Loveyourkidneys

In texas that is against regulations.

It's hard when they have no insurance but their addiction keeps them from working. Another FAIL of our healthcare system.

Thank you.

Where would I direct someone who had a family member finally agreeing he needs inpatient rehab for meth addiction? He is 35 with no insurance. Thanks you for any advice or direction.

Why not the rolled gauze? Never heard that so I'm curious. We have two hero grafts at our clinic. Maybe I'm doing it wrong [emoji37]

If you have supplements like nepro (like ensure for renal pts) give them that. Protein and sugar in it. We also have popcicles in fridge and candy. In reality you most likely aren't gonna have a lot of "groceries" in an out patient clinic. Well unless you work where I do where one of the techs keeps it all in the fridge and cooks her meals there. Lol We do have a glucometer in clinic for sure! Depending on type of glucometer depends when you QC them. Our policy is when you change solution or strips (which I change together and throw out together 90days after opened) or the meter has been dropped or its suspected it might need it. I typically do it weekly.

We do weekly hgb and pt/inr (if on Coumadin) Bimonthly hgb calcium and phosphorus Monthly Cbc with diff, cmb,alt,ast, tsat, urr, glucose, hepb antigen Quarterly tsh, hgba1c, Pth,ferritin hepb antibodies Annual includes a few others I can't think of. Aluminum is annual and psa on men over 50 We draw our labs routinely on second tx of the week Our new pt admit includes all routine annual lab with hepb core Chart that you told patients to bring meds and they didn't. :) We do access flow tests the tx after monthly labs. That way we don't forget them. And we can compare urr and access flow drops. Our doc does foot checks on rounds. By that I mean I check them he documents. I am very spoiled to that! Our dietician is the only one to open a care plan the. We fill in our parts and print it out for signatures. Oops I just realized you said Fresenius people. Lol. I work for us renal. But that's how I do it. :)

Texas regulations: charge nurse can have 12 patients. Not sure where 18 is allowed?? That is too much

Stay out of the coil when cannulating and don't let their bp bottom out or it will clot. NEVER EVER EVER EVER CLAMP ONE. EVER!!!! They have this as a last option. Take the time to hold sites.

I have been working in dialysis for 5 years and I in no way know it all about dialysis. I learn something all the time. But I'm inquisitive and need to know the why behind everything. I personally wouldn't want a manager who didn't know anything except "book info" about dialysis. It's a real art learning it. No degree can teach how it really flows out there. I definitely think a manager should be a competent safe floor nurse first, then charge nurse then manager.

Just wondering if anyone knows specific amphetamines that dialyze off. They have a short half life right? So maybe it's just "time for a fix?"vitals are WNL start of tx or possibly a little high. 3 hrs in... Bp is off the chart and non responsive to clonidine.

We have a fairly new patient who tested positive for amphetamines in the hospital but denied it. Lately she comes in fine but 3hrs or so into treatment she gets ridiculous acting nervous and jittery and wanting off NOW. QUESTION: Can we be dialyzing drug off and forcing her body into withdrawal??

I work at an outpatient dialysis clinic. We have two huge bulletin boards. I like to keep them cute yet educational. (12yrs in preschool before nursing school) any resource ideas?

Report and redness or pain. You should listen before sticking EVERYTIME (however it rarely gets done in the real world) report any hand numbness or pain on access arm (although it isn't alway abnormal) report excessive post tx bleeding for more than 2-3 txs. Arterial side should always sound louder than venous side. If you can't tell which side is arterial occlude at the anastomosis and then listen. Venous should be almost absent bruit with occlusion. Tourniquet should be used with fistulas. Always alway always butterfly tape your needles down. And never allow PTs to cover the access with blankets. They will gripe and whine but eventually comply. Chart EVERYTIME you ell them to keep it uncovered if they are one of those that cover it. We coded a lady should dislodged her venous needle. Charting pt education about keeping uncovered saved our tails :)

It's says a lot about your work ethic which your coworkers appreciate.

We do access flows in all our PTs. Can someone tell me about the >2000 reading. Some say oh that's great but some say no. I can't get a direct answer

I usually work 515am to 6pm MWF. I work Tuesday's prn at another clinic. I typically end up working 45-48hrs a week

I got a ticket on my way to work in Christmas Eve. I was going to the office to pay and discuss the officers very rude behavior with the prosecutor. (Not trying to get out of the ticket but really 7 miles over at 345 am Christmas Eve) what a jerk. As I was talking to the prosecutor, her secretary came in to bring some papers. She stopped in her tracks and ran to hug me and started crying. She said "this lady here is the nurse who took care of my brother before he died (on dialysis) she is the reason I got to say good bye to him" I still paid the ticket but that sincere thank you hug was worth soooo much more

Thank you for taking the time to say thanks. It's like a recharge to hear thank you every once in a while.

Sounds like you work at the prn clinic I do! Omg I feel the frustration. I refuse to increase their goal to "get off the fluid" unless it's a medical/family emergency. The dr is always aware of it and the patient signs AMA prior to being taken off. The techs love it because it starts turn over and they can RUSH the next one on. My full time clinic... The dr reads and questions the patient over every AMA signed. I keep a folder on the rounding cart. We have only one pt to ever sign off their. We have tons of non compliance documentation on her too. And I remind her frequently of the "time she died and had CPR" sometimes that keeps her on.

Gonna be hard to explain in court why you were responsible for that many patients. Tx state regulations say if a nurse is in a bay of patients as the primary tech he or she is responsible for only those four patients. That includes pre assessment, tx initiation, monitoring, meds and post assessment. There is still supposed to be a charge nurse do rounds to verify rx, goal access.

I started with no experience at $27 for one of the big 2. I work for a smaller co in a rural area 1hr from the nearest hospital now. They were having trouble getting a full time RN because it's out in Timbuktu. Luckily I have lived here all my life. I started at this clinic @ 32.50. I've worked here 2 1/2 yrs and make $36.25 now. I looked into a career change and talked to my manager as a friend not a boss. She went to her supervisor and asked for $2 more an hr to keep me. That's why the almost $4 increase in only 2yrs. I am in a 24 chair MWF clinic and it's just me and the manager As the only nurses so I have a lot of responsibility. (I'm in east tx) I wouldn't start at less than $27

We always leave the line unclamped during recirculation. Then dump the prime before tx starts. I was worried wondering how concentrated the dialysate is. I didn't want to be giving a huge bolus of potassium if the bag filled and someone missed it. Thanks so much for yor input

The non sterile part is what I'm concerned about. The patient was never on the machine. But if they were the line would be clamped. That's how know it isn't salkne. The line is clamped in two spots but the bag fills. I asked an area biomed who says to check valve 42 and change the air separator.

What symptoms would I be looking for if I suspected patients dialysate had gotten into their blood stream? Fresenious had a voluntary notice sent out to anyone who uses a certain type of machine. Where the filling program stays on backing up into the saline bag. Ex. You've primed your machine so you should not have a full saline bag. Filling program stays on and next thing you one you have a bulging saline bag. If you suspect that the patient may have gotten dialysate rinsed into them... Symptoms to expect??