Question about patients receiving dialysis

[malenurse122879]

Is it your nursing home's policy for the nurse to assess the patients catheter site to make sure its free of infection when making their start of shift assessments? Specifically a patient that receives dialysis at a dialysis center three x's a week?

[kdhnursern]

As a former dialysis nurse, my recommendations are: NEVER remove the dressing over an IJ for every shift assessment. Just assess for clean/dry/intact/complaints of pain/fever. IF the dressing should become wet during shower, THEN you can do a clean dressing change maintaining the position of the IJ. What you remove, replace with clean. If it is during the operation hours for the dialysis unit, give them a call and follow what they tell you. DO NOT REMOVE THE CAPS FROM THE PORTS!! For the AV fistula, check for thrill/bruit every shift and notify dialysis unit of any problems. This can be reported to the dialysis unit but is not an emergency that needs called to the physician in the middle of the night. Never use the access, IJ or fistula, for blood draws or med administration as it is their lifeline. If there is a life and death problem and maybe the ER needs blood or med admin and cannot get a IV started or lab drawn, it is then that an IJ/fistula can be used as...again...it is their lifeline. I have gone from dialysis to the ER to access the IJ port for them and then repacked to keep it functional.

[PennStudent]

I just note the condition of the dressing and of the surrounding skin, and any sx infection or c/o discomfort on my one HD cath. For an AV fistula, I note presence of thrill/bruit.