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Dialysis Nurse

Welcome to this web site my name is Jacqueline. I am a dialysis nurse and have been working in the field of dialysis now for several years. This site contains information about what dialysis is all about for both the patient and for the nurses. I hope you enjoy your visit here and will be able to find some information that you may find beneficial.

The following information is an overview of dialysis nursing that I wrote in 2001. It doesn't cover every duty of the nurses at my center just some of the highlights. I would be interested in hearing from other nurses about what dialysis nursing is like for you at the center where you are employed.

The nursing job hours vary from 36 - 50, mostly 50. My boss is trying to get the three day 12 hour shifts set up for us as a regular schedule. Though it will mean less money I am looking forward to only working 36 hours. We are downsizing to two smaller centers. One of the smaller centers has been built and we have been transferring a lot of the patients and staff to that other center.

Dialysis nursing is fast paced and can be hectic, there is pressure to get the patients on and off the machines in a timely manner, while we maintain every safety precaution.

I have only worked in dialysis nursing for six months. I am still learning. It is a specialty therefore, the kinds of clinical experience that I am getting is not as varied as would be in a hospital clinical setting. The patients, with some exceptions, all get the same kinds of medications, have the same problems, and have the same type complications. If someone has a life threatening complication an ambulance is called for them and they are transported to a hospital.

When training the first thing I learned to do was to operate a dialysis machine. That includes turning it on, putting the lines in place, priming the air out of the lines with saline, etc. I learned to set the goals, bloodflow rates, and other parameters for individual patients treatments. I learned to troubleshoot the many alarms that go off when there are minor adjustments that need to be made to the machine while the patient dialyzes. Basically, I first learned to be the technician although I do not cannualate yet.

Assessment of the patient is important. I have to carefully assess each patient before and after the treatment. Each patient dialyzes three or four days a week. We have one group of patient that comes in on M,W,F and another group T,TH,S.

It is my responsiblity to enter the doctors orders and change the medicine book accordingly. Each month I do progress notes on each patient. There is an end of the month report on the access. There are three kinds of access that I am familiar with: catheters, grafts, and fistulas. I also have to keep up with nursing notes for each patient. I am responsible for making sure all the entries are made in the computer system for each flow sheet and they have been filed. The technicians usually do the flow sheet entries.

I am responsible for catheter care and putting each of the patients that have catheters on the dialysis machine for their treatment. On each shift there are an average of 3 catheter patients. We run two shifts. The catheter types vary, but they are generally subclavian, tasio, perma cath, or some similar type. Pre treatment I have to draw out the heparin lock which was injected at the last treatment, draw blood samples when needed and flush each catheter port with saline. I also push the pre-treatment heparin bolus. I change the catheter dressings each treatment. When ending the treatment I flush the catheter with saline then inject heparin into the catheter to keep it from clotting between treatments, then cap the ports with sterile caps. I have learned to troubleshoot catheters. There are few complications with catheters; most problems are positional and can be corrected if the patient changes positions or the ports are switched when connecting the lines to the machine. Occasionally there is clotting of the catheter and the patient makes a trip to the doctor to have a chemical injected into the catheter to make it patent again. Infection could become a problem so maintaining aseptic technique is very important. Infection and clotting of catheters are addressed by the physician, although we do site cultures when needed and draw blood for bacterial cultures when infection is suspected.

I have cannulated only one patient with a fistula. The fistulas and grafts are located mostly in the patients arm, but occasionally in the thigh. I assess the sites and am checking for patency when I push the heparin bolus.

Dialysis is safe, but there may complications. One complication is low blood pressure and another is cramping. Mannitol or Saline are given when someone's blood pressure has dropped down too low. There is almost an instant improvement in BP when a patient is put into the trendelenberg position. Each persons sodium profile is formulated by setting the sodium variance on the machine. The sodium variance setting and the UF options have the effect of drawing the fluid off in increments rather than constantly. This gives the vascular system a chance to catch up to the fluid loss more naturally thereby decreasing incidents of low blood pressure and cramping.

As earlier stated, I am a new dialysis nurse and still learning. I would be interested in learning from others: dialysis patients or healthcare workers. Any suggestions, additional information or questions on the subjects I covered would be appreciated. Please send me your comments or additional information about "Dialysis". Please mail comments to Jacqueline Alexander