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Hi! I would like to know if the practice of having a vascular access manager / coordinator is done in the Philippines? Calling dialysis nurses in the Philippines, does your unit (freestanding clinic or hospital based) have a key person that implements dialysis vascular access surveillance and monitoring programs? Let's get in touch!

Hello! First of all, Anguilla IS NOT in the British Virgin Islands. It's an island in the northeastern Caribbean that is an overseas territory of the United Kingdom. It's a rather small island that's very rural by today's standards. Their main industry is tourism, for the reason that they have one of the best and most stunning beaches in the world. I guess you will be rather be bored working and living their as the place is not urbanized. I've been their several times and it's only the beaches that we're after. Not much restaurant, close to zero night life. I don't even know if they have a cinema. However, despite being not so developed, the island has a high standard of living. Thus the offer they gave you for the salary is not enough, even if you have free transport and housing. All these I'm sharing because I lived and worked in an island beside them, St. Martin. St. Martin and Anguilla are contrasting environments. St. Martin is alive and vibrant, a rather modern place with modern amenities compared to the other islands nearby. Just my 2cents.

Hello! I'm a dialysis nurse by profession, but in the past couple of years I have founded and invested in a number of business ventures outside our profession, namely a t-shirt company, a travel agency, a motor engine distributorship, and a micro-finance company. It's a bit challenging juggling those with my bread and butter of being a dialysis nurse, but eventually you'll get the hang of it. It's fun being what they call a "serial entrepreneur!"

Hi Ayelesia, I think what you're doing is increasing or decreasing the "conductivity" as a whole. When it's the conductivity itself being modified, electrolyte content are also affected hence the increase and decrease of these electrolytes together with the conductivity. With sodiium profiling, it's only sodium that gets elevated on the time period that the profiling is active. There is a peak, and a base. The peak is how high you want the sodium to be, for example 145 (as compared to the normal of 137 or 138). The base is the normal level you want the sodium to go back to after sodium profiling is done and automatically turned off (in most cases it's the default sodium level, 137 or 138). There is a time on how long the sodium profile is to be turned on depending on the program, namely STEP (recommended to turn off profile 30 mins prior to end of dialysis ), then Linear and Exponential (usually lasts the same time as the dialysis treatment time.) On another note, current dialysis guidelines have gradually discouraged sodium profiling as studies have shown this led to increased thirst, and eventually increased fluid intake, therefore it was counterproductive. But it's not ruled out to be prohibited, it can be used ocassionally, one indication is for patients with chronically decreased serum sodium levels. It all goes down to the RN's and the MD's discretion.

For further reading: http://www.transonic.com/resources/hemodialysis/transonic-flow-qc-hemodialysis-monitoring-comparison-with-fresenius-on-line-clearance-olc-monitoring/ Access flow monitor equipment - Topic

Hi everyone! As the newly designated vascular access manager of our small unit (15 beds), one of the first projects I'm implementing is to have a Transonic HD03 dialysis access surveillance monitor(s) to replace the Fresenius OLC access flow measurement that we are currently using. Does anyone have an idea how much does the HD03 cost? I got in touch with Transonic already to request a price quote but they haven't responded to my emails nor returned my calls. I've prepared a thorough presentation about the advantages of using the HD03 over the OLC flow measurement to justify the purchase. However it will be more helpful if someone can give me a ballpark figure for the price. Thanks!

Took and passed the June 2006 exam. Never even bothered for a retake. Test 5 was even my lowest. So far so good. Been to 3 countries in the last 9 years since becoming an RN.

Has anybody have experience with the HeRO graft? It's a hybrid of a CVC+AVG. (pretty cool idea!) HeRO Graft It's indicated for catheter depended patients due to central stenosis and also for those running out (or ran out) of peripheral vascular access options! Please share your experience if you have come across it in the clinical area. Thanks!

I sent you a PM.

I sent you a PM jenrv07.

You're welcome. The KDOQI guidelines have a history and rationale behind arriving at these adequacy numbers. You will find it very interesting.

KDOQI Guidelines http://kidneyschool.org

Yes American patients are a different breed indeed. When American patients contact us when they plan on a cruise or a week's vacation in the Caribbean, we give them the requirements on booking treatments with our clinics. A lot deliberately skip the MDRO cultures and play dumb that they didn't know about it when we ask for it. Even their GP's say they don't know about it. I go the extra mile and give them more information (when in fact they can search for information online) and they refute that the cultures are unnecessary nonsense. Wow, how unprofessional of them. Maybe next time I would have to refer them to the CDC. I have turned down numerous treatment requests because of deliberately skipping one or two of our needed cultures and then patients are scrambling to get them done 1 week before their departure. However I experienced the opposite from Canadian patients. I give them the requirements, and even before the set deadline, they send everything, complete, nothing pending. It's not only Americans who have their treatments with us. In a day alone our dialysis floor is like a UN Security Council meeting with a mix of patients from the US, Canada, France, Germany, and UK. We have our clinic requirements and vacation patients have to comply with them. The same way our patients comply with DaVita's or FMC's requirements when they go for vacation or further medical treatment in the US.

Yes of course. Like most of overseas based Pinoy nurses, I also started with being trained then eventually got hired.

I graduated in 2006, but while waiting for the NLE results, I already started working with a large international bank handling offshore wealth management accounts. 2 months into the job the exam results came out and I passed, so even if I was already an RN, I still worked in the financial industry for 2 years. 2008, I eventually found myself lining up and brushing elbows with fellow neophyte RN's fighting for slots for training programs from various hospitals. I was blessed to be part of a "Skills Enhancement Training Program" in a large tertiary government hospital in the province. It ran for 6 months, half the time I was at the Orthopedic Ward, the next half I was assigned at the OR. I didn't had a white horse, so after the end of the program I wasn't on the short list (10 out of 100) of those considered to be hired. However, I got to chance to go abroad just 2 months after the training ended. Unfortunately, the global economic recession in 2009 forced a lot of ward closures in the hospital I worked at overseas. After 1 year they didnt renew my contract and I was back in the Philippines. A month after I returned, I found myself being interviewed for a training program in renal nursing at an outpatient dialysis clinic. I was hesitant at first to pursue it since I wanted to work at a hospital. But I was accepted and went with the flow. Heck, it was better than having nothing to do. My dialysis nursing training lasted 6 months, but they hired me as a contractual employee afterwards. I eventually passed the RENAP exam during that time. When the dialysis clinic opened a new branch, I was one of the staff nurses that set up and started the new branch. I was with them from 2009-2011. In 2011 I got the chance to go abroad again, but this time as a specialized and certified dialysis RN, a nurse with a rare specialization as far as South and Central America are concerned. I worked for 1.5 years in South America before transferring to the Caribbean where I am presently working. Working in the Caribbean presented an opportunity for me to have another specialization, Intervention Radiology. Because of my OR and dialysis experience, I was requested by the Dialysis Department Head Nurse to assist in angioplasty and stenting procedures for dialysis patients with stenosed fistulae and grafts. From then on, the radiologist would always ask for me to scrub in whenever we have those procedures. Eventually I was trained for free in intervention radiology and now I work in 3 areas within the hospital, Dialysis (full time), and Radiology and Cath Lab (part time and on call).

New studies recommend maximum UF rate of not more than 13mL / kg body weight.

That's a nice article that should and must awaken my fellow Filipino nurses to the reality of nursing in the US. I got into nursing exactly as described at the beginning of the text, persuaded by my parents and relatives who promised to financially support my education but sooner or later was nowhere in sight a year after I shifted from Information Management to Nursing. Eventually I graduated and passed the Philippine Nurse Licensure Exam, but had to work in a bank for almost 2 years since there were no local hospitals that were hiring staff nurses simply because of the oversupply of newly licensed RN's in the Philippines. With the help of friends, I luckily got a slot for a "training program" at a nearby tertiary hospital and eventually got hired, and selected for specialization after a couple of years. And here I am now, a dialysis nurse working in the Caribbean, with 5 years of experience and counting. But it won't stop there. I'm planning to get my Master's in the next couple of years, and would do my graceful exit in the clinical aspect of nursing and level up to administration and management, or public health. The thing is, even if I got sucked into a terrible system dictated by economic needs, there are still ways to jump out of it. America is not the only place where nurses can have a flourishing career, there's Canada, Australia and the UK. There's a whole big world out there. So if America is closing its doors, then look somewhere else. If the situation is not to your advantage, then instead of waiting for your papers in the pile thanks to Retrogression, it might be more practical to go look for other options.

I too am interested in working as a nurse in Germany. But I may have a different case, since I've been working for 5 years now as a dialysis nurse in South America and the Caribbean. I am from the Philippines, and I got my BSc. in Nursing and my initial RN registration and renal nursing specialization in the Philippines. Is there any nephrology/dialysis nurse here who can share some details for work as a dialysis nurse in the German setting?

Hi, Rachel. I'm based in Sint Maarten. If you're interested in Bonaire, I suggest you take Dutch language lessons. Of the Dutch Caribbean islands, it's only in Sint Maarten that English is widely used.

I currently work in the Caribbean, in the Netherlands, Antilles, to be specific, and different islands have different regulations regarding nursing practice. Each island or territory usually adapts the system or recognizes the nursing license of nurses registered in their mother country or former occupying country. For example, if you are licensed in the UK, you can freely practice nursing in Jamaica, the Cayman Islands, Barbados, Grenada, and the British Virgin Islands. If not, they do, for example, in Jamaica and the Cayman Islands, recognize a passer of CGFNS or, better yet, NCLEX-RN for an RN to be registered in the roll of RNs there. RNs in the Netherlands can openly practice in St. Maarten, Aruba, Bonaire, Curacao, and Saba. RNs in France can work in St. Martin, Martinique, Guadeloupe, etc. The catch, however, is these islands have a common regulation regarding granting working permits. Before a foreigner is hired by a hospital or healthcare institution, they must prove that no resident is available or applying for that same position as the foreigner; otherwise, they will hire the locals first. In this case, the edge of foreign nurses will be the length of work experience and the area of specialization. In several cases, referrals from relatives/former colleagues already based there are very effective too.

"Actually, it's not necessary for a nurse to be a graduate of BSN. Because these nurses, they only want to be "room nurses." Like in America or other countries they are just like caregivers. THEY DON'T NEED TO BE THAT COMPETENT." She obviously doesn't know what she's talking about, it shows on how she used her own words to describe a nurse's work, "room nurse." What I can't and will never accept is when she said "they don't need to be that competent." Either we work in our home country or abroad, whatever our nationality, every nurse, LVN, LPN or RN, should and must be competent. It's enraging to know that someone, and a senatorial candidate at that, looks at us Pinoy nurses this way. Excuse me Ms. Villar, but I earned my BSN degree, passed the Philippine NLE, fought my way through a lot of hospitals to earn spots on trainings and eventually got employed, respected professionally by my colleagues superiors and ultimately, our patients. And now I'm settled abroad, it's all because I am doing my best as an RN, and not throw everything I worked hard for out of the window.

Is your dialysis unit on a RE-USE system, or you practice single use of dialyzers?

"Sir this is a hospital, not a hotel. The call bell is not for room service."

Certificate of Registration is the PRC Registration Certificate if you're an RN in the Philippines. If you're an RN in the US, it's your NCLEX-RN certificate. The Evidence of Current Registration can be your RN ID that states until what date it is valid. It can also be a certification from the Nursing Board that your nursing license is valid until a specific date.