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diabo

diabo RN

hemo and peritoneal dialysis
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diabo has 18 years experience as a RN and specializes in hemo and peritoneal dialysis.

certified dialysis nurse, piano technician, part time professional clown

diabo's Latest Activity

  1. diabo

    Clinical nurse manager without any training

    You sound like a caring and smart nurse. I say go for it. You will continue to learn. You may get some flack from the other staff people, but with a great and non threatening smile you will do well.
  2. Obviously an upper arm fistula or graft is out of the question, especially because of the location of the anastomosis. The blood flow should never be cut off for any reason. This includes holding pressure to stop the stop the bleeding, or improper use of clamps. In the latter, blood flow should be confirmed above the clamp. Personally I feel, and many doctors agree, clamps should never be used because of the possibility of damage to the access.
  3. diabo

    Too gutsy??

    I applaud you. It takes a special person to work with the little ones. Keep’em smiling🤡
  4. diabo

    Too gutsy??

    How young can these patients be?
  5. diabo

    TIPS ON CANNULATING FISTULAS AND GRAFTS.

    Practice practice. Your smile and confidence will assure your patient. Removal technique is most important and is not always emphasized enough in my opinion. It needs to be taken out as straight as possible with no pressure until it is out, or the razor sharp needle can tear the vein . Even a slight tear can greatly prolong the clotting time. As your confidence grows you will speed up and it will become second nature.
  6. Much cheaper than Citrasate http://www.rockwellmed.com/Collateral/Documents/English-US/CitraPureRevised.pdf
  7. In our 20 chair. 100 or so patients, chronic unit (hospital owned) we use Citrapure only, delivered into the bulk tank. Many patient's don't even require heparin. We still use jugs here in acute.
  8. We use a citric acid soluton for the acid portion, Citrsate or Citrapure, in combination with a 50cc bolus q30 min, with the volume added to the goal. These kidneys should NEVER be primed with heparin, I don't care how many times you rinse them. Read up on HITT! It's bad news.
  9. diabo

    Hemodialysis Troubleshooting

    Sometimes the Dr. will order the Hansens to be reversed for a few treatments to help avoid disequilibrium syndrome if the BUN is really sky high. This doesn't effect the fluid removal.
  10. Many anti hypertensive are pulled off during treatment. Because of that, some of these patients need a bp med like Clonidine mid tx. Also, lowering the QB to 300 and QD to 500 and raising the temp a little can sometimes help. Dehydrating the patient doesn't always result in a lower bp; it can sometimes raise it. They can still crash. Many of these AMA folks will eventually end up in the ER and have to be dialysed by me, or someone else on call at 2 am when their potassium goes to 7.9, or they need to be run back to back for 3 days to keep them off the vent. We need scare these patients a little and explain to them that an enlarged heart will eventually become a big useless muscle. Most dialysis patients will die from heart failure, not kidney failure.
  11. I'm sure you will earn the respect for your commitment to the little one, and to your job.
  12. diabo

    Ultrafiltration Profiling

    Just make sure you have s doctor's order for the sodium deviation, because it is a medication. Our docs don't allow sodium modeling, because it can be tough on the heart, and doesn't completely clear in the last hour for many patients. I'm a critline guy. I rarely see a crash.
  13. diabo

    Patient's PD Drainage

    If the patient uses any supplies from the hospital, or if the staff takes any time with the patient, they are charged for the procedure, and therefore we are their servants, as long as we "do no harm." Just make sure everything gets charted in a factual way.
  14. diabo

    thrill and Bruit

    You know you are a good dialysis nurse when see one of your patients in grocery store, like I did last week, and you grab her arm and begin stroking it saying, " I can feel your nice thrill." I knew her arm and she knew my touch. We both started laughing, as some of the other customers started backing away from us with strange looks on their faces. :hug: Steven
  15. diabo

    Foley insertion on a male patient

    So glad I don't need one......................yet:crying2:
  16. An AVF is the patient's own vein. It's just been arteriolized, or toughened up, by being attached to an artery, giving it a pulse with higher prressure. It usually takes six or more weeks before it can be used for dialysis. A normal vein cannot be used for dialysis and should never be attempted. Permanent damage can occur. These folks need all the vein options they can get for future accesses.