stressful situations in dialysis

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Hi:

I would like to receive advice from experienced dialysis RNs. I may get a job offer as a new dialysis RN fairly soon. I just don't know what kind of emergencies (life or death scenarios) can possibly arise while patients are receiving dialysis treatment. I have heard that patients may code / have strokes during treatment. Is this actually possible? How often are these situations likely to arise? what interventions would be employed to remedy such cases?

Also, what is a typical day like for dialysis RN's in general?

If anyone of you can offer some feedback on this topic, it would be really appreciated.

Thank you

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Specializes in Nephrology, Cardiology, ER, ICU.

Im an APN in 4 outpt dialysis units. Ive been at this job for almost 7 years. On average I have about one code a month and thats covering about 215 pts. Yes, codes can and do happen during dialysis. These are very ill pts to begin with. They also can stroke - again you are dealing with very frail individuals. Ive never been a dialysis RN so cant answer to those questions.

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Specializes in Dialysis.

One quarter of all dialysis patients become hypotensive during a treatment. Some worse than others. Depending on how you respond you may rescue your patient from coding or not. Some will have autonomic dysfunction while others will just have a big floppy heart. You also get to deal with swings in potassium and calcium levels that tend to irritate the heart. A strong cardiac background would definitely be an asset.

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Specializes in Trauma Surgical ICU.

In-patient or out-patient HD clinic?? In-patient, you will see more codes, sicker pts, resp distress etc.. Out-patient, I'm not sure about.. I work ICU so we get several pts from HD that crashed.

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Specializes in Nephrology, Cardiology, ER, ICU.

Outpt is becoming more technical too....we have had pts with LVADs, vents, other ongoing IV gtts for pulmonary HTN.

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Specializes in Trauma Surgical ICU.
Outpt is becoming more technical too....we have had pts with LVADs, vents, other ongoing IV gtts for pulmonary HTN.

Wow, impressive :)

Before going to the ICU, I was a floor nurse on a renal floor but they were "stable" came in for the usual missed HD, fluid overload, HTN crisis etc but no gtts or vents on the floor.. The ICU, we get them. Thankfully HD nurse comes to us for the unstable vented, multi gtt pt.

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It can be pretty routine. So don't let that alter you're attention. Usually they are mostly BP issues. A good pre assessment is essential. Once you know your PT's (if in chronic unit like me)

you can be pro active with there tx I've been doing this 13 yrs. I've never delt with air embolism or hemolysis. I've delt with codes. Keep up on CPR. Where I work we start CPR and activate EMS and they take over. Nurse 9

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Specializes in Nephrology, Cardiology, ER, ICU.

I've been in my position for 7 years now and we are getting acute dialysis pts now in the outpt environment too.

While dialysis can be routine, you don't want to get lulled into a sense of complacency.

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If you are working in an out px dialysis area. Always pay attention with hypotension. So monitored px every 30 mins. Or 15 mins specially wth the px who is hypotensive. So before you going to handle px. You should review the patient chart.

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i also want to be a hemodialysis nurse, but training is kinda hard.

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You should start reading books now specially nephro and cardio..

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