I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Charlie B53 on February 22, 2017, 06:03:33 AM
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I asked if there was any news about Martin, the guy that usually was seated next to me as I haven't seen him for almost 10 days. Last week when I asked I was told "oh, he is in the hospital." I know Martin is narcoleptic and falls asleep almost mid=sentence sometimes. I worried as he always drove himself to treatments.
Wednesday two weeks ago he was particularly 'tired' falling asleep and difficult to awake when his treatment was finished. I am pretty sure the Nurse called his son to come pick him up that he didn't seem able to drive home. Next thing I know I find out he had went into the Hospital.
When I asked again today the Tech's response was "Oh, Martin died." and walked off.
Seems like she didn't have much, if any, feelings at all. When she came around next I told her that I had the carburetor of Martins very old outboard motor, that he was to bring me in all the I.D. numbers off that old motor so I could look up and find a correct diaphragm to rebuild it and make it functional again. I need to find out from Martin's Son what he wants me to do. She told me to just bring it into the Clinic, that they would return it to the Son.
I guess all I can do it write a note and put it in the container, let the Son know I'm Sorry for the loss of his Father. That when he is ready if he wants to finish restoring that old motor, which should be a collectors item by now, to give me a call.
I don't think I could be a Tech. I get too attached to people too easily. Losing a Patient would be a problem for me.
It sure doesn't seem to bother some of these Tech's. Maybe they see it as one LESS set-up and run they have to do?
Rest in Peace Martin.
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I'm pre-dialysis with a buried PD catheter, but what you are describing is one of the main reasons that in-center hemodialysis would be my last choice of treatment types. I just would have a very hard time watching people I have gotten to know over time declining and in some cases dying, especially knowing I am in a similar situation health wise.
You seem like a people person, Charlie. Not everyone is and that's OK. When it becomes a problem is when (like the tech) a non-people person has a job that requires both technical and inter-personal skills. It's hard to watch the lack of empathy.
I'm sorry for your loss.
K.
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I couldn't do it either Charlie. I get attached to people so easily. I live in a senior mobile home park and I am co-chairman of the memorial committee. Its a tough job setting up the services for someone you chatted with and laughed with and now you are putting tablecloths on the tables for their memorial. Every time we have one, I swear I am going to quit, but I never do. Somebody has to do it. May your friend Rest in peace.
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Hello Charlie,
To be honest, I could not be a tech either. In fact, I very much doubt that I could be useful in any medical field, because for starters, I can’t see or look at any blood without getting very wobbly, unsteady feet and ... whenever I see anyone in pain, I iinstantly suffer with them ... But at one time I surprised myself whilst I was shopping and saw a stranger in the distance collapsing toward the pavement in – what looked like - an epileptic fit - and I instantly "launched myself forward" and made sure I was catching this person in time to prevent them from hurting themselves with their head on the pavement. I caught them in time and held them in my arms whilst I pleaded with other pedestrians for more assistance. Fortunately a few more pedestrians saw what had happened and instantly helped, because this epileptic fit was much too “heavy” for one pedestrian to handle and it took altogether three more people to make sure the epileptic fit could not do any harm to the affected person... But apart from this... I still can’t see any blood and whenever someone suffers, I suffer with them...
:grouphug;
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Neigbor called me yesterday morning early to tell me a common friend, a very sweet od lady, pasted during the night.
I would bet money it was congestive heart failure. She had a LOT of water in her. Legs so massively swollen I gave her a bunch of my support hose I no longer need. She couldn't get them on, legs too big.
I had talked with her on many occasions about how Dialysis could pull the water off, clearing her lungs, reducing the swelling in her legs. I doubt if her Dr seriously listened to her, just kept giving her those water pills that failed to take it off.
I was so swollen I was 'leaking' daily. Dr agreed to get me started even though my kidneys were still at 20% then. Legs looked almost normal within a week. That was almost 4 years ago, now at 4% I am very glad I started as early as I did.
It just sucks to learn of two friends gone within hours.
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One of the sad facts as one ages so do the people we know. Past 50 the number of people you know that pass increases each year. My 92 year old fil doesn't know many people anymore. Basically it's the great circle of life. The one thing in centers is the HIPA laws mean the medical people are limited in what they could say, this has lead to the feature of dialysis in which people just disappear, no one marks their passing its sad.
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Sorry Charlie, the circle of life is so pronounced, in- center. Martin sounds like my friend . we talk Wood Smokers that's all we talk about ,i went out and bought one. Take it easy .
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I asked if there was any news about Martin, the guy that usually was seated next to me as I haven't seen him for almost 10 days. Last week when I asked I was told "oh, he is in the hospital." I know Martin is narcoleptic and falls asleep almost mid=sentence sometimes. I worried as he always drove himself to treatments.
Wednesday two weeks ago he was particularly 'tired' falling asleep and difficult to awake when his treatment was finished. I am pretty sure the Nurse called his son to come pick him up that he didn't seem able to drive home. Next thing I know I find out he had went into the Hospital.
When I asked again today the Tech's response was "Oh, Martin died." and walked off.
Seems like she didn't have much, if any, feelings at all. When she came around next I told her that I had the carburetor of Martins very old outboard motor, that he was to bring me in all the I.D. numbers off that old motor so I could look up and find a correct diaphragm to rebuild it and make it functional again. I need to find out from Martin's Son what he wants me to do. She told me to just bring it into the Clinic, that they would return it to the Son.
I guess all I can do it write a note and put it in the container, let the Son know I'm Sorry for the loss of his Father. That when he is ready if he wants to finish restoring that old motor, which should be a collectors item by now, to give me a call.
I don't think I could be a Tech. I get too attached to people too easily. Losing a Patient would be a problem for me.
It sure doesn't seem to bother some of these Tech's. Maybe they see it as one LESS set-up and run they have to do?
Rest in Peace Martin.
Hi Charlie,
Techs, like nurses have to learn to separate their feelings from their job. Cold and callous, maybe...but they, like any other professional that has to deal face to face with the public-and adding in the stress of patients who aren't feeling well and a job that requires the tech to do things exactly right or jeopardize the health of their patients...it takes a special person to be a tech...and be friendly!
When my daughter Holly was a baby and really sick...the nurses that we had when we were in the pediatric intensive care with her the FIRST time (and had become comfortable around) would not be her nurses on subsequent admits, due to them becoming attached to her...and possibly affecting their care for Holly. That was a real eye opener for us...and we were lucky enough to have a veteran charge nurse explain a lot of things to us way back when...which made things easier.
One of the BIG reasons that we pulled Holly from the dialysis center (and started the home hemo on NXStage) was that 3 of her friends at the center died within a month and a half (These were all much older folks than Holly...but Holly can get along with a 75 year old as easy as she can get along with a 5 year old :) ) The losses of the 2 ladies and one guy really devastated her as they sat on either side of her 3 times a week for over a year. The day after Holly's transplant we found out that Holly's favorite "buddy" at the center passed away on Christmas eve.
So sorry to hear about the loss of your friends. May God be with them...and their families.
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For the techs at my clinic, they care a lot. It may not seem like it when a patient asks about a patient who passed and they reply, "Oh, he passed away," but I have seen them cry, attend funerals and still come in willing to do their job. Some of the techs here even take favorite foods to a patient's house when he/she aren't doing well or visit in the hospital. One of the techs recently was taking a patient who was very ill a milkshake because he had stopped eating and the tech thought he might drink a milkshake. When she got to his house, EMS was there and he had passed. I just had a patient I was close to pass yesterday. She dealt with a lot of loss in her life and had never gotten over her husband's death four years ago. I held her hand and hugged her when she cried over him just last week. It doesn't get any easier losing a patient, so you have to suck those emotions down and keep going. Sometimes all you can say to the other patients is that he passed and quickly walk on so you don't cry in front of the patients. I am so sorry for your losses, Charlie.
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Sorry for your loss, Charlie B. His son would probably find comfort in knowing he had a friend in you that he could talk "shop" with. Maybe you could put your name/number down in a sympathy card and someone at the clinic can give it to him or the family if they want the carburetor. Who knows but maybe your friend sensed his time was coming and left his carburetor in your care as a sort of token because as a mechanic he knew you'd appreciate it.
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I'm very sorry for your loss Charlie? I know how you feel, I think. It's the lack of info about the situation as a whole. Of course it's understandable that the paid people can't afford to get emotionally involved, they would breakdown than etc. But it's virtually impossible for most patients to not get involved.
For the techs at my clinic, they care a lot. It may not seem like it when a patient asks about a patient who passed and they reply, "Oh, he passed away," but I have seen them cry, attend funerals and still come in willing to do their job.
That's the whole point Smartcookie, why do patients have to ask!! why is there not a notice on a board to like hang the card that the family (probably) has sent to inform them? Or just write it in a tactful way themselves? Some fellow patients know each other for years, but won't be on the "must inform by passing" list of the family. Most clinics or hosps are.
So to just pass on the info they do have might be a help?
Love, Cas
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why do patients have to ask!! why is there not a notice on a board to like hang the card that the family (probably) has sent to inform them? Or just write it in a tactful way themselves? Some fellow patients know each other for years, but won't be on the "must inform by passing" list of the family. Most clinics or hosps are.
I've seen a notice in my clinic lobby on a table of some sort of remembrance for about three people who passed - as if maybe its something they do once and while for multiple people. But the one person who passed on my shift I knew about because I might have asked where he was.
I'm sure there are all sorts of privacy laws limiting them from flat out telling us when something happens.
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That's the whole point Smartcookie, why do patients have to ask!! why is there not a notice on a board to like hang the card that the family (probably) has sent to inform them? Or just write it in a tactful way themselves? Some fellow patients know each other for years, but won't be on the "must inform by passing" list of the family. Most clinics or hosps are.
I think they need to have permission from the family before they can say anything. There have been a couple of times where a nurse came to me and whispered to me that someone had died because they weren't really supposed to tell anyone. In my clinic, when they have permission, they will put up a photo of the person who died on the counter in the waiting room. Also, I live in a small place, so if someone should die, it's usually not hard to figure it out.
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The penalty for HIPA violations are extreme. Plus family filing lawsuits is a definite possibility. If the clinic fixed cars they could tell everyone but the medical privacy laws are very strick. A family member who was in the hospital and the social worker called the house I felt there was info the hospital needed to know. I started to tell the social worker some facts that were relevant social worker told me HIPA did not allow her to talk to me. I explained the law allowed me to speak tell her what I knew and what she couldn't do was comment. It worked out.
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Michael Murphy is right. HIPA is the reason we can't really say anything or post anything. Also, companies do not like you telling patients that other patients died. It looks bad for the company. My experience is that deaths come in bunches so I might have three deaths this month, but none for four or five months. But to the patient looking at a memorial wall, they just see that there was three deaths in a month and start doubting the skill and care of our team. I know that sounds bad and twisted, but that is how the higher ups look at it.
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I guess I am odd one out on my day shift because I transferred in from nocturnal to the day shift with a longer treatment so I come in at an odd time and do not sit and chat with anyone.
I really do not chat with anyone but the techs and nurse. I sleep most of the time I am at dialysis. I did get to know a few people who passed away. My heart ached each time.
I guess I do not really get to know people beyond nodding hello at them.
I have noticed that I just do not get to know people around me as well as I probably could. I am not nosy and do not pick up on names often. I have a friend who knows everyone in her center at her shift and tries to tell me about them from when I was there for around a year. She mourns everyone when they leave or pass and is involved in their lives.
I just do not do it.
I am involved with my friends here on IHD.com.
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I think I get to know people in my center because they try to get to know me. I look a lot younger than I actually am (unless you ask my mom. *L*) and I think that makes them take an interest. I'm actually the "senior" patient at the center, because I've been there the longest, and I can usually answer questions that they have. I've gotten to know a lot of my fellow patients, and I've lost count of how many we've lost, but I can't stop talking to them, especially the newer patients, who tend to have a lot of questions, and the nurses can't answer all of them.
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.......... I can't stop talking to them,.............
I had to chuckle just a bit at this. My in-clinic Tech and the Nurse keep telling me to 'Shut Up!' I have a Venous Cath and they keep telling me that the vibrations from my voice upset the machine causing alarms. That and I turn my head to the right which also somehow makes a small difference in flow and alarms go off. Some days they are very often having to come over and push buttons to turn off the noisy thing.
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.......... I can't stop talking to them,.............
I had to chuckle just a bit at this. My in-clinic Tech and the Nurse keep telling me to 'Shut Up!' I have a Venous Cath and they keep telling me that the vibrations from my voice upset the machine causing alarms. That and I turn my head to the right which also somehow makes a small difference in flow and alarms go off. Some days they are very often having to come over and push buttons to turn off the noisy thing.
One of the 100's of reasons I'm so much 'happier' at home. And Charlie even when you are very much likely returning to PD, this is a good opportunity for you to learn a bit about this machine. When you talk and the flow changes you could 'relieve' the nurse or tech and press the button your self. Although that might be also prohibited in the US of A too?
Love, luck, strength, Cas
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When you talk and the flow changes you could 'relieve' the nurse or tech and press the button your self. Although that might be also prohibited in the US of A too?
I am a home hemo patient, but have used many clinics while traveling. They have ranged from "Oh, you know this machine, just let us know if you want any help" to "Patients are not allowed to touch the machine". When told the later, I channel Bob P and respond "Actually, the rule is I am not allowed to touch the machine when someone is looking". It's good form to use gloves when touching the machine, as this is the policy (at least at FMC) for staff.
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LOL
I've already been told Do NOT Touch the machines. They won't even let me turn my chair so I can LOOK at it.
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I've already been told Do NOT Touch the machines. They won't even let me turn my chair so I can LOOK at it.
If Mohammed cannot go to the mountain, bring the mountain to Mohammed. Have them turn the machine so you can see it.
I've never been refused this courtesy in any of the dozen or so clinics I have used.
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I generally use 2 clinics one in New Jersey the other in the Adirondacks in New York. The Adirondack center angles the chair and machines so the patient can see the screen. This angled setup means I never have to ask "what time am I getting off?". When I asked the charge nurse in New Jersey about doing the same thing she replied "Absolutely not, we need to be able To see the screen from the nurses station"". Then I realized the difference between the two centers, Adirondack center did not have a nurses station in that clinic. In New Jersey They had a constantly occupied nurses station. The Adirondack clinic staffs two nurses for 16 chairs one of which is the clinics nurse manager the New Jersey clinic has a nurse manager and usually 4 additional nurses for 18 chairs. This
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When I asked the charge nurse in New Jersey about doing the same thing she replied "Absolutely not, we need to be able To see the screen from the nurses station""
Everything sucks in NJ.
If there is an alarm, they should get up and service it. If not, do you really think they are monitoring the pressure readings from the station?
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We have a nurse to patient ratio of 1:3, at least during the 2 day shifts.. for those 2 shifts, all 16 chars are usually full... in the evening, we have 3 nurses on, no matter how many people are in, and I don't think I've ever seen 9 patients in the evening... I think there's usually 6 of us in the evening.... though, we don't have techs, so that's why we have more nurses...
As for turning the machines, the nurses have no problem doing that.. they have to get up and do a check every hour anyway, and if there is an alarm, they have to check it.. that much is a safety thing.. having to see the screen from the nurses station is a load of bull.. that center is staffed with lazy nurses...
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That's an incredible NT ratio. Here in the US I see more like 8:1, with 4:1 for the techs.
As to lazy RNs - ergophobia is a disease that knows no boundary of profession, race or background, except perhaps Asians and Indians (I've never seen a lazy Asian or Indian (spot, not feather) ).
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LOL
I've already been told Do NOT Touch the machines. They won't even let me turn my chair so I can LOOK at it.
I always carry my little hand held mirror. It's purpose is to view the machine. Works great! :beer1;
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I have never seen a nurse sit at the station and ignore a alarm. However now and then I have seen a nurse jump up and run to a patient who was starting to get in trouble. One of the most frightening things I have ever seen is the guy next to me was starting to drift off with low blood sugar when one of the nurses jumped up ran to a cabinet and ran to the patient with the biggest dam syringe I have ever seen. I just layer there thinking omg they are going to stick that guy with a elephant needle. Turned out she stuck it in his tubing and the effect was unreal. From pale and pasty to roses cheeks in seconds.
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We have a really good and talented group of techs. I know they care about the patients because I have seen how hard they work to give us the best care they can. I have also seen them cry after a patient has an incident, though they try to hide it. I have tried at different times to explain to them we (the patients) all know there is a risk to what we do, but we also know the results of not getting the treatments. I do know they are denied by law being able to discuss other patients, so I usually do not ask a lot of questions. Besides, it is usually not long before another patient hears any news.
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With the number of alarms that regularly sound off, it's a wonder the Techs get a half second to breath. But I have noticed that the Tech's in my Clinic seem to KNOW which patient and which alarm is more critical. My machine makes noise regularly, it's no big deal, the Tech comes over, pushes a button and all is well again. Many times it is like that with a number of patients and the Tech doesn't seem to be in any hurry.
However.................
There are those patients that when an alarm goes off the Tech is there IMMEDIATELY. It's like the Tech KNOWS which patient and which alarm requires an immediate response.
Experience, there is no other explanation. These people know their business.
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My chronic Low BP freaks the techs and nurses out. The one that have been with me longest tend to not freak do much, but check in on me to see if I feel okay.
The new ones tend to hover.
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Low BP always sounded good to me-- as someone who naturally runs high. It wasn't until my BP was lowered too much by a new drug that I learned how awful low BP can be. I was dizzy all the time and fainted multiple times. So it can be a big deal. With an adjustment of the dose, my BP moved into good territory. Thank heavens.
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Unfortunately my BP is what it is. Midodrine does not work for me. Just gives me a huge headache but no BP changes.
So we get to watch the crazy BP each time I go into dialysis. Seems to go in cycles, too, but no one has caught the cycles yet.
I just went through two months of higher BP that I have had, and now it is back down.
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I still so new to all this. I have only been at my one clinic. If you don't count the VA Hospital and the University Hospital across the street from the VA. So what I have seen/experienced in my Clinic I would mistakenly ASSUME is much the same at all clinics. WRONG, as usual.
My Fresenius clinic has
2 Nurses
4 Techs
1 Floater Tech
1 Secretary
21 Chairs
The big room is divided but a low divider wall with a sink on each side. This makes it seem like two treatment areas. Each area has 5 Chairs/Machines down the outer wall and 5 down the 'inside divider wall.
There is one more Chair in the 'Clean Room' in one corner.
One Nurse tries to stay at the desk/monitor while the other one roams. Only one Tech is allowed to take a break at any time so there is always at least three. With the roaming Nurse there is always two persons in each treatment area.
Wentzville was a corn field 20 years ago when we moved here. About 60 miles West of St Louois about the only thing around there besides corn/farmers is the GM plalnt making pickup trucks. With the housing boom a LOT of corn fields have been developed and whole neighborhoods sprang up. Major freeway exchange widened and over a mile of mini mall businesses, Home Depot, Lowes, and all the rest of 'Society'.
I'm glad we live another 20 miles/3 towns farther West away from all the todo, noise, and crowding.
But I am surprised to learn that my clinic is rather large as compared to many of yours.
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But I am surprised to learn that my clinic is rather large as compared to many of yours.
I use the Burlington, WA DaVita clinic when visiting that area. Nice people, lots of personal attention - 1 RN, 1 Tech, 4 chairs. (actually 5 chairs if you count the one in the isolation room, but there was no machine with that chair the last time I was there).
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I've got a couple cuisins near Burlington.
I really miss living just North of Seattle. As much as it's grown, now if I was to return I'd have to go farther North a bit past Everett, or out on one of the Islands.
Too many people. Makes me crazy(ier).
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But I am surprised to learn that my clinic is rather large as compared to many of yours.
I use the Burlington, WA DaVita clinic when visiting that area. Nice people, lots of personal attention - 1 RN, 1 Tech, 4 chairs. (actually 5 chairs if you count the one in the isolation room, but there was no machine with that chair the last time I was there).
I was there as well two years ago when visiting my brother outside of Bellingham.
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But I am surprised to learn that my clinic is rather large as compared to many of yours.
I use the Burlington, WA DaVita clinic when visiting that area. Nice people, lots of personal attention - 1 RN, 1 Tech, 4 chairs. (actually 5 chairs if you count the one in the isolation room, but there was no machine with that chair the last time I was there).
I was there as well two years ago when visiting my brother outside of Bellingham.
Really? I though that clinic only opened up a bit over a year ago. Was the clinic you used a very small one behind a Taco Bell on the main drag in Burlington down the street and on the other side from the Burlington mall?
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But I am surprised to learn that my clinic is rather large as compared to many of yours.
I use the Burlington, WA DaVita clinic when visiting that area. Nice people, lots of personal attention - 1 RN, 1 Tech, 4 chairs. (actually 5 chairs if you count the one in the isolation room, but there was no machine with that chair the last time I was there).
I was there as well two years ago when visiting my brother outside of Bellingham.
Really? I though that clinic only opened up a bit over a year ago. Was the clinic you used a very small one behind a Taco Bell on the main drag in Burlington down the street and on the other side from the Burlington mall?
yes four chairs, we were there Nov 2015, it felt new back then, but that could have just been because it was built for 20-30 chairs and only had a few installed. DaVita Cascade Dialysis
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yes four chairs, we were there Nov 2015, it felt new back then, but that could have just been because it was built for 20-30 chairs and only had a few installed. DaVita Cascade Dialysis
That's exactly the place I referred to - Nov 15 is less than two years ago. I only counted enough plumbed chair slots and space for a total of 9 chairs - 4 additional in the main area plus the isolation room. Nice people.
4 chairs makes for a great ratio - one RN and one tech for 4 patients.
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My chronic Low BP freaks the techs and nurses out. The one that have been with me longest tend to not freak do much, but check in on me to see if I feel okay.
The new ones tend to hover.
I have that problem too, to a point where the doctor had to put an order on my chart to no do anything unless I'm having symptom. Their policy is to put the machine in minimum, so it's not pulling fluid, for a few minutes to get the pressure back up, but it doesn't do anything for me except have me leave a little heavier than I wanted. I have to tell the new nurses sometimes that the order is there, because they automatically start pushing buttons on the machine when my bp goes below 100 (they really only look at the top number, can't remember if it's systolic or diastolic *L*). I say something like "It's only 97, I'm good." and they say, "but we have to do something, that's low." and I say, "not for me." It takes a few minutes of arguing and shuffling through the chart to find the order before they finally agree with me.
As for my unit, it is the largest one in my province. It has 16 chairs, with room for 2 more. I highly doubt that room will ever be used for patients, though. It's used now for training and to set up and prime machines while connected to the water system, so they can swap machines out, making turn around times easier. The unit is kind of split in two, as there are two nurses' stations. One side has 5 chairs, plus the 2 isolation rooms, and the rest are on the other side. When I'm on in the evening, there are usually only 7-9 patients on. We have a nurse to patient ratio of 1:3, so we have 3 nurses and 1 DSW, which is just a resident care worker, or what was once known as a nursing assistant, but have specialized in dialysis. They can set up, strip, and wash machines, do blood pressures and take temperatures, take care of all the supplies (ordering, organizing, putting together "packs" of supplies for different things, like putting people on, taking them off, dressings, setting up the machine), and they do things like get pillows and blankets, make tea and coffee, plug devices in when they start to lose power, pick up my phone off the floor when I've dropped it.. *L* They're great folks
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We have 30 seats with 6 techs, 3 nurses when full. If anything we have a nurse problem. It is not that they do not do their job, but that some of them give the techs no help. Our two best nurses quit to take other jobs because they were tired of the director giving them the shaft on shifts. They could do anything in the clinic, listened to patients, and ALWAYS helped when asked. We have great techs, but sometimes they need a hand, like when a patient cannot hold their sites but there also are other patients coming off the machines.
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I say something like "It's only 97, I'm good." and they say, "but we have to do something, that's low."
I do home hemo, but in center when traveling. I always tell the tech/RN "don't even thing about a saline bolus unless I go below 80 systolic" and have never had any pushback.
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I say something like "It's only 97, I'm good." and they say, "but we have to do something, that's low."
I do home hemo, but in center when traveling. I always tell the tech/RN "don't even thing about a saline bolus unless I go below 80 systolic" and have never had any pushback.
I've never had a problem while traveling, except for the last time I was in New York. When I went in for the first treatment, they asked me what my max goal was, so I told them. No big deal, I needed to get some of it off. The next time I went in, I didn't have the same amount on, but no one said anything to me, even after I weighed in. They automatically put me on at my max. I didn't notice it until I had about half an hour left, and I was starting to feel light headed. I asked to come off early, before they totally drained me.
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I occasionally see a tech tied up with a patient and unable to immediately answer an alarm. Usually, she winds up yelling at a nurse to get the alarm as they sit at the desk. We have really good techs, some nurses, not so much. I see techs often ready to take a patient off and have to call a nurse to give the patient the rst of their iron or calcium. I hear them call over and over "Catheter ready."
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The new nurse we have had finally gotten into the run of things. She runs a tight ship, but has time to talk to patients about life and treatments.
She even had my chair moved from the back corner up the front where she is so an eye can be kept on my whacko blood pressure more often.
I like her. It took us awhile to get to know each other.