I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Centers => Topic started by: kitkatz on November 04, 2006, 09:26:05 PM
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Last Friday I had a problem holding onto one of my sites after the tech pulled needles. They did not have any sure seals available. My arterial went crazy on me and would not settle down under the pressure I had on it. The tech said: Put pressure eon it. Well, no
shit Sherlock, I was putting pressure on it. I have been doing this for eight years so far! And the tech left me sitting in my own blood and i had to ask twice for her to clean it up. My questions are:
Do I complain about the unit not having any sure seals?
Do I complain because the tech left me sitting in a pool of blood on the chuck underneath me for fifteen minutes and did not change it until I had asked her twice and my sister walked in and saw it? Would she like to be left sitting in blood for a while?
Also it is so damned cold in the unit I am freezing all of the time, even my sister, who is never cold, says it is cold in the unit, do I complain? I already have a thick blanket.
Am I just being picky? Will it help to tell the upper echelon in the unit how I feel about it?
After eight years at this same unit, I feel I may be listened to more than other patients due to me surviving all of the changes we have been through in companies and in staff. I just want the care I pay for and deserve.
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Difficult question. If you complain then you become known as a whiner and somebody is going to be offended. On the other hand you have some very valid complaints. Being made to sit in a pool of blood is not cool. Is the temperature in the unit being set for the comfort of the patients or for the staff? The unit might have run out of sure seals but it is really their responsibility to keep on top of supply needs. I usually let things stew for a while and if I think the problem merits a complaint then to hell with what other people think, I'll let them know just how I feel.
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I would speak up and tell them whats on your mind. As far as it being cold, ask the Doctor if they can bump the machine up .5, it helps me lots. :twocents;
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I agree, you need to pick your battles, but lack of supplies and neglect are not minor issues.
You have to ask all the questions, and allow your staff to reply. Nothing whiney about wanting
answers. You should never be concerned about repercussions or being labelled a "troublemaker."
If this is an issue for you, there SHOULD be a grievance procedure available and a way to
state a written complaint anonymously, though I believe that open complaints to the proper
people is always the way to go. Let's face it, some people make an issue of everything, but
you know when a complaint is ligit if you've been around as long as you have, kitkatz.
Just state your situation, and ask for answers. If your negligent tech was handling a crashing
patient, and the shipment of sureseals was delayed, just chalk it up to a rough day. However,
you are absolutely entitled to an explanation for what happened to you .
As far as the cold issue, have you inquired about setting the MACHINE temperature
higher? I had that problem at my last unit, and tried everything and could not get warm.
When I had exhausted my options and was consistently miserable throughout treatment,
I asked about the machine temperature. My unit physician initially refused, saying that increasing
the temp would contribute to dropping blood pressures. Knowing that this actually WAS an
option, offered to me at a unit once before, I persisted. I discussed this option with other
patients, and they began requesting it as well. Obviously, there is just so much that they can
increase the machine temp, but I found a big difference in my comfort level when they raised
it only 1 to 2 degrees.
I agree with livecam. Think about the issue and you will know if it is a valid complaint.
Always assume that your staff WANTS to address patient issues.
If patients have complaints, and fail to raise the issue, how can staff respond?
Good Luck
Carol
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Being made to sit in your own blood to me sounds like neglect and reminds me of hospitals when a patient is made to sit in their own urine because no nurse would come bring this lady her bed pan (she couldn't walk).
I know nurses are busy but sometimes it feels like they are punishing us. Like "you didn't hold it tight enough so now you have to sit in it" type of mentality. Sorry if I am being synical but that is the mood I am in since yesterday.
I would complain but here in my city I can go to the renal social worker and she brings it to the right people. That way names can be left out and you don't get labled as a whiner.
I don't think the temp would be adjusted however. I have learned at least in my unit that it is set for staff comfort.
When I have went to staff to complain about certain things that really upset me (I hardly complain) I found they protect each other and don't take the patients seriously at all and basically just shrug it off or get defensive or protective.
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I would at least talk to the head nurse. There is no reason a tech couldn't have come over and changed the bloody chux. That is a given. You've been at that center 8 years now, and this is a valid complaint. It could have been a new tech that isn't aware of what should have been done. If you don't tell management and they are not made aware of the situation, they can't do anything about it. Again, I feel this is a valid complaint. As an ex-clinic manager I'd like to have taken this on. It is merely good practice and this should be brought up generically in staff meeting.
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Yes, I think you have legitimate complaints. The tech should have replaced the chux or at least added another one (or more) so all the blood was covered, for various reasons but especially patient comfort.
Sure Seal bandages - they may no longer stock them. The clinic I worked in used to always have them and we didn't appreciate how great they were until they took them away. Why? To save a few pennies (no more than 10-15 cents per bandage). And for that you got: unhappy patients (more bleeding, longer wait times), unhappy staff, and more usage of chux and other materials. Some savings! However, I think if enough patients complain they might well consider bringing them back. And your clinic may have just run out... which management might not be aware of.
Unit temperature - oh, what a common complaint. And no, it's not kept like a freezer for staff comfort - many of us were just as miserable as the patients. It's for certain staff comfort - usually those who are closest to the thermostat... again, complaints can be very effective.
As pp has mentioned, it is often most effective to involve the social worker to either bring this up with the FA for you or with you as they act as a patient liaison; however, it is certainly not necessary. You have a lot of credibility based on your seniority there and I'm sure others look to you as a leader. No doubt, these are also complaints that many others would like to make!
Good luck!
DeLana :)
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Regarding Sure-Seals, aren't they the stops that had to be removed two hours after application? In all fairness I remember they were still on the accesses two days later when the patients came back in and that caused a wave of access infections not to mention if you didn't take them off within the recommended two hour time frame they sort of "grew" into the clot and could cause maximum bleeding when you took them off. Sometimes it is not all cost, but patient safety. Believe me, I am NOT towing the corporate line but from my experience it was a safety/infection control issue, as well as cost.
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Regarding Sure-Seals, aren't they the stops that had to be removed two hours after application? In all fairness I remember they were still on the accesses two days later when the patients came back in and that caused a wave of access infections not to mention if you didn't take them off within the recommended two hour time frame they sort of "grew" into the clot and could cause maximum bleeding when you took them off. Sometimes it is not all cost, but patient safety. Believe me, I am NOT towing the corporate line but from my experience it was a safety/infection control issue, as well as cost.
That sounds like Tip-Stops, which have a thick white gel-like substance in the middle that works like a dream for the heaviest bleeding; we rarely used them and (probably for that reason) never had a problem with them; need I add they also stopped buying them?
Sure Seals are like a regular bandage with a thin layer of absorbent material; they work for all but the heaviest bleeding (and are better than a regular bandage anytime) and can be removed whenever the patients chooses to; even if they left them in place (a common problem with nursing homes), it never caused a problem for us.
When I asked the FA specifically about this I was told that it was a $$ issue - they couldn't justify spending 15 cents or so on a bandage - and it was a corporate decision, out of her hands.
DeLana :)
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When I asked the FA specifically about this I was told that it was a $$ issue - they couldn't justify spending 15 cents or so on a bandage - and it was a corporate decision, out of her hands.
DeLana :)
The reasons for not having them in the clinic is due to overall cost. If I was able to reach my monthly supply budget, or get below it I would be allowed to order them. Save a Penny Spend a Penny, it all comes down to that almighty dollar. You can however purchase your own and use them.
Fixed Quote - Rerun - Moderator
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Now why in the hell should I buy my own bandages!!! I go every time to every treatment. I try to treat the staff with respect. I am the patient. I am hardly in control of supplies for the dialysis center. I feel the dialysis center should provide what the patient needs in order to have a treatment that is proper and complete, down the the tiniest bandage and the biggest dialysis machine!
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Tip-stops - yes they were the ones. Thanks DeLana.
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Now why in the hell should I buy my own bandages!!! I go every time to every treatment. I try to treat the staff with respect. I am the patient. I am hardly in control of supplies for the dialysis center. I feel the dialysis center should provide what the patient needs in order to have a treatment that is proper and complete, down the the tiniest bandage and the biggest dialysis machine!
Amen. But I rest my case, I wasn't able to get through to my manager (I think she would have bought them if she could have - but total supply cost probably made that impossible, probably because they ended up spending so much more on other supplies: gauze, gel foam, chux- which are much more expensive than Sure Seals ::)).
DeLana
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Now why in the hell should I buy my own bandages!!! I go every time to every treatment. I try to treat the staff with respect. I am the patient. I am hardly in control of supplies for the dialysis center. I feel the dialysis center should provide what the patient needs in order to have a treatment that is proper and complete, down the the tiniest bandage and the biggest dialysis machine!
I agree with you completely. Unfortunately that's not how it works. In my case both the staff and the patients are to blame for our out of control supply costs. More so the staff, but myself and several other staff have caught patients walking up to the supply carts and grabbing entire boxes of supplies and putting them in their bags as they leave after their treatment. I'm sure the staff probably take things with them too on top of what they just throw away. We are going back to the pack system (supplies packaged for each treatment) to reign in the problems with theft and waste. Then all that will be on the carts are the packs that they need for that shift, and a few extra gauze and what not in case of an emergency or a bad bleeder.
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See the I hate dialysis thread to see the letter and and response I got at the unit under general discussion.
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Leaving you sitting in blood isnt very nice, but if theres no bandaids then just use gauze and tape. I dont see a need to complain about no bandaids, unless it is a continual problem. Nothing wrong with just using gauze and tape.
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Hmm not sure about sure seals... we use these circle things - tape around the outside and a bit of gause or something in the "dot" to cover the access pointand seal it. They then tape a wad of gaude over it with instructions to take them off the next morning before a shower or so. These work pretty well and only once have I had bleeding and they had to pull it off go again. Think we were just a bit too eager to get me off in time. Now I know how long i take to stop bleeding and time it :)
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I am sitting longer and longer to stop the bleeding. I also am starting to bleed through on the sure seals. The needles go in awkward places on the graft and it is hard to get to it to hold it. They have solved the Sure Seal problem. I just have to ask the supervisor to get me a supply and she will. She said there was no reason they should have been out of sure seals for two weeks. They just could not get in to her office to get them. Seems it was her fault. Oh well.
My letter worked wonders. The nurses are telling me what they have for me before they give me meds. The place is slowly warming up after turn over time. The chairs are uncomfortable, but oh well.
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In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds. Maybe they need to use less blood thinning medication (the name of which is escaping me right now) if you're having bleeding problems. Our unit will also apply something called Caltostat to the wound to stop bleeding if necessary. For me, bleeding is generally not a problem.
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In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds. Maybe they need to use less blood thinning medication (the name of which is escaping me right now) if you're having bleeding problems. Our unit will also apply something called Caltostat to the wound to stop bleeding if necessary. For me, bleeding is generally not a problem.
Heparin.
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In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds. Maybe they need to use less blood thinning medication (the name of which is escaping me right now) if you're having bleeding problems. Our unit will also apply something called Caltostat to the wound to stop bleeding if necessary. For me, bleeding is generally not a problem.
Heparin.
That's it. Thanks. Don't know why I couldn't remember it.
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In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds.
When I first started at my clinic we had these clamps. Our Medical Director told us to stop using them because he was afraid the pressure created by them was damaging the patient's sites.
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In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds.
When I first started at my clinic we had these clamps. Our Medical Director told us to stop using them because he was afraid the pressure created by them was damaging the patient's sites.
Ya ours is going to get rid of them too. But you want to know my opinion? Well for me the clamps aren't very tight since my arms are so small. The real culprit are the nurses! They wrap tape around the arm so tight that I KNOW that must NOT be good for the fistula.
So I got these black velcro bands that another patient made and that way I can loosen it when out of the nurses sight. ;)
If I just relied on the clamps I bleed all over. I know this is different with anyone with bigger arms but for me I know that the tape is much tighter than the clamps .. so wouldn't that be more of a worry for any dialysis unit for the longetivity of the fistula??
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My vascular surgeon said NO CLAMPS, NO TAPE all the way around the arm ever. I have had good results following his directives.
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My surgeon also said nothing tight around the fistula EVER, and as most know, no BP on that arm, no blood tests no nothing. He doesnt even like the idea of fitted tops that you roll/push up for dialysis. He told me to get a loose shirt, cut up the sleeve and sew some buttons in the sleeve so you can just undo it for dialysis. Pfft theres no way Im doing that to all my tops. I just wear tops that if rolled up arent tight.
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I hold my own!
One step closer to sticking myslef! HA ;D
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I wish I knew who to talk to about the clamps. I mean in my unit they are not tight on us at all but the nurses and their tape .. holy crap you would think they were terrified a tornado was gonna come for us and they had to strap our bandage on tight!!
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They all know, no clamps and no tape all the way around the arm. I still tell them what the surgeon said to me. One tech told me I could tell the surgeon to stuff it. Haha! Not me, I loved my vascular surgeon. Too bad he has retired now and his partner retired, too. Who knows who I will see next time I need a graft put in! Pray it does not happen soon. I know what you mean about the tornadoes and the tape. Shheez! If Dorothy had taped Toto to her the way they tape the bandages to my arm, she would not have gone to OZ!!
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Ya ours is going to get rid of them too. But you want to know my opinion? Well for me the clamps aren't very tight since my arms are so small. The real culprit are the nurses! They wrap tape around the arm so tight that I KNOW that must NOT be good for the fistula.
So I got these black velcro bands that another patient made and that way I can loosen it when out of the nurses sight. ;)
If I just relied on the clamps I bleed all over. I know this is different with anyone with bigger arms but for me I know that the tape is much tighter than the clamps .. so wouldn't that be more of a worry for any dialysis unit for the longetivity of the fistula??
I think the tape on my clamps leads to more pressure than the clamps. I've wondered about pressure on the fistula (or in my case, a graft), but then you've got to have some form of pressure to stop the bleeding, don't you? Is there much difference in potential damage between a clamp and a tight grip from my hand?
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I think if you are capable of holding your own sites, then I dont see why clamps are needed.
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I think if you are capable of holding your own sites, then I dont see why clamps are needed.
The nurses in my unit really don't want them to get rid of the clamps because a lot of the patients don't hold it long enough and then bleed all over. But I find myself I have to hold them because the clamps simply aren't tight enough.
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If they took the time to teach them how to hold and check I dont see how its a problem. Unless they just dont care. After a while you get to know how much time it takes to stop bleeding.
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If they took the time to teach them how to hold and check I dont see how its a problem. Unless they just dont care. After a while you get to know how much time it takes to stop bleeding.
Think it is a matter more so of not enough staff..
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Ugh. I wish I'd known about these stories before. I thought I was the only one going throught this crap!
My last straw -- the one that propelled me from hemodialysis to peritoneal dialysis -- was when techs would call me if they were running ahead so I could show up early and they could leave work early. But did they ever call me when they were running late?? Or did I show up at my appointed time and have to sit in the !@#$! waiting room. I say complain loudly, complain often. What the heck. Then do it yourself in order to maintain control. It was hellish being at the mercy of one tech in particular who was ALWAYS on her cellphone while dealing with patients. Then there was the time I was a captive audience to a tech who decided to share his religious beliefs with me at length and in detail.
Good luck to us all. :beer1;
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Here we go again. I go to dialysis tonight. They shifted a lot of people around the unit and closed one side. Therefore patients were crowded into chairs tonight and they were getting off late. I am third shift patient arrive at 3 o'clock to begin dialysis. I get there and I am told there is a twenty minute wait. Okay, fine. Then I find out it is bloodwork day. I ask the center director after thirty minutes of waiting if I was going to run my full time today. He says yes you will. To make a long story short I finally got onto the machine at 3:45. At 7:20 the tech says time to come off now. I said I have half an hour to go yet. He says everyone comes off at 7:30. I said no way am I coming off this machine unless I have done my entire run. You put me on at 3:45. You have taking a half hour away from my machine sometime tonight! You are doing bloodwork tonight. You are taking me off half an hour early. I hollered so loud the floor nurse came over and they gave in. I almost had to make them call Rudy, the center director, at home and he would have TOLD them to keep me for the half hour. It was NOT my FAULT I was put on late today it was the centers fault. So I deserve to run my entire time damn it!
Also I asked one of the nurses if she could call a doctor and ask for an antibiotic for the sinus infection I have. I even asked the center director to remind her. Nothing was done. Shit.
Third class citizen here sitting in the back of the short bus!
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Third class citizen here sitting in the back of the short bus!
Hopefully your not all the way to the back. >:D ;)
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Kitkatz,
Good for YOU! Bullsh_t them deciding to shorten your run. And to top it off doing it on lab day!
It infuriates me how late they run. Unbelievable!!!!!!!! Good thing you made a stink this way your
labs will show that you had all your treatment and will reflect that. Don't want to be "NON-COMPLIANT"
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I used to be cold alot, too, but then I discovered these hand warmers. They retail at 711 and Walgreens for 99c/pair but if you like 'em you can get a case of 480 for $156. I am still working on my case. I think I'm gonna do a separate post about these warmers, cuz I'm bored and I really think it might help someone.
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Hello, I was reading your site here the other night, having just resigned from DUH-Vita and feeling uplifted about my decision after reading some of the comments on this site. I've been a dialysis technician for over 10 yrs and have worked for Fresenius, Gambro, Davita, NNA and SMMC which is a non profit unit. And i can tell you as a Tech all of what you say is true and it happens to one extreme or another in all of these units. All employees are constantly torn between being a good employee and being a good tech or nurse or biomed, etc. I only wish they would use these postings in their training modules. Maybe then we'd get somewhere. However i felt the need to perhaps offer you a bit of insight and answer your questions if i can.
One of the reasons it may feel colder in your unit is that warmer temperatures breed infections faster and dialysis patients already have compromised immune systems as it is from the nature of your ESRD. Like hospitals most dialysis units attempt to keep the clinical areas cooler for this reason. Dialysis patients generally feel much colder from being anemic and also having their blood circulate thru the extracorpeal unit regardless of this. It's one of the reasons most companys offer you blankets, not that they seem to do you all much good, I know. But truly it's not cold in there to torture you, it's there to help with infection control, one helpful suggestion is to wear long johns, they're thin, lightweight and will help keep you warmer.
Sure-seals are very expensive and certain "for profit" company's are going to cut cost and corners anyway the can, often times you can get a doctor's order for gel foam which is essentially the same thing and fill it on your own as an Rx and bring it with you to treatment. But try complaining to the director first... maybe they were just out of stock or a tech was too lazy to restock. It happens, even in the best of circumstances.
Leaving you in a pool of blood is definately not cool. Granted with the use of heprin during treatment a little blood loss can really look like a whole lot, which may or may not be why the tech wasn't overly concerned or panicked. And typically you're not going to catch anything from yourself. Often times the chux pads are also very expensive or at least as employees that's what we're told, and again certain "for profit" companies have a moto to use one per customer, it's a little uncooth but sometimes that's how it is. While i can't advocate as to the rationale of the person that left you sitting in a pool of blood and didn't clean it up... at that point it was probably justified to give you a clean chux and yes you should complain to the director of the unit, in my opion anyway based on the fact that the rapport between staff and patient is lacking and maybe that tech needs a "refresher" from the boss.
Also if you are bleeding that profusely after treatment, despite putting pressure on your access, talk with your nurse and doctor about your heprin dose, perhaps it needs to be adjusted. There's many variables which affect it, anything from blood labs, to infection, antibiotics, other anticoaugulants and human error (too much, to little) so on.
I hope this helps and never ever feel you can't complain or advocate for yourself, you've lived in your body longer than most have been doctors, nurses or technicians, if anything you know it best, so don't let people tell you differently if you're not feeling comfortable with your dialysis treatment.
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What an outstanding post.
HemoTech please go to the introduce yourself thread and post your intoduction.
Thank You
Sluff, Administrator
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I wrote a letter to the director of the unit and she jumped pretty high. Putting it into writing has definitely made them repond more than just verbal complaints. I have learned to write it down, then they are required to respond. Hehehehehe. >:D Now we have a new director who used to be one of the RNs. Hard to find him lately. I will get him too eventually. hehehehe. >:D
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I willg e thime to evetually. hehehehe. >:D
Huh? Somebody forgot to use spell check. :lol;
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I willg e thime to evetually. hehehehe. >:D
Huh? Somebody forgot to use spell check. :lol;
I feel the breeze from a huge swinging stick DUCK!
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I willg e thime to evetually. hehehehe. >:D
Huh? Somebody forgot to use spell check. :lol;
Crap! Okay I fixed it.
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I willg e thime to evetually. hehehehe. >:D
Huh? Somebody forgot to use spell check. :lol;
Crap! Okay I fixed it.
I'm sure you are quite busy with your new duties on the site.
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Complain to the manager. Even though you think she knows what is going on, sometimes we don't. I moved my office to the lobby so all my patients can have immediate access to me.
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I was just wondering if any of you have nocturnal dialysis in any of your areas?
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There are a couple I'm aware of in Dallas.
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We do here at one of the downtown hospitals and it was pioneered here in Toronto (1994 I believe) by Dr Robert Uldall. There are also a number of home patients doing nocturnal. A Google search of "nocturnal dialysis Toronto" yielded quite a bit of info on it in our city.
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I just felt I had to add to this post -
My husband's unit does not even supply sure-
seals, the patients bring in their own from the
outside.
Anyone else have to do this? I think it is disgusting!
Anne >:(
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I just felt I had to add to this post -
My husband's unit does not even supply sure-
seals, the patients bring in their own from the
outside.
Anyone else have to do this? I think it is disgusting!
Anne >:(
I think it's disgusting too.
Here, we have a choice of bandages. Ones with fabric type stuff, sticky. Ones that wrap right around the arm but stick to themselves. Sure-seals and bandaids.
We also have a choice between three types of tape. Paper, plastic and fabric.
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Must be nice to have all of those options. I get gauze and paper tape.
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Must be nice to have all of those options. I get gauze and paper tape.
and Kitkatz aren't you still sleeping with them
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Must be nice to have all of those options. I get gauze and paper tape.
and Kitkatz aren't you still sleeping with them
HEhehehe! Yes as a matter of fact I am.
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do not complain
just use your big stick in a creative way
really, you spend the night there and you should not be freezing
my unit freezes us and the techs are happy b/c they have to wear those yellow jackets or gowns and they get hot easily
you are not a whinner so complain when something is wrong
:cheer: Kitz cheering with her big stick :bandance;
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We have ways of dealing with complainers who make waves and upset our apple cart.
Disent will not be tolerated.
Give us a hard time and we will black ball you and you wont be able to get
treatment anywhere in this city.
We'll crash your ass every other treatment and if that doesnt teach you to shut up,
we'll destroy your graft or fistula. If need be, you might be poisoned or infected.
Go ahead and run to your ESRD network, we bought them off a long time ago.
We own your congressperson too.
We will build a case against you and label you.
Complain all you want.
Really, dialysis centers should have stricter regulations, be inspected more frequently without notice,
and provide much better care than the status quo. They should be holding your site for you! They should
have adequate supplies and the patient's needs should come first.
....bd
:bunny:
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I say compalin. About whatever. I get complaints often and they are always adressed. I get some to my face, some on paper slipped under my door. They are adressed. State surveyers will ask for a log of patient complaints when in clinic. If you don't have any, they think you are hiding something. Complaints have to be logged, with interventions and outcomes. You bet they will listen! As far as the Sure Seals, they are not that expensive, they should certainly be able to keep them on supply for you. Try Betadine swabs folded under the gauze if they are out. That will stop bleeding pretty fast.