What should EVERY nurse know about Dialysis

Specialties Urology


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?

Specializes in Dialysis.

No!! It still needs monitoring, as well as fluid. Also pt's should only have light snacks during tx. Having a meal frequently causes bp issues, as well as other issues while being dialyzed.

Specializes in LTC (LPN-RN).

Patients eat all the time at my clinic. Who refuses to dialyze because they are eating? Patients do as they please.

I just had a patient a couple of days ago that was doing fine during treatment... so I excused myself to go to the bathroom right after obtaining vitals. When I came out and back to the floor, another nurse had turned off the patients UF and given her a 300ml saline bolus because the patients BP dropped... yes, that fast!

All because the patient was eating... you can never tell what is going to happen in a case like that, so it is preferred that they do not eat while on the machines... and since this is the first time happening to me, I must agree..... scared the bejebsus outta me!

Specializes in LTC (LPN-RN).

Plenty of patients eat during dialysis. Everything they eat builds up in their system. There could have been another reason why the pressure dropped since it is dialysis after all.

Specializes in Nephrology, Dialysis, Plasmapheresis.

Things I wish every floor nurse knew about dialysis patients:

1. Don't ever give these patients orange juice for their blood sugar- NEVER!! Potassium ! Also no oranges, bananas, and prob should avoid tomatoes. Diet is very restrictive in general, but these are very important restrictions.

2. If you don't give the phosphorus binders WITH food, and I'm talking while they're actually eating, you may as well throw it away. The binders BIND to the food to remove phosphorus, once the good is being digested, no use. Examples are Phos-Lo, Tums, calcium acetate.

3. A creatinine of 5 is not alarming. Heck, a creatinine of 8 is really not alarming either. This is baseline for some folks, sad but true.

4. If your patient needs dialysis, and the blood sugar is 300 or above, dialysis should actually help. I've seen people try to hold dialysis and put them on an insulin drip and transfer to ICU. These patients that are heading to DKA, NEED dialysis more then anything. The bicarb that is given has a dextrose of 100, so the concentration gradient that occurs during dialysis will improve the acidosis and the hyperglycemia. It is amazing to check the blood sugars hourly during dialysis and watch them come down.

5. We only give IV antibiotics post HD if your patient truly has no other access. In the hospital, we are working 12-18 hour days and we really need to move on to the next treatment.

6. Don't ever call me in the middle of the night to tell me a dialysis patient will need treatment in the morning. Please don't call me after 10pm unless it is truly emergent and I need to put my clothes on and come in. Thank you!

Specializes in LTC (LPN-RN).

Reminds of how much people don't know. Good post.

OK -- dumb question time. What is the difference between the "arterial" and "venous" needle in an AV fistula, and which is which? I find this mighty confusing, because the two cannulation sites are both in the venous limb of the fistula, right? Sorry for the very basic question; I don't work in an area even remotely related to hemodialysis. :sorry:

Specializes in Dialysis.

Direction of flow. Important to know after the needles (2) are placed as the dialysis machine will pull blood from the arterial side and return to the venous side. Determined by applying pressure with fingers in the middle of the access and with your other hand palpating each side of the access. The stronger pulse is arterial which establishes which side the machine will pull from. It's like a river that you want to be drawing in dirty blood from upstream and returning the clean blood downstream.

As a dialysis patient, 99 percent of this information is true, but, not always. I have very low potassium and calcium levels. Even when I was In-Center, I had to take potassium and calcium supplements. Yes, I took the horse pill and took 2,400 mgs of calcium per day, to get my calcium levels to the normal level. My renal diet includes at least one glass of low sugar orange juice. I was at a sleep apnea study, recently and they have you sleep without your mask for a few hours, which is stupid. Blood sugar levels are difficult to impossible to control without the correct amount of sleep(Indiana University Home Dialysis). I had to have 5 small glasses of OJ before the room would stop spinning. Then, I needed to have breakfast at McDonalds. I am a Nocturnal person. I hate going to the hospital because then I encounter the "Renal Diet Nazis." I have come to the hospital with a potassium score of 2. I love my Nocturnal treatments and I hate shorter treatments. Yes, it is true, 99.9 percent of dialysis patients cannot take OJ for their blood sugar, their system will freak out. Yes, I do my own sticking :) I love the IU Nursing staff, good, good people :) If you have individuals who have fluid issues, try to start a Nocturnal program. I do have alot of issues with coughing, because I have had asthma for 32 years, since high school, I use inhalers and a breathing machine. Right now, the allergies are really bad. :(

Yes, Katherine, you are right, it is amazing at times.

No, I do NOT call the on-call RN in the middle of night. I call them during the standard work day. Trust me, I know how much I hated that as a police officer.

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