Question about dialysis staff

[Katey]

I currently travel about 30 miles to my dialysis center.  I have to take a cab one way which is about 35 dollars 3x a week.  I inquired about another center closer to my home.  They had told me there is a Davita center closer to my home.  I was very excited to not be losing so much money on cab fare.  Last i went to dialysis i was speaking to the tech about it.  She then informed me that she previously worked at the center and they had minimal staff (8-1 patient to tech ratio)  I am very concerned by this information but am not sure what is an acceptable ratio.  She also then informed me she was fired from this center.  I don't know if it is bitterness or it is a true concern i should have.  The only reason I sincerely like my far away unit is because it is a teaching hospital exactly where my neph is located.  The new center says they will give me lidocain shots where the center i go to now only gives the cream... I WANT THE SHOT.  Is it normal to have the shot or is it just cream everywhere??  I am unsure about this new center???

Any suggestions??

[Zach]

She also then informed me she was fired from this center.  I don't know if it is bitterness or it is a true concern i should have.  ... I am unsure about this new center???

Here is Medicare's info on different centers.

http://www.medicare.gov/Dialysis/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=Safari%7C2%7CMacOSX&language=English&defaultstatus=0&pagelist=Home
 

[aharris2]

She then informed me that she previously worked at the center and they had minimal staff (8-1 patient to tech ratio)  I am very concerned by this information but am not sure what is an acceptable ratio. 

The new center says they will give me lidocain shots where the center i go to now only gives the cream... I WANT THE SHOT.  Is it normal to have the shot or is it just cream everywhere??  I am unsure about this new center???

Any suggestions??

Katey, go visit the center and see what you see, more than once to get a good idea. Our unit seems to have a 4 to 1 tech ratio (when they're not on break or chatting each other up, ignoring their patients) and it is a Davita unit. Regarding the shots, I've never seen it done that way. A few patients use Emla Cream, a few more use something sprayed on that chills the area and deadens the pain. Many use nothing.

$35 3 times a week! That would be prohibitive for us.

[Katey]

Thanks I will go visit the unit.  The shots were given to me while i was in the hospital.  They said they don't normally give them on the unit since only the nurses (limited resource) can push the shot.

Yea if it weren't for my parents helping financially I wouldn't be able to go to dialysis

[Rerun]

She also then informed me she was fired from this center.  I don't know if it is bitterness or it is a true concern i should have.  ... I am unsure about this new center???

Here is Medicare's info on different centers.

http://www.medicare.gov/Dialysis/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=Safari%7C2%7CMacOSX&language=English&defaultstatus=0&pagelist=Home
 

Yes, but this site doesn't tell you if they have an ice machine or if you can have snacks.  Very important to me.  Good luck Katey.  Mostly DaVita is a good place to dialyze.  If there is such a place!!!

[Katey]

Thanks so much and yes the snack part is extremely important to me!!  Also TV's!  It helps pass the time

[boxman55]

The spray aharris is talking about is called ethyl chloride. Your nepth can write a script for it. I use it and as long as the tech is ready to stick right after they spray it works pretty good. it wears off pretty quick so even if they have to unwrap the needle it has already lost some of it's effectiveness. They have to be ready to go with this stuff...Boxman

[thegrammalady]

it shouldn't be up to the unit if you use shots or cream it should be what you and your doctor want since both need an rx. each state is different based on what state law says, but in units in colorado the tech gives lidocane shots. i personally use cream, applied approximately an hour before takes less than 5 minutes to apply and wrap and works very well. visit the new center and ask lots of questions. let us know how it goes.

[Meinuk]

Does your unit social worker know the financial stress that you are under? 

Is there any way that you can consider home hemo?

[Katey]

Yes my social worker is aware and has taken my cab receipts and trying to get money from a grant to reimburse part of the money.  I am going to visit the 'new' clinic sometime this week to see if it is something that I would like...

I will let ya'all know how it goes!!

[BigSteve]

Don't let the staff control your dialysis. If the needles are painful, use Lidocaine no matter who has to inject you.
In California either nurses or techs can inject it. When I started using my second fistula the needles insertion were
very painful. I suffered for over a month until I finally told the nurse how bad they were. For some reason the staff
was reluctant to use Lidocaine, or "chicken juice" as they called it. The Lidocaine injection hurts a bit depending on
who gives it to you, but it hurt much less than the needles.

[monrein]

http://www.nwrenalnetwork.org/QI/AVFCannulationSkills.pdf   

I have found this site to be useful about cannulation and it also addresses some of the issues that can result from anesthetic use (like lidocaine).  I have only ever used lidocaine once, many years ago when I first started dialysis and it made my vein impossible to cannulate.  The vein just seemed to shrink away in disgust.  That's when I started my own desensitization experiment with pinching myself as hard as I could with my fingernails to get used to the brief pain of cannulation.  I don't use cream because I don't want to limit my free time even more by doing it an hour ahead.  I try to go to the gym every morning and that would interfere. There are also some people, often black people, who develop a lot of scarring which makes the skin very tough to penetrate. 

Since reading this article, I've also started washing my arm before sitting down to cannulate.  It's a nuisance and a little messy (my upper arm) but if that helps to reduce the risk of infection then I can live with it.

[twirl]

I like the cream it works better for me
my center will give shots but they say you are getting stuck 4 times instead of 2
go visit the center and observe during a treatment time
we just had a tech fired and she needed to be fired
she was barely 19 and rude as hell
and she made several mistakes with placing patients in the wrong chairs
she was only there for about 7 months

[Stacy Without An E]

A List of Things I Would Look for When Visiting a New Dialysis Center:

1) Are the staff lounging around napping or playing on the internet or are they dealing with patient care?

2) Do you have to wear headphones to watch TV?  There's nothing worse than having to listen to someone else's TV simply because they are egotistical goons.

3) Is the equipment (chairs, machines, bathrooms) in good working order or do they need some maintenance?

4) Is it a Nazi clinic (no cell phones, no snacks, no nothin') or will your needs be met?

5) Are there cute nurses and techs to flirt with?

Yes, you're right.  I was just kidding about #5.

[monrein]

You were so NOT kidding about 5).     And that's OK.  I just hope you flirt with patients too.  We have a ball most days at my clinic.

[nursewratchet]

Visit the clinic, unannounced. At turnover if possible.  Depending on your state, ratios will vary.  In Texas, it is 4:1.  I can't imagine being safe if caring for more than 4 patients at one time.  As far as the tech is concerned, if she was fired, she will say stuff about the clinic she came from.  I have seen, and fired many dialysis employees.  I fire quickly if they are not doing a good job, if they are careless, or rude, and I promise they probably all went to another clinic and badmouthed the old one.  Check with the Social Worker for assistance with transportation.  There are resources for that.  Good Luck!

[Katey]

Thanks everyone for the advice.  I did go check out the other clinic unannounced.  It was very clean and everyone was particularly nice to me BUT it was almost like they were to nice and to perfect.  This center is 25 min away from the nearest hospital where my "old" unit is 2 min away.  With all of that being said, I have decided to remain with my far away center.  Now they are using my graft and not my catheter I have felt good enough to drive myself!!

PS.  Thanks for the advice about resources for rides to dialysis but unfortunately my soc worker is not helpful.  I had to find about a special bus and some reimbursements for the cab.  However, the reimbursements only pay for things in the future and not in the past.  If my soc worker would have checked this out for me ( I asked) weeks ago, I could have been reimbursed! 

[monrein]

Katey, would you consider putting that in writing for your social worker's boss?  That ought not to have happened if you asked weeks ago.  Be very clear about dates.  The social worker ought to have known about that resource for sure.

[nursewratchet]

Of course she knew.  That is BASIC Dialysis Social Work stuff.  That makes up a great part of the workload,  getting resources for transportation.  LAZY,LAZY, LAZY!!!!!  Monrein is right, definately a reportable offense

[RichardMEL]

totally agree! That's what social workers are there for. In fact in all the seminars and info I've had over the years from the dialysis/renal team it's always been stressed that the social worker mostly helps with transport, parking and that kind of thing. Even to the extent of underplaying any other roles the SW may have (such as referring to counselling or other support services in terms of dealiong with the condition, depression etc). I'm stunned they didn't "know" when that is the job they would be doing day in and day out.... does indeed sound lazy. sigh.

I am so lucky I live across the road from my unit. Transport not an issue