imperial

Would that mean that -130 would be good. A larger needle was used, not sure why, but that is what nurse told patient. Usually AP runs -200. This was contributed to larger needle and nurse said that -130 was good. Never been below -180. Actually, don't know if this is related but patient has the best day, after dialysis, then she has in a while. I

Can someone explain the arterial and venous pressures. Would a 130 - 150 be considered good?

Again I have come to believe that nurses who work dialysis, as well as techs are 'caught in the middle'. The corporations are out to make money for the stockholders. End of that. So, forget the part about the corporate person who calls it a village. He might be nice etc but remember he,also is accountable to someone and that is the stockholders. Make money!!! I watched today one patient who always sits in her chair until she stops bleeding, however, due to more patients, she wsa asked to sit in a w/c until the bleeding stopped to give her chair to another pt. This is the part of getting pts in and out.. and meeting schedule times. I am sure it is hard on the nurses. The RN apologized and thanked her for moving to the w/c.. I thought that was nice, she did not have to. I see more and more every day at the units there is alot of tension and trying to keep one's head above water. Often it is difficult to ask these questions and some of our patients, can't ask or do not have the ability to ask. We do allw e can to ensure they get care that is quality. thx.

Well, It certainly is interesting. We looked at the patient handbook which clearly states that a temp after dialysis, after the patient gets home, can be a reaction to the dialzyer.. The Rn stated NO... well, should we go with the RN or the handbook for patients that the unit gives with information? Then one neph said from the dialyzer .. ofcourse, the patient, to my recall is also taking zemplar although all labs are wnl... pth is only 190 or less... having some GI problems now. maybe just the stomach flu.. hopefully will go away,, oh yes, pt is also losing weight. Now, to our understanding if a pt is losing weight, without this being related to fluid being removed, it couldmean they need more dialysis time.. so we were told.. hmm. whoever said so many variables, so true.. but it is interesting to get such a wide variety of explanations.. and, actually, could be one of numerous things. thx.

Sorry, did not mean strange that tylenol took temp down, strange that it happens after dialysis and no one knows why.... then it goes away. wonder if it could be some inflammatory process? thx. just trying to understand what happens with various pts.. considering when these questions asked of staff or doc they seem not to know.. :)

thanks all... what is really strange is that the temp went away with tylenol, but apparently the patient has experienced this before wtih dialysis. Any ideas, staff at unit and doc say.. 'i don't know'...........hmm

thanks :)

Is anyone familiar with why a patient would develop a temp of 101 about3 hours post dialysis? Took two tylenol and in am no temp. Staff at this particular unit did not know why. This has happened before - temp post dialysis (3 hrs) then no temp after tylenol.. thanks.

The bottom line is the care is only as good as that individual who is giving it. There is good and bad in all dialysis corporations, all hospitals, etc. I can not say that one dialysis company is better than another for I have seen good and bad in all of the companies. Therefore, I say again... care is only as good as the staff who are providing it.......................and, kudos to those who care and provide good care in spite of the restrictions that corporations place on them. Again, today I observed how hard staff work in one unit. The more patients the more money (corporate level/share holders).

Thanks J.B. that would make sense. I believe this patient has a 180 size dialyzer, is that what you mean? How does the venous pressure actually cause change in amount removed. thanks. tried to look up in various books to find out but could not find. thx.

Welcome. This is a great group of well educated nurses who have helped me, and, continue to do so, understand dialysis. I work iwth patients on a advocate level.

Can someone explain what is meant by 'tight heparin'.. Thanks

j'nette: thanks.. think it explains. Now, if a patient becomes dizzy and has hypotension after dialysis it could mean too much fluid taken off. So, let me make sure I am understanding this.... if the patient only has rinseback taken off.. but loses, let's say, .7.. that means that there was additional fluid to be taken off. I guess the part that is confusing to me is how the machine tells that it is not too much. I am always interested in the rationale/mechanics, etc. thks.. today.. this particular patient entered and left .1 under and 500 was goal including rinseback.. so, guess only .1 needed to be taken off... One patient told me that she was told she might continue to urinate for the remainder of treatment. She is in similar situation with fluid goal, etc.. again, thanks.

J'nette: Yes, the clinical manager stated that he did not know why it was .7 less. Yes, the goal or number in the UFR was 500. I tried to find this in the manual (machine) as well as two books but can't.. Again, thx. Three of our clients got 'ultracare' t shirts.

Hello all: WOndering if you can answer this question. I have read all I can and can't seem to find the answer. (two books and research online) If the UFR is set for, as example, only 500 (including rinseback) and patient does not have fluid taken off, but after dialysis is .7 under pre weight, what is cause? Also, if UFR were 500 (400 rinseback) 100 fluid removal and patient left at .7 under what would cause be. Thanks. I

I don't think in my lifetime that we will see corporate doing a case mgr due to cost effectiveness for the upper big wigs. Saturday, went in to unit when dropping off a patient and observed staff working so hard, along with one stating they could not get additional staff due to budget. So, do the top big wiggies really understand what goes into a treatment and the staff that are needed? I am not so sure. Ultra Care - I have been trying to find on the internet, as well as several of our clients asking for written document stating what ultra care is and we have only received the marketing/public relations written information. If any of you know the specifics related to delivery of care, besides single use, clearance, etc etc.. appreciate it. Back to single sticker. I thought I had read whereby a patient requested a certain staff, due to better sticker, that it was part of ultra care to comply with request. thx.

The 'consent and release' states... "This consent is not restricted by time or geographic limitation................." For those of you who are not aware of this 'consent and release' that was given patients to sign without explanation..........''' I.................hereby grant to National Medical Care, Inc., its parent, subsidiaries, affiliates, and agents (the "Company") the absolute right and permission to use, publish, broadcast, and copyright my voice recording, name picture, and likeness, or anything made from it, in any manner or media whatsoever for purposes of advertising or trade in promoting and publicizing hte Company, including without limitation the Company's UltraCare@ brand and its locations, items, goods or services. 1. I agree that any voice recording, picture or likeness of me, or anything made from it created by the Company is owned by the Company. 2. I agree that I do not have to approve how the Company uses my voice recording, name, picture, and likeness, or anything made from it and that I will not be paid (now or ever) for my persmission to use my voice recording, name, picture, and likeness, or anything made from it. I agree to not to sue the Company for using my voice recording, name, picture, and likeness, or anythning made from it or due to any alteration, distortion, or illusionary effect, or use in any composite form (incluuding, without limitation, a lawsuit based upon invasion of privacy, defamation, or right of publicity). Looks like FMC sure did cover their behinds. Saw this on another board, found it very interesting, also. Is this taking advantage of patients? Am curious if anyone knows. Does the UltraCare program say that one staff can cannulate one patient, if the patient so chooses to have a certain staff. I saw a post regarding this situation and was curious. J'nette: I appreciate your responses and oh yes, these have been addressed with those at higher levels, often. As a matter of fact, one patient, as a direct result of her addressing a specific problem encountered direct retaliation and was told 'if ya don't like it leave"..........:) sorry to burst your bubble :)

I was surprised that this was being done during work hours.. but, after hearing about the consent that was needed to be signed by patients, I am wondering if they will be taking pictures as that is what the consent said.. that fmc could use pictures or any taped verbal statements for their advertising and pat would not be renumerated, nor could sue in the future for renumeration. I just think that is interesting. IT is like the patients are on exhibit. As if staff does not have enough to do.. I have been thinking in all my 30 yrs of healthcare experience I have only once been asked what I think and that was in a management position. However, I did, during staff meetings and individual 1 to 1's ask my staff what they thought would improve deliveyr of care.. Personally, I tihnk it is terrible that the industry does not take feedback from nurses. Do they not realize it is the nurses that are d ealing at the level whereby they can give input that is realistic and sensible, along with what is best for patient. ANother thing that is most bothersome is such that when a medical director of a large company, i.e. Dr Lazarus of FMC, or any others does not understand the nursing problems and putting patients in jeopary,,, what is wrong with this patient. I truly believe that once the upper crust experiences what it is like to have a family member or significant other on dialysis, or in a critical situation, will they, maybe, perhaps, understand and realize what it is all about.

I just heard from a few patients giving information regarding the consent the signed for the ultracare open house. They have told me that information is related to them signing a waiver saying that FMC can, at any time/place, use them for advertising purposes... using their name, picture and taped voice. It also further states that the person who signed the consent can not sue FMC and will NOT receive any money from any advertising, etc. I am wondering how many patients actually read this release for open house, etc and it they truly understand that their name MIGHT BE used in public for advertising? I know, not only from person experience as a nurse, but now, that often many staff will just say to the patient..'here is a paper to sign giving consent for the open house;'...............now,, what are your thoughts on this...

I truly admire all of your and what you are stating. Having worked with several patients at FMC units they are telling me that it seems unfair if their family members can't be with them during put on and take off, but visitors on open house day will be. ALthough, one person stated it will be betweenhours of 11 and 2.. Although my work is mostly (volunteer advocate) dealing with doctors appts, clarifying situations, etc. I am finding this entire dialysis world quite interesting. I noted that FMC has been given yet another supeona. Not sure if it is the same as before which has to do with the testing of pth and administration of vit D and charging. Interesting how some of the staff at FMC units are praising over and over the use of single dialyzers when I am not sure they fully understand what a money maker it is and does the company REALLY believe first in patients, or first in profit. FMC makes it own single use dilayzer then charges each time. Definitely profit making verses reuse. .. even tho it is better for the patient. It would be nice if FMC gave staff better salaries to compensate them for what they do.

I appreciate your understanding. Several of our clients (patient advocates we are) have said that their staff have stayed late, worked holidays etc in order to give them treatments.. and all the staff asked was for patients to come in 1/2 hour early.

Does anyone know about the FMC 'open house' that the units are going to be having this coming week? I have heard, from several, that numerous states (Louisiana, California, for example) will be having open houses? Also, what happens at an open house and does the patient have to sign any kind of paper for it? Thanks.

Yes, you do understand the mechanics as well as others on this board. The RNs need to be skilled.. I appreciate bringing to my attention that one years experience is pretty standard... however, just seems there are so many things that can go wrong and that more experience would be needed. thx.

once again, thank you all who provided information. I must say that recently I visited an elderly patient at a unit, after driving them there.. The staff were overworked, running like crazy and I, better than anyone, realize and KNOW that staff do not intentionally make mistakes. I appreciate the hard work that staff do on those that I am connected with. I must address whoever stated that I am looking for mistakes that staff make, etc.. NO WAY!!.. trying to understand. I had the pleasure to attend one care plan meeting of a patient of whom I work closely with, as a patient advocate/ombudsman (volunteer) and must admit that the information received is more detailed here at this site. Thx...

I am not and refust to stoop to your level of rudeness. I am NOT a paid anything for the prosecution, or whatever/whoever you state. Furthermore, I don't need to justify to you and do appreciate the responses of truth and experience that are shared. The situation in question was witnessed by two patients... emailed to me....re concern about what could happen. The blue connecter was connected to jug. The red connector was not connected to anything either in the wall or in the jug. It was not until the patient asked 'isn't there suppose to be two jugs' did the staff go and get another jug and connect to the red connector. The jug had written on it 3k 2.5 ca.. the staff stated clearly that there was another patient on themachine prior,, therefore, basically stating that before the next patient was connected to the machine there was not check to ensure accuracy of what needed to be done. I find your defensiveness eye awakening and hope you don't respond with such distaste when your patients ask questions. Again, I do so thank those who share their knowledge. This staff was not rude, nasty etc when the patient asked the question. My simple question was what would the patient experience should there not have been the accurate bath.. thanks.