Your worst experience/accident/mistake?

Natkat, BSN, MSN, RN · Jun 2, 2006

I have been an RN long enough to know that accidents happen. That nurses are not perfect ( even though we think we should be). Can you tell me what your worst experience was when working with HD patients? What were your "close calls"?
What happens if the dialysate is mixed incorrectly? What happens if there is too much K+ in the solution.....

In our facility the dialysate is mixed and ready. If we notice the patient has the wrong bath, we simply take it off and put on the correct one.

In dialysis we always check each other routinely. Before you put a patient on, someone else comes behind you and checks your equipment and your solutions to make sure they are correct before you start treatment.

The worst mistake I've made is forgetting to clamp a line and then an entire bag of saline ran into the patient, followed by air that got into the lines. Thankfully the machine will alarm and stop pumping once air gets into it. Unfortunately it is a gigantic PITA to get the air out of the lines, not to mention now I've got all this extra fluid in the patient that I have to remove.

The worst thing I've seen someone else do is not tape the patient's needles down securely and their needles fell out. I didn't see this one, but a co-worker told a story about a patient's needle falling out while she was asleep. The machine didn't alarm and within minutes all her blood pumped out of her body and she died.

I don't know what to say about blood exposure. I'm exposed constantly. We try our best to wear PPE but sometimes things happen. If a patient's site is bleeding and I don't have gloves on, I'm going to grab his site and stop the bleeding right then and there. I'll yell for assistance and keep holding his site while another staff member suits up and gets gauze ready. Then I let that person take over and I wash the blood off immediately. Then I suit up and go back and take over, remembering to thank my co-worker for their help. Sometimes when you cannulate a patient blood shoots out, and if you aren't wearing a mask and shield you can get a face full.

I've shot blood across the room before, and unfortunately onto someone who was walking by just as I was cannulating. I've left clamps open accidentally and had blood run out and form a giant pool on the floor. I've had patients pop open and bleed like Niagra Falls from their cannulation sites - and that happens about once every day - and sometimes from both sites at the same time. In this job, blood is a daily occurence.

I've never really liked the sight of blood, but after doing this job seeing blood doesn't bother me at all; not after all I've seen in the year that I've been in dialysis. If you're worried about blood exposure this is definitely not the place to be. You'll be wearing it, even a little bit, every day and massive amounts of it on occasion. If your are dilligent about wearing gloves, shield and mask you should be okay. It's such a daily occurence that I've never bothered to do any paperwork about blood exposure. If I did I'd never get anything else done.

You do have to be careful about needlesticks. We have Wingeater cannulation needles http://www.aossmedical.com/jms_needles.htm that retract into a sheath so that you can safely withdraw a needle without sticking yourself or someone else. Granted, this feature is useless if you don't bother to retract it. But if you're dilligent about using them correctly you shouldn't have a problem with needle sticks. You just got to be ready to eat someone else's face off if you catch them not retracting the needles correctly.

Sorry this post is so long. I hope I've answered your questions.

AmyLiz · Jun 11, 2006

NatKat pretty much nailed it. Wrong dialysate, although it's a problem, isn't hard to fix. It's pre-mixed (at most clinics), so the only thing you could bone up would be if you picked up the wrong jug. At our clinic, someone goes behind you and re-checks everything (our policy is within 1/2 hour of the start of the pt's tx), so mistakes are quickly rectified usually.

Our clinic has 24 chairs, but it's split up into 3 sections of 8 chairs. Usually there is at least 3 people working each section, a combo of techs and nurses. Not too bad if you look at it that way...plus we have a charge nurse that is helping out in each section as needed during turnovers, etc.

Dialysis isn't a bad gig. Sure there is higher chance of exposure, but as long as you take precautions, it's not bad. I always wear gloves...if a pt's sit starts to bleed like heck & I'm ungloved, I usually grab a chuck & press it onto their site & wait for someone to come gloved with some gauze. Our clinic has a rolling sharps container in each section, so when you go to take out someone's needles, you can take them out & immediately put them into the sharps container. We wear impermeable lab coats, so that's not an issue, and we have sheilds or masks, goggles or visors that we wear incase of splatter or squirts.

You may want to see if you could perhaps job shadow a dialysis nurse. That would give you a better idea of HD nursing is for you.

AmyLiz, OCDT, CHT

pogo · Jun 20, 2006

a patient coded on the machine (this was while still in training, in

i always keep in mind--every tx is a new one and what might have applied last time may not this time. so i would agree that 90% is "not running around like a chicken with your head cut off" time, but the other 10% is "potential for something to go wrong" time.

the good news is you develop a sense of when to be worried and not, the more experience you get.

soo, that's my 2 cents.

1940Nurse · Jun 20, 2006

a patient coded on the machine (this was while still in training, in
i always keep in mind--every tx is a new one and what might have applied last time may not this time. so i would agree that 90% is "not running around like a chicken with your head cut off" time, but the other 10% is "potential for something to go wrong" time.
the good news is you develop a sense of when to be worried and not, the more experience you get.
soo, that's my 2 cents.

'

Several subtle tip offs are:

vomiting

yawning

staring off into space

trying to get up ( fight or flight with low b/p) also restlessness.

not answering to their name

To name a few.

pogo · Jun 21, 2006

'
Several subtle tip offs are:
vomiting
yawning
staring off into space
trying to get up ( fight or flight with low b/p) also restlessness.
not answering to their name
To name a few.

yeah, these are BIG indicators. thanks for the reiteration.

1940Nurse · Jun 21, 2006

yeah, these are BIG indicators. thanks for the reiteration.

I've seen many "newbies" miss them. Looking at the b/p instead of the patient.

Hellllllo Nurse, BSN, RN · Jun 24, 2006

Some dialysis units are good places to work, others are hell. It all depends on the mgmt.

As a traveler, I've worked in nine units.

1940Nurse · Jun 24, 2006

Some dialysis units are good places to work, others are hell. It all depends on the mgmt.
As a traveler, I've worked in nine units.

As a traveler I've worked in 11 states in 4 years. I've worked in over 20 units. Hospitla based, Fresenius, Gambro, DCI, Davita etc.

Like anything else perception is the key. I don't like some Holiday Inns either.