chatty-rn

I work in a hospital based chronic dialysis unit and cover call at the hospital. When the ICU first got CRRT (prisma) the call dialysis nurse would go in and set it up (any time of day) and ICU nurses then ran it- monitor, change settings, etc. If it clotted off, dialysis was called back in just to set it up. It was a pain as it only takes about 15 minutes to set up and prime. Sometimes, esp if septic, would clot off 2-3 times the first hour, and then the lines would not work good. So if CRRT was started, dialysis call pretty much planned on staying at the hospital the first night. This went on about 2 years, then we let the ICU nurses take over completely, set up, connect, monitor, everything!! They call us if they have something with the catheter itself but now it's pretty rare anymore that we get called. Much better situation, let ICU do it all

Hi, which exam did they take? I see that there are at least 2 versions. Also, do your techs run pts? We have techs that set up machines, do blood pressures, stock and occaisonally hold sites. We are having them take the test, but I don't know how they will do because we don't use them in that capacity. We do have two techs that run pts, one came to us certified and one just passed her exam through ANNA.

Not good! The unit should be laundering the gowns if they aren't disposable. At our unit (hospital based) we use a different washable gown with each pt and it gets sent to the laundry. If we get blood on our clothes, we are to put different scrubs on and send the soiled scrubs to the hospital laundry. We do wash our scrubs ourselves if not bloody.

Just wondering if any other chronic hemo units are stressing from the new Conditions of Coverage regs?

I give IDPN (intradialytic parenteral nutrition) at a chronic unit. It comes directly to the unit from the company. The rate is already figured to cover the length of the treatment. Each pt. has an individulized prescription for it. We hook it by the venous chamber to the pigtail. We add the IDPN volume to the removsl goal. On the diabetic pts we check blood sugars pre-tx, mid-tx, and post-tx. Some pts get insulin at the start of the tx to cover the IDPN. Most pts have seen an improvement in their albumin levels and energy.

Hi, I work for a hospital and do chronic, acute and PD. I acute/call about once a week, all the RNs take turns from the chronic unit, we do weekend call-Sat and Sun every 2 months. We start at the chronic unit and if we have pts to do at the hosp. then whoever is on call goes and does them until they are done. So my day starts at 0600 and ends whenever, last night it ended at 2250. We now get time and a half after 1630 when we are on call. I get about $3.50/hour for carrying the beeper from 1630 to 0600. If I get called in I get a minimum of 2 hours time and half even if it only takes 5 minutes. Nice when we get called to set up CRRT or PD cycle. So yesterday I got straight time from 0600-1630 then time and a half from 1630 until 2250, then $3.50/hr until 0600, we never get double time. Then anything after my 40 hours of not call time is time and a half. Hope this makes sense

Just wondering what different units lock their catheters with. We use 1000unit/ml Heparin, does anyone use saline or stronger heparin? Thanks for your info.

I don't work med/surg so can't help you, but.... I'm exhausted just reading what all you're doing! Good Luck!

Hi, I don't agree with the dermatologist idea, but I think fistulogram to check it out and see if there are any problems that can be fixed before the fistula stops working. Good luck.

Are the staff rotating sites on the fistula? If they are going in the same area, it could cause a psuedoanuerysm and could get painful. maybe they need to do a fistulogram to check how well it's functoning. If it isn't a long fistula, doesn't have room to rotate, maybe it would be good to buttonhole it. Also, if they don't use lidocaine, maybe she could get an RX for EMLA cream to put on prior to acccessing. Hope some of this helps.

Does she have a fistula or a graft?

You made me giggle! I think it's crap too! I usually refer to my PD pts as my hobby. You should see my pt load when I'm training a new PD pt. HD pts in the morning, hopefully get to lunch, train in the afternoon, and if I'm really unlucky for the day, go back and take off some HD pts and chart on all. But, anyway thanks for the ideas, we usually get the Sw and dietician at the same time too.

I was wondering how PD nurses schedule the clinic visits. Do you schedule your visit separately or together with the doc? (we have one nephrologist) Right now I schedule them at a time convenient for the doc to coincide with when he does weekly rounds with the HD pts. Which means I have PD pts that day along with 4-5 HD pts. I'm feeling very overloaded on those days!! and yes, I have asked repeatedly to have less HD pts. those days but... that could take me on another long spiel. I have 7 PD pts to manage along with chronic hemo pts and doing acute care. I just don't feel like I am giving enough attention/time to the PD pts when they come in, esp. when I only see them monthly, I can feel the eyes of the other staff burning into me when my HD pts alarms are going off and their time is done and I'm still with the PD pt. Any suggestions or how you do things would be great!

Hi, I couldn't find anything about forearm being an accepted SQ route, I think they just don't want to have to push up the pts. sleeve or take off the BP cuff! If they think it is acceptable they should be able to show documentation that it is. Good luck

Hi, I just renewed my CDN, I studied from the same books as above. It wasn't too bad to take. I also did it "for me', but the hospital I work for did reimburse the cost of the exam. Good Luck