientation experience remotely good for these new staff members. Anyone have an ideas?

So I talked to my clinical coordinator about this, and she's not bending on the idea that new staff (we have 3 new hires with no dialysis experience) need to be practicing independently (no preceptor) after 6 weeks. Are there any regulations or standards of practice to back up the need for a longer orientation?

I've been a dialysis nurse for 3 years and am starting the educator role for my HD unit (hospital-based, mostly chronics). We have just had a large turnover so I will be working on new staff orientation for several LPNs and RNs. Our unit does 6 week orientation for all roles (RN, LPN, PCT), which I don't believe is nearly adequate. What is the standard orientation length for HD? And are there any regulations regarding this? I'm looking for information to take to my clinical coordinator besides just "I don't think it's long enough"...

I'm working on an evidence-based practice paper for my BSN, and the subject I've chosen is CLABSI prevention with IHI's central line insertion bundle. I'm trying to show that this is a nurse-driven topic, and I'm trying to find statistics on RN scope of practice, without much luck. Are RNs in all states allowed to insert PICCs? And how many states allow RNs to insert IJs/femoral lines?

Our facility uses the standard CDC policy for central line dressing changes (q48h for gauze, q7 days and prn for occlusive), but our clinical coordinator has said there is research indicating that infections are lower when no dressing is used. I can't find any information about this online. Has anyone heard of this?

How many other RNs are there? If there are none, and you've only received 6 weeks of orientation, then it is very unsafe (I'm assuming you've never done HD before). You are well within your rights to refuse to do this. If something happens, you will be held responsible (along with the facility). If the director han't done HD before, she will be of no help to you at all. This is a potentially very dangerous situation.

If I understand you question correctly, you're asking who should write the dialysis orders, the intensivist or the nephrologist? It should always be the nephrologist who writes the dialysis orders, although it gets confusing when the intensivist is also a nephrologist. If that's the case, you need to look to hospital policy. In our hospital, we have some (lazy) nephrologists who will write "use chronic dialysis orders" or "use previous dialysis orders from x date", in which case I will write an order clarification listing the entire dialysis prescription from the previous order. Your facility may not allow this, so it's best to follow facility policy. And if there's any confusion, you should always call the nephrologist for clarification.

I just finished my microbiology class in a week. Statistics took me two weeks. I have not yet done my micro lab, but don't expect it to be difficult. WGU is a good program but you have to be very self-motivated to be successful, as you are setting your own deadlines and planning your learning strategy.

Your facility should have a policy regarding use of a dialysis catheter for non-dialysis reasons. (I'm assuming you work in an acute care facility). In my facility, we do have a policy allowing non-dialysis nurses to use the dialysis cath for blood draws, but in my experience, most non-dialysis nurses are not comfortable accessing a dialysis cath. If you don't know what you're doing, you could do more harm than good by introducing infection or pushing in a dose of heparin or TPA packing accidentally.

In our unit, dialysis pts who want to end their tx early must sign a release of responsibility. They are basically agreeing to leave AMA.

We currently have only one tech for our 19 chair unit, so, yes, our nurses do tech shifts. It's a bit weird, actually, because the nurses have pods assigned to them, while the tech doesn't; he floats during turnover, mixes baths, and does a lot of the cleaning and stocking on the unit. The nurses are very good at cannulating and stringing machines...

I've been working in a hospital-based dialysis unit for a couple of years. We're different from other units in that we don't do acutes (inpatients) and chronics (outpatients) separately, which has its advantages and disadvantages. Most hospital based dialysis centers will have a separate acute unit, and you will do either acutes or chronics, but not both, in a shift. In an 8 hour shift, you will probably have 6-8 chronic patients (or more, depending on your role), because most dialysis treatments take 3-4 hours. A chronic unit will be divided up into pods of 3-4 stations (chairs) each. Many units will have a tech for each pod, who are responsible for getting treatments started and ended, as well as machine care. Treatment times will be scheduled so that patients in the same pod ideally aren't arriving or leaving at the same time. The pace is very fast during turnover (when one shift leaves and the next arrives) so you need to be very organized and good at multitasking. There is also a lot of documentation, both with the treatments themselves, and the patients generally (education, lab values, orders and so on). Reimbursement is closely tied to documentation, so there is a lot of pressure to make sure your paperwork is done correctly. There is a very steep learning curve with dialysis - it is very specialized, and very different than most other types of nursing. I only had 6 weeks of orientation, but the big two dialysis companies offer a much longer orientation. It takes a few months to become familiar with the machine, let alone the rest of it. One other thing to consider - if you are doing any sort of inpatient treatments, you will be expected to take call once you have enough experience. This entails going in to do treatments on acutely ill patients (often in the ICU) when the dialysis unit is closed. You will be the only one there who knows dialysis, so you need to be part plumber, part biomedical technician, and part nurse. This may happen the night before you are expected to work at 0630, or on a holiday. It's not for everybody, for sure.

Absolutely. However, it is completely appropriate for the dialysis unit to have a policy of not allowing pts to get off dialysis for a smoke break. In that case, the pt can decide to do dialysis OR smoke, not both. I have several dialysis pts who frequently ask to leave early. I make sure they are aware of the consequences, have them sign the release, then take them off without arguing. Dialysis pts do have rights, but they don't extend to placing the unit at risk or inconveniencing other pts. I will also share that as a taxpayer, it find it extremely frustrating to have to pay (literally, through Medicare funding) for the consequences of the poor choices of others. Of course, this doesn't apply exclusively to dialysis pts....

That's interesting - we were soaking hansens in bleach for a little while, but there was concern about corrosion, so we stopped. I'd like to know more about flushing the ro - do you use a portable ro, or a larger one? Our ro water goes into a large holding tank (several hundred liters), not sure if we can flush it. Not sure if it's coincidence or not, but we didn't have these culture issues until a few months after our city water supply switched from chlorine to chloramines.

Folks, Godwin's Law was invoked in the very first post. Any further discussion with the OP is pointless....

I think I would rather be safe than look good with the patients. There is no good rationale for piercing tubing - it breaks sterility and invites leaking, as well as raising the potential for needle stick injury. Why on earth do your coworkers not use the injection port?

Just an update - I had spoken to my clinical coordinator about this issue, and last week she showed me a letter from Fresenius (think it was dated 2005), the gist of which was that they say there is no harm in turning off the UF. I guess if the manufacturer says it's OK, then it should be OK.

I'm also confused - are you a dialysis nurse? If you're not, you should not be doing anything with a patient's access. If you are, are you being asked to insert a needle into the access tubing? You should never puncture tubing anywhere other than an injection port. Normally dialysis tubing comes with injection ports for medications and blood draws.

I don't think new grads should go into a specialty right away - at least a year of med/surg experience is the best thing to develop your nursing skills. It also sounds like the dialysis unit you interviewed with is poorly managed, which would make me run the other way. From what I've heard, there's a world of difference between well and poorly run dialysis units.

Our unit has been having some nasty issues with biofilm in our machines/connectors/loop (I don't think anyone's really figured out exactly where it is), and our biomed guy has been coming in on Sundays to clean the machines and loop with peracetic acid (same as Renalin, which I've never used). Now our coordinator and biomed wants us to start doing chemical rinse on the machines with peracetic acid 3 times a week. My big concern is that we will be using this stuff while there are still patients in the unit. I've talked to my coordinator about this, and she says there's enough ventilation on the unit that she's not concerned. I'm concerned about both vapors and contact with patients if this stuff is spilled, but I can't find any information about this. Does anyone have any information about using peracetic acid around patients, or can point me to resources where I can find out? We're going to start doing this as soon as we have enough supply.

Yes, we Americans are unusual and a bit confusing :)

Pubmed publishes research from around the world, not just North America. You will not find a North American researcher or clinician who uses the terminology "24-hour diuresis" or "hourly diuresis". If you are writing for a North American audience, they will not be familiar with this terminology. It's not a matter of what you personally find intuitive, it's about what your audience will understand.

I am not familiar with the terms 24-hour diuresis and hourly diuresis, actually; these are not terms that are commonly used in North American medicine. Any references to these terms that I found through a Google search led me to Non-American websites. What you refer to as "24-hour diuresis", we would call 24-hour urine output. I cannot speak to how the word "diuresis" is used in your part of the world, but I can say that here in the US (and in Canada, as I received my nursing education there), it refers to increased urine output. If you are writing for a non-American audience, you should try to find clarification from experts in that geographical area, not Americans.