You got this!
What screens must be complete in chair side before treatment can be initiated?
A,C,F and B or D
What requires RN notification?
+ or - 20 points or more change in BP
symptomatic patient
any errors noticed (heparin clamped, bath, UF goal etc.)
Patient is complaining of pain in their access, what's first?
STOP the pump
What must be in chair side snappy prior to ending treatment
Last line- MUST have a BP
What time does Fedex come for labs?
before 5pm
Who must have an RN assessment
AKI
Sitting BP >180/100 or <90 systolic
HR <60 or >100
Temp >100.0
Respirations >24
Arterial Pressure is alarming- where do you start to troubleshoot?
Clamps- are they correctly clamped or unclamped?
Arterial pod, should it be full or empty?
Kinks in lines
Kinks in needle lines
Needle adjustment is ALWAYS the last thing you do.
Needle needs repositioned, what do you do with the blood lines?
Lines are put into recirc and the needle is not adjusted until a syringe is connected to ensure proper placement.
How much additional rinseback is okay for the PCT to give?
200mL- but RN still must be notified
Who is responsible for labs getting shipped
Everyone!
4 Factors when determining UF Goal
Previous post weight
Current weight
TW
TRENDS
Venous Pressure is alarming- where do you start to troubleshoot?
Clamps- are they correctly clamped or unclamped?
Venous pod, should it be full or empty?
Kinks in lines
Kinks in needle lines
Needle adjustment is ALWAYS the last thing you do.
Patient is on the phone to call out- who can take that call?
RN's ONLY
When is it okay to drain the dialyzer?
Once ALL post treatment vitals are complete AND stable
What is the process for drawing a post lab?
wait until treatment is COMPLETE
machine in bypass
BFR to 100
wait 15 seconds
spin immediately
What is weighed WITH the patient?
NOTHING- remove all coats, hats, keys, bags, O2 tanks from wheelchairs etc.
How often are vitals required per policy and CMS?
every 30 minutes-no exceptions!
Name a reason for REM
Infiltration
multiple cannulations
Any errors
Anything abnormal about a treatment
Weights don't make sense, what do you do?
Re weigh with the patient
if the patient is already gone, get your nurse
When are lab tubes labeled?
Chair side, As they are drawn, Never before
How long is a setup good for
2 hours from opening the FIRST package (saline, lines, dialyzer)
Patient is cramping- what do you do?
Opposing pressure
UF to minimum
NS bolus is the LAST option
Who does REM's?
The person responsible or taking ownership of the event
Who does patient education?
Everyone!
How long are Chevrons to be?
Must be adhered to the SKIN minimum of 2 inches