This new policy is stupid

[karen547]

So now we have a new manager at my unit who by the way I haven't even seen/met! And we all get a letter passed out to us which talks about the new 'policies'. I don't usually complain or say anything but you guys tell me if this sounds ridiculous- so the new policy is in regards to the needles. Before we were allowed to use 2 clamps for the fistulas, but now, we are only allowed one, but if we choose we can have 2 but only if we take one out at a time, and let it clot for 10 minutes , then we can take the second needle out, and clamp it.. for another 10 minutes. I am really confused at this new policy because it one takes up more time, and 2, I don't think it should be up to them if I clamp or not, its my choice! I am sure this is all $$$  related anyways! And then to top off my week I get a bill from the ambulance for 1000 dollars which I just had to sign and send into my insurance but that just made me so angry, I mean 1000 dollars for a ride?? They didn't even give me any drugs! My parents told me they just want to come get me next time I have a seizure, because most times they do nothing for me at the hospital anyhow. Sorry if i am sounding whiny, but I am really fed up with my unit lately.

[Rerun]

One clamp at a time!     I hope everyone chooses it.  The workers will be there until midnight! 

Do it!  Show her/him how stupid it is.  Oh, and don't move to the lobby.  Tell them you feel dizzy and don't feel safe moving.

Yes, all health care costs are outrageous! 

[karen547]

OH I can take both clamps out at one time, however most times after dialysis, I have to PEE badly! I cannot unzip my pants with my teeth though lol. I mean what do they expect us to do ?? I feel like getting a petition going! lol

[BigSky]

I would ask them what the rational is behind the new policy.  Their answer may well be very entertaining.

[chiefsfan301]

The Doctor who did my fistula said I should never let them put a clamp on my arm! So I sit in the chair and hold pressure with my right hand.

[Sluff]

Why is it that no matter how smooth things go, somebody somewhere always wants to change things. Especially New employees, it makes them feel and sound important to justify their pay and their position.

[sullidog]

I had a tech that always demanded I used clamps, we got into an argument once and still she put the clamps on me. I think that aided in the clotting of my old graft, this one though they are going to do it my way or the highway!
Troy

[galvo]

Never heard of clamps, at least not in the dialysis sense. We just use the other thumb and fingers to apply presssure. Some people do one at a time and others (me included) do both at once. Takes me 8 minutes. Please tell me about the clamps.

[karen547]

Well clamps are basically  just like your thumb and finger would be, but with a spring. I just hate how someone who doesn't even introduce herself to us, just throws this new policy at us. I truly feel this will backfire on the staff, as I think a lot of us would prefer to use 2 clamps at once. If they are bad for a fistula why have them at all in the first place?? And also we cannot have hot drinks given to us anymore, which they never gave in the first place really but now there's actually a rule against that. I just hate when the 'managers' treat us like children. I REALLY HOPE MY KIDNEY COMES ASAP!

[caringpct]

At my unit we encourage our patients to either hold both site, or one at a time if both cannot be held at the same time. We don't like using clamps because it can cause clotting in a fistula or graft. I do agree that the new manager should have come out and introduced herself before enforcing new policies. At the very least she could have explained why the new policy was being placed.

[monrein]

I never used clamps as we were told they were not good for the fistula...too much pressure that can result in clotting off.  Some people insisted but all the medical people I spoke to said not to do it.  The people who did were usually elderly and couldn't seem to hold their sites manually. 





http://www.scribd.com/doc/9141411/On-Course-With-cannulation  (from 2004,  AAKP)

Here is an excerpt from the above document.

"10. Education for caregivers and patients.

Not only should regular education be provided to facility staff on the topic of vascular access, but patients should learn about caring for their own vascular access.

Did you know:

Needle sites should be rotated each treatment.

You should not sleep on your access arm or leg.

You should not wear tight fitting clothes on your access arm or leg – not even a watch.

You should feel your access for a thrill (vibration) and listen to your access for a bruit (swishing sound) every day.

Clamps are not recommended for use after dialysis to stop the needle sites from bleeding.

11. Outcomes feedback to guide practice.

In order to track and identify opportunities for improvement, the ESRD Networks collect data from all dialysis facilities and provide feedback reports that compare their vascular access rates with the average rates in the ESRD Networks and the United States. Do you know what your facility’s AV fistula rate is?"





This of course has nothing to do with your center's new policy and how it was introduced to you Karen.  If it is to prolong the life of your fistula that ought to be explained, in fact I strongly believe that rationales should always be thoroughly explained from a medical standpoint.

I'm often quite suspicious of some of the things that are done in for profit dialysis centers since very often they don't seem to be about best practice but rather about what is financially expedient in terms of the cost of supplies or of labour.

[RichardMEL]

could be cost related but also maybe they've had issues with too many people bleeding.

No clamps for me or in my unit. I hold both spots(usually, unless they are too far apart for my hand) but I only take 2 mins to clot up, so I am usually out of there 5 mins after the first needle is taken out (YAY!). If I was forced to sit there for ten times that (2x10 mins) I'd go nuts and want THAT policy changed. Everyone is different - there's one guy in my unit who takes 15 mins per site to clot up, so it takes him 30+ mins to finish up (poor guy) while I take a fraction of that amount. most folks are around 5 mins or so that I have seen.

Seems stupid to enforce a blanket rule for a population that probably varies like this.

[YLGuy]

My unit uses clamps but I hold my sites.  One hand covers both and I can let go in 1 minute.  Lucky I guess.

[thegrammalady]

i've heard that clamps cause too much pressure, but i've had techs use more pressure than any clamp.

[lola]

Otto was told to NEVER use clamps.......Also Karen WTF you can't unzip with your teeth

[looneytunes]

I see this thread as one more example of the dialysis professionals (used the term loosely) treating the patients like sheep.  Maybe if all the patients would just go in saying "baaa...baaa...baaa" they would get the point.   

[melobelle]

Being pro-active in your care is the BEST way to be. If you have complaints make sure you let them be heard. Go to the Head Niurse with your complaints. If you still feel you are not being heard go up further on the ladder. My doctor actually own the dialysis center, so whenever I mention that I will go directly to the doctor with my frustration/complaints, I feel things get done. Good Luick!

[YLGuy]

I see this thread as one more example of the dialysis professionals (used the term loosely) treating the patients like sheep.  Maybe if all the patients would just go in saying "baaa...baaa...baaa" they would get the point.   

We are numbers. I am chair 1, 2nd shift. Period.

[RightSide]

If you complain, you can make a difference.

At my dialysis center a couple of weeks ago, they put up signs at the doors saying "Do not come in until the previous shift of patients have finished using the bathrooms." 

I scribbled on the sign, "This sign directly targets ME!"  And I signed my name.

The signs were removed.

Remember:  No matter how much you squawk, they can't fire you--because you don't work there!

[pdpatty]

No clamps . Seen too many patients in the centerw where I go have trouble with fistulas and had to have grafts put in.
I won't use clamps unless my left arm falls off.Ten mins. and I am ready to leave.

[RichardMEL]

We do not have assigned chairs and I think that actually works. Each session we'll be in a new chair. Oh some folks generally have similar spots, but certainly for my afternoon shift it's more about which machines are available depending on when the in patients and ambulance transported patients have shown up and finish etc. So anyway I'm not always in spot 2, I could be in 3A or 5 or 7. Besides I know I'm not a number to the staff. I'm more of a pain in the backside to be just a number!!! 

[RightSide]

I don't think the policy is stupid.

Clamps can damage a fistula over time.  Using only 1 clamp, once for one puncture and once for the other, seems sound to me--it's an attempt to minimize the pressure of the clamps.

Also, holding (or clamping) one puncture for a few minutes and then holding (or clamping) the other one rather than doing them both together, has helped me prevent post-session bleeding where the punctures open up again and start bleeding after I get ready to leave the dialysis center.   I've had some real disasters where the punctures opened up again as I was walking to my car in the parking lot and I had to run back to the center, leaving a trail of blood behind me.

I had dialysis last evening, and that's how I did it:  I held one puncture shut for 4 minutes, then I held both punctures shut for 6 minutes, then I let go of the first puncture and held the second one for 4 minutes.