What should EVERY nurse know about Dialysis

Published

I am a dialysis nurse turned home care nurse...live in a rural area that recently has had a dialysis center open (I work there PRN). With this opening the local home care agency has seen an influx of dialysis patients...and due to conflicts of interest I can not be their primary home care nurse. I am planning an in-service focusing on basic need to know info on dialysis patients and care needs. So I ask you, the dialysis nurse....what do YOU wish EVERY nurse knew about the dialysis patient?

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

Whew - there is so much. I'm a nephrology mid-level:

1. No BPs, IV sticks, finger sticks in their access arm.

2. Check for thrill/bruit in access and document.

3. Many medications, especially anti-virals MUST be renally dosed.

4. It does no good to give an anuric dialysis pts diuretics.

5. If they are SOB and/have edema, think dialysis - maybe they need an extra treatment or a PUF.

6. Cardiac disease is what kills dialysis pts - chest pain should be evaluated in an ER.

Up Vote Up Vote ×

Thanks! Anyone else??

Up Vote Up Vote ×

Im not a dialysis nurse but one thing that acute care dialysis nurses felt like floor nurses should know at my particular workplace (hospital) was that after dialysis

PLEASE REMOVE THE PRESSURE DRESSINGS WITHIN 3-5 HRS after HD; unless notified by the dialysis nurse in report to dont remove the bandage.

rationale: something about the site clotting off and potentially cutting off access to continue treatments.

I do so with caution b/c Ive heard of a dialysis patient profusely bleeding out from the site....so I monitor my patients for bleeding.

Very limited knowledge on the subject...(please get a second or third or 4th or 5th opinion)

Up Vote Up Vote ×

Infection control education as that is the number two killer of dialysis patients.

Dietary restrictions, collaborate with the dialysis dietian.

Up Vote Up Vote ×
Specializes in Dialysis (acute & chronic).
Im not a dialysis nurse but one thing that acute care dialysis nurses felt like floor nurses should know at my particular workplace (hospital) was that after dialysis

PLEASE REMOVE THE PRESSURE DRESSINGS WITHIN 3-5 HRS after HD; unless notified by the dialysis nurse in report to dont remove the bandage.

rationale: something about the site clotting off and potentially cutting off access to continue treatments.

I do so with caution b/c Ive heard of a dialysis patient profusely bleeding out from the site....so I monitor my patients for bleeding.

Very limited knowledge on the subject...(please get a second or third or 4th or 5th opinion)

These patients should not have a "pressure dressing" on their access site. there should only be a small amount of tape or a bandaid.

You do not want to occlude an access off, the access should be checked on both side of the dressing for a bruit and thrill to confirm there is flow.

The bandaids or 2x2 with tape should be left on for 12 hours, in case of bleeding.

Up Vote Up Vote ×

I have been a paramedic much lionger than I have been an acute HD nurse. But I apply the concept that we always had said. A wound is like a women, keep it dressed you never get in trouble. Leave the 2x2 gause in place and more than anything hold or have pt hold it. I ve always follwed this and have no prob with it. Its when, just like a women when you don t pay attention to it that you get in trouble. Dialysis pt s have a lot of co- morbidities, goes with the turf. The number 1 concern/ prob. is infection. Always a culprit.The other thing that I would ask of my fellow nurses with in hosp. to understand is DAILY WEIGHTS. I can never stress enough of the HD pts wt.

Up Vote Up Vote ×

Thanks! I, also asked this question on the Home Care site...got a very different type answer! Also, PLEASE do NOT put a pressure drsg on the access site EVER! We struggle daily with our local ER with this....always a pressure dressing and always a call after hours once the pt gets home to have it removed. UGH!

Up Vote Up Vote ×

---Give their medications after dialysis--they might get washed out with dialysis.

---Many doctors think--hey they are on dialysis, we don't need to decrease their antibiotics or medications--not true.

---Give them handouts for food to lower their potassium, sodium, and phosphorous which can harm them (they probably won't follow them real close but at lease they have it)

---Make sure that they take their phosphorous binders with their meals!!! It doesn't do any good if they don't and you wouldn't believe how much they cost (several hundred dollars a month sometimes)

-- Have the patient call their doctor before taking any over the counter medication even vitamins--they can do harm.

--Not every patient will have chest pain--remember a lot of these pts are diabetics and they don't feel pain that way.

Up Vote Up Vote ×
Specializes in Nephrology.

i have a question:

Isnt it when theyre on Dialysis it's the best time for them to eat anything? or still should be monitored? i just remembered years ago on my clinicals the nurse told me when theyre on dialysis thats the best time they can eat... just enlighten me thanks :)

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

No - eating on dialysis causing shunting of the blood to the GI tract which results in barfing and barfing, and hypotension, diaphoresis.

Bad idea.

Up Vote Up Vote ×
Specializes in Dialysis.

no eating on the machine!! lol. I don't want to watch you puke and cramp and pass out.

Up Vote Up Vote ×
+ Join the Discussion