Mad at new procedures.

[kidney4traci]

  Has anyone else been trained on how to now check for conductivity before every treatment?  I went in today for my monthly and am now very upset.  They have given me some 4 bottle contraption and a meter to check the conductivity before each tx.  And they added more steps to checking the chloramines too.  I have now added so much to home dialysis that I figure I have doubled the hours
I use to spend when I was incenter. WTF!!???



EDITED: Fixed Rant icon error-Sluff/ Admin

[Adam_W]

I was shown the more complex procedure for checking chloramines, but I haven't heard anything about checking conductivity before every tx. It doesn't really bother me that much, though.

Adam

[kidney4traci]

What bothers me is that it now averages out to 19 hours a week messing with this and in center I was only speng 9 hours there!  And who's to say they won't keep adding more stuff to do?

[kidney4traci]

This is a picture of the new test kit.  You have a new meter to learn to read.  It didn't work very well, but I only had 10 minutes training.  IThe readout of the conductivity numbers changed the longer I held it.    You have to rinse the meter's syringe with bleach (one of the containers) then with water (another container) then test the conductivity with a standard fluid ( another bottle) and then rinse and then test the 4th bottle with a standard buffered solution to test the ph.  Then rinse, AGAIN.  Then test the water in a cup you have poured from the blue line.  Also, this makes you open the blue line up every day you do a treatment, increasing your chances of contamination.  Also, the reading can be off .4 either way. 

[karen547]

I know home dialysis has some good things over being in center, but wow, that seems like an awful lot of stuff to do! I think I'll stick to in center .

[kitkatz]

Well, thbbbbttt on them!

[jbeany]

My center just makes us do a once a month dialysate draw now - what they've got you doing sure sounds like over kill to me!

[kidney4traci]

I wrote a complant to the charge nurse today.  I would really love to hear from others if anyone gets this new kit added.  I am stressed out.  Please email,PM or post a reply.  Thanks!

[Roadrunner]

I think the tests you need to perform and how many times you need to do them depends on the state regulations.  I live in MA and they just changed the way I test the chloromines. 
It seems when we started in Nov they had just changed the regulations and I had to draw water out of the chicken foot twice and test the second sample with a strip. 
Two weeks ago the state came up with new procedures.  I now have to disconnect the line between the SAK and PAK.  Since everything must be sterile you should wear gloves, place a syringe on the tubing you are not using.  Put the "Mr. Peanut" on a 30cc syringe and withdraw water twice from the Pak. Our nurse says that NxStage is working on making a special connection (spigot?) to make testing easier and less prone to contamination.
How can they expect everyone to keep up with all the changes? We don't do any conductivity tests.  The Pure Flow does it.

[Adam_W]

This is a picture of the new test kit.  You have a new meter to learn to read.  It didn't work very well, but I only had 10 minutes training.  IThe readout of the conductivity numbers changed the longer I held it.    You have to rinse the meter's syringe with bleach (one of the containers) then with water (another container) then test the conductivity with a standard fluid ( another bottle) and then rinse and then test the 4th bottle with a standard buffered solution to test the ph.  Then rinse, AGAIN.  Then test the water in a cup you have poured from the blue line.  Also, this makes you open the blue line up every day you do a treatment, increasing your chances of contamination.  Also, the reading can be off .4 either way. 

That looks like the Phoenix meter that they used in-centre to test the conductivity before each tx (one of my nurses actually let me use it when no one else was looking). That does seem to be over-kill considering the Pureflow automatically checks it for every batch of dialysate. I still would gladly do that before returning to in-centre.

Adam

[kidney4traci]

I think you are right Adam, that is what it is.  I think the pureflow does do it, so why do it again?  And each time?  Roadrunner, those changes were the same for me as well, and then they added the conductivity.  I don't want to go in center.  No way.  But would rather just hang bags each time maybe, as the pureflow is "draining" me with all this extra stuff.

[terry3004]

Yes, that does look like the contraption that is used in-center to test the dialysate before they started a treatment in-center.

I just finished my NxStage training and I was not informed of having to do this.  Sounds like a state thing to me and that your state medical board doesn't know what they are doing, but just want to make people work harder.

I would talk with your clinic about this and find out who told them that this needed to be done with every treatment.  If it is the state, then someone needs to contact the medical board and try to edumacate them on the PureFlow.

[Bill Peckham]

I use to have to do that when I was on the B Braun using an RO and for the four years I was using the Aksys PHD. The thing is, if it comes up showing the dialysate is out of range the action was change the battery in the tester or generally assume that I did the test wrong. That's a relitively inexpensive device compared to the sensors built into the machine. I remembering being very frustrated by the process. This was the hardest procedure for me to take seriously.

I can't see why you'd have test it more than once a batch. I think this flows from AAMI regulations and it varies state to state depending on what the state surveyors look for when they do their periodic surveys. The surveyors survey based on the Medicare Condition for Coverage and there are new ones coming into effect this spring.  There is quite a bit new in there on water quality. The PureFlow is even identified by name in the CfCs and the guidance to surveyors document - at least the last draft I saw.

[kidney4traci]

Bill, all I have learned is that is stems from Medicare requirements.  I am one of the first it seems in my unit, but they say it will be everywhere.  I have been on bags ever since, as I am just not very confident about the meter.  As you said, it does not seem to be a  quality product.  I also agree, if we are to mannually test the conductivity, why not once a batch vs. every tx?  Again, you are opening up the lines for contamination more and more.  They test the water too ever month, and the pureflow tests itself too. 

[Bill Peckham]

Bill, all I have learned is that is stems from Medicare requirements. 

That's right but if you read the current Medicare Conditions for Coverage for dialysis they say something to the effect - water purity must meet Association for the Advancement of Medical Instrumentation (AAMI) standards and water testing must be what ever AAMI says needs to be done. The current Conditions for Coverage have been in effect since 1983 so Medicare keeps them current by relying on outside experts in the field of water purity. Then something new like the PureFlow comes along and even if it would be justified to have different standards you still have to go by whatever the Conditions of Coverage say and by extension whatever AAMI says. I hear AAMI is slow to act - they are mostly experts that have day jobs and they get together only periodically.

FYI the AAMI website: http://www.aami.org/

[kidney4traci]

Thanks for the info and web site, I am going to check it out...