seppuku

Do you guys not do Access Flow testing? We do ours monthly and it basically tells us the blood flow through the fistula or graft. You can then see monthly trends if the flow is getting slower. If it's coupled with increasing arterial / venous pressures, difficulty with cannulation, or attaining prescribed blood flow then you know it's certainly time for them to see their vasc. surgeon. I can't begin to tell you how many AVF/AVG's have their life prolonged by doing access flow testing.

Here is what I know. The field of nursing does not allow time for everything to be done by the book, it is impossible. EVERYONE does shortcuts. Shortcuts such as drawing all your meds at the start of the day, using clamps on every single patient, rinsing back patients the fast way, etc... I think it's good to know the right way of doing things AND know all the shortcuts. Time management is the single most important trait a nurse can have. NOT the ability to do everything by the book. Always know how much time you have for each task and do that task as closest to the P&P with that amount of time. If you have to shortcut, as one of the posters above said, make sure it is still safe for the patient. There is ALWAYS more than one correct way to do things. Look at your situation as a whole and do what you think is best. The last thing you want is have patient crash on you because you ran off to change gloves and wash your hands with soap and water for 15 seconds going between patients.

First of all, no not all three modes are part of every dialysis. Ultrafiltration, yes. But UF and sodium profiling are only used for certain patients. Majority of patients do not. Now, to answer your questions: 1- No. As far as I know, profiling and modeling are used interchangeably. 2- Not necessarily. Although I really don't know what you mean by phases and how it is relevant to UF profiling. In general, UF profiling removes a large amount of fluid at the beginning of treatment, and a small amount towards the end (to give the body time to refill the vascular space). Each dialysis machine has its own unique profiles and if you look at them, it will show you the rate fluid will be removed from the patient over the course of treatment. Sodium profiling has three main profiles that I know about: linear, step, exponential. Basically, sodium profiling will start treatment with a higher sodium level in the dialysate and lower it back down to normal by the end of treatment. It increases a patients serum sodium level to help support blood pressure during treatment, and also thought to help prevent cramping. Can be very useful when used in conjunction with UF profiles. 3- Is this even a question?

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​I'd agree with the doctor and wouldn't send him to the hospital unless he became septic (fever, hypotensive, etc...) because other than positive cultures and pain (normal for uti), he seems okay. It's when the infection gets into the bloodstream that you should be really worried. Try ask the doctor if he wants him referred to an infectious disease doctor. They are specialists and usually know the best treatments for recurring infections like that. But given that he had so many infections with all different organisms though, my guess is he plays with himself without washing his hands >

1) Yes its true you don't need dialysis nurse certification (CDN/CNN) to get hired. For my company, it is optional and we get a tiny tiny raise if we do get it. 2) There are more than 2 types of dialysis nursing. The main ones I can think of right now are acutes, chronics, home therapy, and peritoneal dialysis (or travel RN, if you like travelling). I've only done chronic, but I heard that acutes is much easier since you're only caring for one patient at a time. However, you have to do everything yourself including machine setup, cannulation, monitoring patient, and machine disinfection. If things go wrong with the machine or the patient, you are on your own and need to know how to fix it. Home therapy I heard it easier than chronic also but supposedly it's busier in the sense that you have more paperwork to do. I think chronic is the best place to start though because you get more patients, which leads to more exposure and faster experience. I like chronic HD, and would like to try acutes but I don't like having to be on-call, just sitting at home waiting and wondering if some ESRD patient is gonna be admitted to the hospital and ruin the rest of my day 3) Well you definitely don't want all those need sticks to the fistula itself lol. It's not super bad like you'll lose your job if you do it somewhere else on the same arm though, as I heard that for some patients it may be preferable. For example, we had one patient who repeatedly had IV/blood draws done on the opposite arm and the accumulation of sticks/infiltration prevented it from being his last future AVF site. But really, I don't know anything about that. All I know is that we CAN draw it from the fistula so we're lucky

I wear black, grey, and dark colors because honestly, they look cool. No patient has yet to complain of my scrubs being depressing because 1) im wearing PPE like 80% of the time so all they see is white anyway and 2) its all about your attitude. If you have a good attitude and are wearing black, i doubt patients will get depressed from the color. as other people have said though, the bleach drops do suck and my black pants got some nice faded pink spots on it but whatever, dialysis nurse trademark right?

as one of the other posters said, your techs will make or break you. If they dont know what they're doing or are just plain lazy, then you will suffer. My usual crew of techs is fortunately very good and even when I do 16 hour shifts, it seems only like 8. Don't be scared, just learn as much as you can. You will be seeing the same patients every other day and be doing the same exact job everyday. You will get good at it naturally with experience. If not, then I would quit.

UF profiling basically adjusts the rate that fluids are taken out of a patient. With no UF profile on, the machine will remove fluids at a constant rate that is determined by your fluid goal and treatment time. With Uf profiling, you can alter the rate so that it takes out more fluid during the beginning of treatment and less at the end. If you look at the picture of the different profiles, it shows you how the UF rate will be altered throughout treatment. UF profiling helps with patients who are trying to remove larger than usual amounts of fluid and often cramp or go hypotensive near the end of treatment. It's very rare that a patient will cramp within the first half of treatment so might as well take out the most fluid during that part, then when the rate slows down, the body has an easier time replacing intravascular fluid. For me, if cramping or hypotension is the problem at the end of treatment, I would try profiles 1 or 3. I have not found a single patient yet who likes profile 2 or thinks it works better than the others. Now, assuming you're using the fresenius K or K2 machines, profile 4 is the intermittent profile (looks like teeth on a comb). it alternates between periods of slow and rapid fluid removal, then levels out towards the last half of treatment. I've always imagined it like testing hot water with your finger. At first, you dip your finger in and take it out super fast because the waters hot. then the second time you leave it in a little longer, then the third time longer, until finally you get acclimated to it and can leave your finger in. Its the same way profile 4 tests the body, by rapidly taking out plenty fluids for a short time, letting it rest, and then repeating, until the body is acclimated to fluid removal. for some people it works well, and for others not so much. It is my go-to profile for people who start out with low bp and have medium or high goal settings.