What should EVERY nurse know about Dialysis

[Twink]

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?

[dianah, ASN]

Twink (or traumaRUs), would you consider writing an article on this and submitting so it's viewed by more nurses?

Knowledge is power, and all that. :)

[traumaRUs, MSN, APRN]

Twink - what about you? Dianah has a good idea - have you got time?

[anurseadvocate]

Some dialysis units let patients eat, others do not. As far as eating foods with potassium, phosphorus, etc. I would certainly have the Dietician go over the diet with the patient. It is very important because it has alot to do with the bath also. Alot of nephrologists, I have found, will leave the bath at 2K and it gives the pt more leeway to eat certain potassium food, esp if the patient loves food wtih potassium in it.

[traumaRUs, MSN, APRN]

This is not sound medical practice. Pts should adhere to a low K+ diet because if there are unforeseen events and they miss dialysis, they can and do die of hyperkalemia.

I know of no nephrologist or mid-level worth their salt who would advocate a 1k bath just because a pt wants to consume high-K+ food.

You are just asking for a lawsuit.

[Twink]

I will work on something. I am going to inservice my fellow home care associates on the basics of care for the home care dialysis patient, gathering as much feed back as possible.

[mrwelter]

This is not sound medical practice. Pts should adhere to a low K+ diet because if there are unforeseen events and they miss dialysis, they can and do die of hyperkalemia.

I know of no nephrologist or mid-level worth their salt who would advocate a 3k bath just because a pt wants to consume high-K+ food.

You are just asking for a lawsuit.

A 3k bath is not a low k bath. A 1 k bath is.

(:) Only commenting to prevent confusion.)

[traumaRUs, MSN, APRN]

Ooops - my mistake - shouldn't type when I'm tired.

Yes, a 1k+ bath is low potassium, a 3k bath is the highest potassium bath.

Sorry for the confusion.

[nursezilla]

When patients are on dialysis they should not eat. Choking is a big concern. Doing the Heimlich on a patient strapped to a dialysis chair while watching the needles is not a good idea. Secondly, during dialysis your blood pressure drops naturally due to fluid removal and lower volume in the body. If you eat, digestion will cause the blood pressure to dip down further. Turning the UF (fluid removal) off when the blood pressure crashes is counterproductive to treatment.

[sunfirebsn]

There was a patient in a clinic I worked at who was on a 1K bath for at least 3 years, she is probably still on it today. Her K was normally over 6 with labs. Under 6 was a miracle! Dietary education from everyone was no use.

[sissib]

The best time to eat is not while on the dialysis machine. Some of pt's blood is in the bloodlines, while eating, a lot of blood goes to digestive system. That leaves brain and heart:redbeathe short of blood, then blood pressures drop to dangerous levels.

[lenovo]

Eating during the dialysis treatment causes sphlanic effect thus the patient's blood pressure dramatically drops.

Sometimes, if the blood pressure is okey or above the normal range, we allow the patient to eat during dialysis session. We just monitor the patient's blood pressure regularly.

[jb2u, ASN, RN]

I wish doctors understood this, too!! We wanted to make it so that they couldn't eat while on dialysis, but we can't get the patients or the doctors to go along with it. We do not allow patients with low bp's or new starts to eat, but in general everyone else eats.

A lot of floor nurses think we are just being mean or lazy. I actually had the opportunity to "show" some of them the fluid shift while eating by showing them the critline machine while the patient is eating. It is something. You can see the blood volume drop and after they stop eating it goes back up!!!