AcuteHD

Our hospital requires a consent for every admission, even for chronic pts and the ones that use the hospital for their routine treatments (uninsured). How does your hospital do blood consents?

The acute HD nurse that I trained with would routinely remove the nitro patches from pts prior to HD and said they are incompatible with dialysis. With everything else that I was trying to learn at the time I just put that into my knowledge box without really questioning it. But now that I am questioning it I can't find anything online to support it. Is that really an absolute contraindication? Obviously it could lower BP, but is that enough reason to remove it? I'll ask the doc tomorrow, but just wondering what other nurses are doing.

It looks like it went through a 'successful' trial 16 months ago, so where is it now? I can't find anything about it recently. What really caught my attention was that it recirculates the dialysate and only uses a pint of water. If they could build that feature into a regular machine it would be great for bedside treatments. Take a little acid, a little bicarb and a little water and no portable RO unit or hoses. I'm getting giddy just thinking about it.

I don't get paid per treatment, just hourly, but expect feast or famine. In my personal experiance I've never had a problem getting enough hours and have plenty of PTO banked up if needed. I work 4 days a week and take call on Sunday, your schedule will be site specific. As for when you can go in for a single treatment, that will depend on the doc you are working with (they have to see the pt while on the machine so do they want to come in early or stay late), the condition of the patient (if K is high you better get there before ER doc gets excited and orders kayexalate), what else is going on with pt (d/c after dialysis, procedure before or after dialysis). Rule of thumb, never put off a treatment that you can do now because you never know what later is going to look like. PTO and sick day benefits I guess are site specific, I get PTO. I don't have any experiance with 1099, sorry. I usually work by myself with 2-3 patients at a time, I would love to have a tech but that's been a non-starter since I've been doing acutes. If you have a tech, you'll need to justify it by taking on more pts per shift. I try to call for pts at 0800. This gives them time to have breakfast, labs resulted and docs are coming in. I am on call from midnight to midnight the day I work, but very rarely get called in. I may have to stay late if there are a lot of patients, but usually don't get called in. Good luck.

Update: My biomed talked with her boss and we all agree the water temperature is fine, the logs are wrong.

What's in the carbon tanks now?

Okay, I looked at this some more and I think our checklist is wrong. 18C is a great temp for both the RO and the HD machine, and our upper limit is way too high. (too late to edit post)

Where do y'all get incoming water for portable treatments from? All my hookups are from the cold water side and the water is COLD! Usually around 18C this time of year which is okay per mfg specs, but below or checklist min of 21C. I don't see the hospital adding a blending valve to all the hookups, but I don't know how else to get the incoming water to a passing temp. Any suggestions? Do any portable RO's have an integrated heater? Thanks!

What about pts that sign out AMA but need EMS transport? Is the hospital supposed to arrange that?

I've only been to our mourge once and it was definitely a low person on the totem pole job. Anyone that's never transferd a 250 lb body has no idea what dead weight really is.

That's easy. Find a brick wall and talk to it about Potassium, Phos or Fluid control. Then procede to bang head against said wall.

Too late to edit, but I should have said I am using what I have on hand as an example. Don't know what size dialyzers you are using. Thanks for the question.

The F200 has a prime volume of 112 mL, the F160 is 83mL. 29mL doesn't seem like enough to make a diff, but maybe. Also, unless you are wasting the prime, you're replacing blood with equal volume of saline at hookup. Can you challenge pt with a smaller dialyzer just to see?What about giving albumin to shift fluid? I feel your pain, hypotensive and overloaded is a bad combination.

Yes! If binders are ordered for meals they should be given with all food. There may be a meal dose and a smaller snack dose. Not all renal pts will have binders ordered, but it's kinda rare not to.

Sorry, should be 0.8 G / kG / Day

I spoke with the dietition at one of the clinics in my area and she said that pre dialysis pts need to restrict protein intake to about 0.8mg / kG to preserve their remaining renal function. However, once on dialysis they will need more protein and the restrictions no longer apply. She did stress that protein usually comes with calories which can be an issue. Along the same lines, please be sure to give phos binders 5-10 min before food or immediately after if ordered, they don't do any good if given long before or after. Calciphylaxis is a terrible disease Calciphylaxis - Mayo Clinic Hope that helps.

Thanks for taking the time to research this. I'm surprised the diet is just 'Renal Diet', look in the orders and see if K, Phos, Protein and fluid restrictions are specified. I have never worked in LTC so maybe that's the norm. I would think peanut butter and ghram crackers with apple juice would be a fairly safe snack. If they have a snack time binder order be sure to provide that also. But, as calroann mentioned, the best resource (by far) will be the dietition at the pts dialysis clinic.

I had to look that up, sorry I doubted you We are audited by JC as part of the hospital accreditation, what's the difference? Sorry, OP for the sidetrack, but you've gotten some good answers.

Are you talking about the same Farawyn that has 25,000 Likes? Or to put another way, over 3 likes per comment? Or to put it yet another way, 24,908 more likes than you? Yeah, we've seen her before.

I would think the issue wouldn't be bleed through (99 44/100% sure it won't) but infection control. You would have to dispose of the sharpie afterward. Like, right then and there after. You don't want ID on your case.

I think case management would be my 3rd career if I ever leave dialysis.

Hey, USRC here too. Also, our dietitian would be quick to point out there is no 'c' in dietitian. Lol, she has a thing about that.

Corrected Ca = ((4 - Albumin) * 0.8) + Ca When I asked one of the nephrologist I work with which value we should use he said, 'dietitians say the CorCa' but he was pretty much meh about it himself. Do we not correct the Ca for hyperalbuminemia also? I have been A quick online search didn't provide an answer except that the calculators will accept an Albumin level > 4

I'm not afraid to flaunt my ignorance here, what's the significance of Mg in this scenario?

Why not use her dialysis access? Seems appropriate for the situation to me. Unless she was a PD pt, of course.