Somebody please explain...

[mikey07840]

I would like to know why if a patient asks to end dialysis early, they are non compliant, but if it is for the convenience of the lazy nurses, it is just fine.

For about the past 6 treatments, about 3 1/2 hours into my 4 hour treatment, I clot the system. The first couple times I allowed them to send me home 15 to 20 minutes early, cutting my treatment short. Then I thought about it, and decided I want my full 4 hours. Tonight the nurse tells me I can go home early, I clotted. I asked her how much treatment time was left. She replied "27 minutes." I told her no thanks, I would like to stay for my full treatment time. I had to insist 3 times before she agreed.  27 minute is 1/8th of my treatment.

What does everyone think?

[RichardMEL]

I guess clotting requires a lot of work. I know in my unit if someone clots the lines or wants to finish and they have like 10 minutes to go the staff will let them off, it it was 27 though I am certain they would keep going because they understand the value of proper dialysis.

Just about the question I think there's a key difference.

If I whine and yell and demand to go off early because I just can't stand it and demand to be taken off - then I am making a choice and a decision to end my treatments early and as such am not following my dialysis treatment schedule as medically advised - therefore I would be non compliant.

However if the lines clot, or the bicarb runs out, or there is some other failure in the machine that is not MY choice or my decision. If a nurse decides it's easier for all concerned because there's 10 minutes left (in my case I do 5 hours, and 10 minutes is neither here nor there in that context as mostly the fluid is off, and the dialysis is done) then it's not a compliance issue (and I don't really think it's an issue of nurses being lazy either.. though sometimes that can be the case).

In the end though YOU as the patient should have the final say - and if you want to stay on then you should (and sounds like they did agree in the end which is good). Indeed in this case you should be marked as being extra compliant Most people would take the early out and be happy for it - so good for you!!!

[Zach]

You need to communicate this problem of clotting with your nephrologist.
Someone or something is very wrong.

[aharris2]

I get the idea that dialysis treatment is better  down under than here in the USA (or at least better in RM's clinic)

Bravo Mikey for insisting you get your full treatment. We, too, have noted that they are quick to deem a patient noncompliant and equally quick to take the easy way out themselves.

A good question here is why have you clotted off for your last 6 sessions?

[mikey07840]

I clotted the first 3 sessions because I almost always clot when the permacath is used. The last 3 times because I need an order for more heprin.

[Wallyz]

Your medical treatment, your decision.  But yeah, work on that clotting with your neph.

[Rerun]

You need to communicate this problem of clotting with your nephrologist.
Someone or something is very wrong.

Zach is correct, as usual!  Why do you keep clotting?  I do think that if you insist on finishing the clotting thing may stop!  The staff may think "oh, crap, we don't get to go home early after all".

                 

[peleroja]

When I was on hemo I also had some clotting problems.  One time I had 40 minutes left, so they set me up with a whole new system.  I still had a few clotting problems but I got that extra 40 minutes.  They may not like it, but ask for a whole new cleansing system to get all the minutes to which you're entitled.  After all, it doesn't affect them, it only affects US!

[mikey07840]

When I was on hemo I also had some clotting problems.  One time I had 40 minutes left, so they set me up with a whole new system.  I still had a few clotting problems but I got that extra 40 minutes.  They may not like it, but ask for a whole new cleansing system to get all the minutes to which you're entitled.  After all, it doesn't affect them, it only affects US!

When I clot, I always need and get a whole new system.

[jbeany]

More is better when it comes to dialysis. Good for you for insisting on a full run!  I refused to cut my time even when my clearances were high enough thaqt they said I could do less.

[cloud393]

I also had problems with clotting.  My RN requested an increase in heparin and no more clots.  Maybe the same would help you.  No harm in asking.  Good luck to you.

[Dana Renee]

Yea some centers are like that, some people are just lazy and rude. It sounds like to me though that maybe your heperin dose is not large enough, you should not be clotting off of your machine this often, you might want to see if your neph. can up your heperin dose, the nurses at your center (if good nurses) should notice this themselves and let your neph. know.

[murf]

Ask the nurses or your specialist to increase the heparin at thew start of your dialysis. I have pasted a few sentences from an that I goggled.
These doses are not set in stone, it really is based on a lot of factors. Your protime levels, whether or not you are on coumidin and really how fast your body clots. Not everyone is the same and just because you weigh more then the person next to you doesn’t always mean you will be on a higher dose of Heparin.

[thegrammalady]

of course my nurse knows me well and generally doesn't argue with me. she's and i have been doing this together for almost 3 years. when she does argue with me i find she's often right. people who don't know me get the same line every time. " this is my life, you do it my way or you don't do it at all" if they insist on stopping treatment early for whatever reason, you need to document it every time by sending a letter to the clinic director. use the policy posted at all centers regarding the complaint process. that's what they are doing when they have you sign a leaving against medical advice form if you want to leave early. documenting, covering their asses. it's a legal document that you can bet they'll pull out and use against you if you every have a problem that ends up in court. i never sign anything that isn't completely and correctly filled out.   but really there is a reason you are clotting. they should have already contacted your doctor. if they haven't you need too.

[lizabee]

At my center they cut your time if you are not done at the scheduled time but they also let you cut your time, if you sign the consent form.  I know of a couple people that cut their time often, but for the most part everyone is always on for their allotted amount of time.

[CybeR]

At my center they make it a big deal if you try to skip out early. I have only done it once in 5 months. And it was on my extra day (Tuesday) when I only get 2.5 hours. I left 30 minutes early and I had to sign a form that basically released them of any wrong doing and that it was my choice to leave early.

[d-man]

there are two sides to this in my opinion there is policy and personal opinion. I am very friendly in the clinic and listen as much as I can but I know policy and sorry to say friendships do not really work in the medical industry. I would document things and keep people on their toes a little. some one is doing something wrong or you have a very special problem if your coming off early consistently and some one will get in trouble or at least have to change something to make it better if you document and complain. It's not that hard to change the tubes and filter out they do it in about 2 mins the only thing I ask is are you the last shift? I am and have to "motivate" people a little to remember the days not over yet     

[kitkatz]

If I do not like something, I tell my tech, I tell the nurse on  the unit, then I write a letter.  I got my sensitive skin tape by writing  a letter that I was NOT going to have my skin ripped to shreds because they ran out of that type of tape!  I now have my own stock of tape paid for by my center!

[mikey07840]

UPDATE:

I spoke to the social worker about my concerns. She spoke with the clinical coordinator. The Social Worker said that the clinical coordinator was aware of the situation, she heard a nurse trying to convince a patient to end treatment early when she clotted the other day. I was told this is NOT ALLOWED and not center policy. The social worker explained that all the nurses were advised to provide full treatments at all times. This must be true, tonight I clotted the needles, then clotted at the end with only 10 minutes to go. The nurse changed my system for a third time so I could get my full treatment. She never offered to send me home early. Yay for full treatments.

My heprin order was increased tonight, but obviously, not enough. The nurse put a note for the nephrologist to increase the order yet again.

[tyefly]

Kitkatz     I am going to tackle that type of tape.....     Can I have a copy of your letter......  I hate the tape they use..... its the tape that is the most painfull part of the whole thing.......  whats with that........    I know that paper tape breaks my skin out so they have been using silk... but that is still sticky ichy...... and painful...  what other type of tape is there that wont pull your skin off.....     

[kitkatz]

I found the letter!   Here it is!


Dear Dialysis Unit Manager:
      I have had for the past six weeks an ongoing discussion over tape in the nocturnal unit. I have sensitive skin and have requested several times that sensitive skin tape be used on my arm when putting me onto the machine and certainly when taking me off. They tell me none has been ordered for the nocturnal crew to use. 
     I have talked to my tech about the tape issue. I have also talked to Eric about this tape issue.  Every night I when come in for dialysis I ask for the sensitive skin tape.  They tell me: ”We can only use the materials we have been given. We just do not have it.”  Now I know this is a large operation in the daytime. I also know there has to be patients with sensitive skin during the day shift that use this tape.
     I am requesting that sensitive skin tape be ordered for the nocturnal shift immediately to meet my needs.  I am tired of ripping my skin raw from tape that is not good for my skin.
I appreciate your looking into this matter for me.

[Zach]

... tonight I clotted the needles...

Maybe you should ask the person who cannulates you to use wet sticks--saline in a syringe attached to the needle tubing.  That way, they can pull back and then flush first before attaching the lines.

At times when I had a very high hemoglobin, a tiny amount of heparin was added (from the heparinized saline bag used to flush the filter) to the wet sticks.

[mikey07840]

... tonight I clotted the needles...

Maybe you should ask the person who cannulates you to use wet sticks--saline in a syringe attached to the needle tubing.  That way, they can pull back and then flush first before attaching the lines.

At times when I had a very high hemoglobin, a tiny amount of heparin was added (from the heparinized saline bag used to flush the filter) to the wet sticks.

Normally my nurse does use wet sticks, last night she needed to get bloodwork so the one needle needed to be a dry one. That is the one that clotted. I am very good at clotting. I do not fear that I will ever bleed to death...

[hurlock1]

I guess clotting requires a lot of work. I know in my unit if someone clots the lines or wants to finish and they have like 10 minutes to go the staff will let them off, it it was 27 though I am certain they would keep going because they understand the value of proper dialysis.

Just about the question I think there's a key difference.

If I whine and yell and demand to go off early because I just can't stand it and demand to be taken off - then I am making a choice and a decision to end my treatments early and as such am not following my dialysis treatment schedule as medically advised - therefore I would be non compliant.

However if the lines clot, or the bicarb runs out, or there is some other failure in the machine that is not MY choice or my decision. If a nurse decides it's easier for all concerned because there's 10 minutes left (in my case I do 5 hours, and 10 minutes is neither here nor there in that context as mostly the fluid is off, and the dialysis is done) then it's not a compliance issue (and I don't really think it's an issue of nurses being lazy either.. though sometimes that can be the case).

In the end though YOU as the patient should have the final say - and if you want to stay on then you should (and sounds like they did agree in the end which is good). Indeed in this case you should be marked as being extra compliant Most people would take the early out and be happy for it - so good for you!!!

I agree. I go for 5 hr. By the time 4 and a half hr. rolls around, I need to pee so bad and I'm insanely hungry. I try to stay on. Lately they have been using the Nurses to do the techs jobs, making them stick instead of just hooking up the catheters and doing nursing assessments. For whatever reason, it takes the Nurses longer to get to me to hook me up, making it that much later that I get off. I'm not sure if it's a more bang for the buck issue or if it's just too few techs. Anyway, the nurses are slower and less confident sticking and setting up the machines than the techs. One way or the other, if my needle is clotted and it's going to be the time involved to get re-hooked up is added to my time, rather than being passive-aggressive to prove a point, I choose to get off. I'm ready to go home. Usually by the time the needle gets clogged, I've been thinking about getting off early. I look at as a bonus!