urrRN

Chronic

Does anyone have a protocol for achieving hemostasis in a AVF or AVG after dialysis, addressing things like how long pressure is applied, what supplies to use for dressing, etc. Everyone here seems to do something different.

Thanks, Rizenfly. This sounds pretty much like what we do EXCEPT the 3-5 minute betadine soaks. I know this is a practice I've seen in the past. Sounds like a good one. We'll give it a try. I appreciate any help with this.

I don't know what ESRD Network area you're in, but I'm sure your network has pretty much the same manual and tools as Network 13. Look in the manual or on the CD for the Provider Conflict Tool Kit. It's pretty helpful.

Can someone share their policies and practices regarding care of dialysis catheters? Our infection rate was up last month, and I'm wondering if we're using the best practice we can. We're a small (68-70 pts.) independent facility. I appreciate any input.

The URR and KT/V are actually specific to that day (when the blood is drawn) but should be a pretty good indicator of the adequacy of the pt's. dialysis. It's not supposed to be an indicator of their overall health. We do our draws on Mon. and Tues. We used to draw on Wed and Thurs, but the pre BUN is higher after 2 days without dialysis, so we get better KT/V's. We're forced to play the numbers game. The KT/V you get on the 2008K is actually a sodium measurement done without incorporating the pt. ht, wt, age, sex, tx. time, KOA of dialyzer, etc. The best thing we've found to use it for is figure out if the dialyzer or line is clotting. If the venous and/or arterial pressures start going up and the KT/V goes down, you probably need to flush the kidney.

I'm a nurse manager in dialysis and have worked dialysis for 10 years. One of the good things about nursing is we can try different areas and find our niche. I admire you for hanging in there, but if a job stressed me out that badly, I doubt I would have stayed. I've seen a lot of people come and go in dialysis, and that's ok. It's not for everyone. I worked in the OR for several years, and it was the same way there, a lot to learn and scary to a new person. I thought I would never learn it. Then one day it just clicked. Anyway, whatever you decide to do, good luck.