kladouci

I would also recommend buttonholing technique if you have addressed the issues of heparin and fistulagrams. Another thing we do, simply to slow the bleeding is to apply gelfoam and reinforce it with tape. It works wonderfully but again is only a quick fix.

I often prefer the tourniquet but if someone has a "rope" in their arm I don't use one. I agree that if the fistula is underdeveloped that the tourniquet can be more harm than good. They shift too easily and are easily infiltrated. At one point to you begin accessing your new fistualas? We have a protocol in place where we initially canulate our new fistulas approx. 6-8 weeks after creation. we start with the arterial using a #17 for 3 treatments, then we do 3 venous #17 for 3 treatments and then we use both # 17 for 3 treatments or until the fistula works well. We keep our pump speeds to 200 during this time. I would be interested to hear how others do this.

Where I work we have a ratio of 1 RN to 3 Patients. It sounds like I have it pretty good. We do have tech aides who help string the machines etc. but for the most part we are responsible for everything else - accessing, orders, IDPN, Epo, any other meds, etc. My unit is a very active one in Ontario Canada. We have 21 patients that we dialyse in the morning, early afternoon, and again in the evening. Our unit operates from 07-2300 from Mon-Fri and 07-19 on Saturday and Sunday. We are closed on Christmas day and Boxing Day. I would love to hear more about your units, does anyone provide nocturnal dialysis in their organizations?

A couple of other things to consider: what type of dialyzer was being used, I agree with the hg, and quite possible clotting. What I found to be useful at times is to increase the QD to 800 for a couple of minutes, perhaps flush with 200 cc of saline as well, this generally will ease your symptoms of + TMP. Hope this gives you some other ideas.

Hi I am new to this forum but I have been a renal dialysis nurse for the past 2 years. I am from Canada as well, so some of your comments sound a little foreign to me. You made mention that on your chronic unit - please correct me if I am wrong - that your nurse to patient ration is 1:7? Wow. I am employed at our Regional Health Centre where our current ratio is 1:3 for most patients and those in ICU, PACU, and elsewhere outside of the unit are considered "off unit" are 1:1. Especially with antifreeze overdoses we can be pretty much at the bedside providing continual dialysis for up to 24 or more hours - this is not to be confused with CRRT - a completely different thing where I work. It is our responsibility to take the dialysis equipment, including RO machines up to the unit, assemble them and dialyse the patient. We take on call approximately 1-2 times in a 12-16 week period. Not bad. It is an excellent facility and I might like to invite you to come to Canada - Peterborough to be exact. I would love to hear more on how you operate in the States. Do your patients pay for their treatments? If so what is the cost and have you every come across a situation where someone was unable to pay and therefore had to withdraw? That would be tough. In Canada, anyone and everyone gets their treatments for free. What is your vascular access like? Mostly fistulas, grafts, CVC's? I think you would enjoy the acute patients as you become extremely familiar not just with the process of dialysis, but with the setting up as well. I look forward to your reply.:)

Hey, how does a Walmart greeter sound? Just kidding. I originally wanted to be a physician but I have kind of changed that to may be an esthetician (sp?). Something frivalous. And fun.

Although i am relatively new to this discussion I might add just a couple of points. When looking at this objectively one can see the following: a great nurse tried to help calm a restless patient down during the night shift (probably to aide other patients in sleeping I am sure), all of her required work had been completed up until that point, the patient was on a ventilator (which automatically alarms), and she inadvertently fell asleep while committing an act of compassion & caring. How often have we been able to actually sit at the bedside lately? Where I come from, not that often anymore. Too many tasks at hand. Although I am not a believer in sleeping at work I do feel that there may be other factors to take into consideration here as well. Lets face it, nursing is facing an extreme shortage, so for the sake of argument, lets say she kindly agreed to come in on her night off to help out her colleagues, because if she had not they may have had to work short. Secondly, ventillated patients are now on chronic floors as well, and as most of us know, they are not usually staffed so well since it is not such an attractive place to work. Very hard and physically challenging work - that is not to say other floors aren't as well. To say that a nurse must be fired over this when she has had not other strikes on her record is a grave error. Instead of looking to fire nurses, we must begin to empower them in order to keep them on the job. Retention is key to the livelihood and evolution of our profession. If we cannot retain the nurses that we have there is no future in nursing. Yes, the nurse made a mistake, but perhaps the circumstances were extenuating and I personally feel, this should not be treated so harshly and that organizations should seek to support their nurses in whatever way possible. I am not sure who commented on this but I strongly agree with the concept that we must stand up and support one another and not eagerly await for each other to fail. We must start caring for one another in order to nurture the profession that we all love.