Dialysis Center Roles

[YLGuy]

I am sure each dialysis center is different but i am sure somewhat similar.  I am still new at this.  I am trying to figure out the different roles at the center.  I see what I would call techs the most.  They seat me and get the supplies, take my weight and BP. (does anyone know what kind of training is required for this position?)  Then because I have a catheter, they yell "catheter" and I believe an RN comes over to hook me up and disconnect me.  There seems to be a supervisor who is also is an RN.  Once in a while my neph strolls through the center and talks to me for a minute or two.  I then speak with a social worker who has helped me with dealing with insurance, bills and getting my meds.  I was told that they usually have a dietician but I have not seen one ever.  (Once in the hospital I talked to one). 

Anything anyone can tell me about the different roles/training needed/who to speak to about what at a dialysis center?







EDITED:Moved to centers area-kitkatz,moderator

[Phraxis]

You seem to have all the players down. But track down the dietition as soon as you can. They have diet recommendations  that can smooth things out for you allot. Mine was able to give me a shopping list that I used to replace virtually all the food in my house. Had to throw out the seeds, nots, veggies and fruit (especially dried fruit) that was a huge part of my diet. (didn't really throw it out but gave it to the local food bank)

Had some stay with me to help with cooking etc in the early part which was a big help. They were a master a the steak, white bread and red wine diet that got my potassium and phosphorus levels in line real quick.

[monrein]

I'm in Toronto, Canada so things are different.  Only RNs deal directly with patients, doing needling or anything related to medical.  Techs only clean machines and deal with that end while the maintenance folk take care of the machines actual functionning. 

The neph, social worker and dietician are all at the hospital and we see the neph in clinic once a month but can go extra if something comes up.  Each patient has a primary nurse who can relay concerns or have things scheduled and who reports on blood work.  We see the SW and dietician at the beginning and then we ask to meet if needed and often it is the primary nurse who might suggest the necessity or possible usefulness of meeting with these members of the team. If you are dialysing at the hospital, as we do at first then doctors etc come into the unit there but it is often a different person who is "covering" the service in a big unit.  Once you're at a clinic (mine was a self-care clinic which I liked) then you have the same people to deal with every time.

[Stoday]

They were a master a the steak, white bread and red wine diet that got my potassium and phosphorus levels in line real quick.

Now I think I could live with a diet like that. Do you have any limit on the amount of red wine? A glass? A bottle? 

[BigSteve]

If you haven't seen a dietitian yet you will, possibly after your first labs. If I am not mistaken in the U.S.
the Medicare administration requires a dietitian at each unit. As for your neph write down all your
questions and make sure he or she answers them all. Once you start getting you EOBs from Medicare
and insurance you can see what the neph makes, so they should listen to you.

[dwcrawford]

Sounds like you have a similar staff as mine.  There are a few exception in duties however.  The dietician comes by at least weekly and comes and sits and discusses issues right after the labs come out.  They takes labs twice monthly unless there is a special request.  One of mine they do weekly because it has been requested by another doctor and I asked to not get stuck  for that.  There'll be too much sticking soon.  There are several dieticians and social workers on staff but there is a specific one assigned to each individual.  My neph rotates weekly with his father and a third neph on their staff so over a 3 week period i see them all.  They will stay as long as necessary.  I always have a list of questions and they alway tell me to call the office when I need something.   The techs hook me up as you said and only the nurse can hook up a catherter.  When you have a fistala you can choose who you want to stick you.  They will even come from another bay if you requests someone special.  By the way, this is the largest Davita center in America and they try and impress the corporated people anytime they can.  They refuse to wash my car while I'm on the machine.

[Hanify]

Over here (New Zealand) when I did HD there were only nurses and they did absolutely everything.  The nephs popped in as did the dietician, but we have no techs that I'm aware of.

[YLGuy]

I saw the new dietitian today for the first time.  I have been going to the center for 2 months.  She went over my labs and spent some time answering my questions. 

[Phraxis]

They were a master a the steak, white bread and red wine diet that got my potassium and phosphorus levels in line real quick.

Now I think I could live with a diet like that. Do you have any limit on the amount of red wine? A glass? A bottle? 

So far half a liter, if I am good and no coffee etc for the day. 5 cups per day. But steak and bread that I can I can have!

[RightSide]

It's too bad you haven't seen a dietician.  In my case, I saw a dietician roughly every other week, as my nephs struggled to balance my blood chemistry.  My dietician started me off with a stricter diet to help get my blood chemistry under control; but now that my blood chemistry actually looks reasonably normal, she has relaxed my dietary restrictions.

Now I'm even eating a banana occasionally, with no problems.

[hurlock1]

You are right. The techs do seat you and hook you up. At my center, the new techs go through a daily on the job training for about 2 months, that is following around a lead tech for about 2 months before ever being allowed to touch a patient. I haven't found out how much training they get before coming to work at the clinic. The nurses are there to hook up the catheters, take vitals, do nursing assessments etc. You will see a dietitian.  The one at our center is not only really nice, but she's encouraging, and pretty as the day is long in July. The kidney diet must agree with me because I've been doing really well. It could be that I want to keep seeing that smiling face of our dietitian. I do eat at least 2 snickers bars a week. and it doesn't seem to make any difference. The question is "How many carrot sticks will it take to overcome the desire for one snickers bar?"  The answer is, "there is no amount sufficient." I do like the fact that we can eat White Bread, and any kind of cereal that previously was deemed "not as good for you" ; Cornflakes, frosted flakes. Rather than Whole Grain cereals. I was making my own Rice milk, for my cereal, 'cause store bought Rice milk is so expensive, but I found that "milk" made from non-dairy creamer, One part creamer, two parts water, Is better, and it's cheap.

[Bajanne]

There are no techs in our centre here - just nurses, cleaners and maintenance men, with whistle stops from nephrologists and nutritionists!

[Jean]

TWO Snickers bars a week!!!!! Egads, I was so desparate for chocolate tonight that I made sugar free fat free pudding with 1% milk, and even allowed my husband to have one serving instead of just pouring it down my throat. How did you get to be so good that you can do that?

[kitkatz]

Dark chocolate does not seem to affect my bloodwork. Strange isn't it?