no more free coffee

[paddbear0000]

Give me some more straight talk, and explain how this can be dangerous to the unit because I do not know why units do this.

Its pretty simple and has to due with staffing of the unit.   I have been in 9 different units and the staffing ratio tends to be 1 to 3 or 1 to 4.

As such if someone aspirates that takes nurses away from those other patients.  At a minimum two nurses if not more are going to need to attend to the situation thus leaving others unattended thus possibly putting them in danger.  All over something that can be avoided.

Hell, the nurse to patient ratio in hospitals is much higher than that! And patients press call buttons, machines alarm, and codes are called all the time. And how many dialysis patients do you really think are going to be crashing all at the same time? I think you may be a little paranoid and are overreacting to what might happen.

If you want to make more accusations about diabetes, bring it on. But you better be prepared and some criticisms from other diabetics on here.

 

[Aubrey]

Not allowing people to sit next to each other is bizarre. At the place I go to you rarely get sat next to the same person two sessions running; but that's to do with the order in which you arrived, and which machines are ready. Deliberately splitting people up suggests that they think you might be plotting something. You could always write notes on bits of paper then chuck them to each other.
I look forward to dialysis because you get a pot of tea and sandwiches, plus ice and juice. At the other place I was at diabetics got sandwiches and otherwise you could get one if you begged and there were some left. Everyone got tea or ice and juice, and toast (cold, but sometimes just the thing). It is amazing how much you come to rely on it, though. I think now the food is seen by the hopital as something that settles us down for a couple of hours.

[Rerun]

Not eating for four hours is not a big deal if you are say... driving a car or at work.  How many people do you know that drive for four hours without a coffee or water or a snack.  How many people do you see at work that don't get 15 minutes every 4 hours by LAW that deserve a break and a snack and something to drink.

Let alone if you are on dialysis and all the protein is getting sucked out of your system plus other essential vitamins and minerals and fluid.

There is no question that a person will feel a little better if they get to replenish their system a tiny bit during a 4 hour session of dialysis.

The few times a nurse or tech has to clean up a mess is minimal. 

After my dialysis I have to wait 2 hours for the bus.  So the staff lets me sleep in the chair an extra hour.  So in turn I wipe down my chair and the floor around me, and empty the garbage.  Tit for tat~

I have seen techs sitting and talking on their cell phones, playing on the computer, and going on break during a three hour dialysis session.  I don't think it would be too much for them to help a patient who has spilled a glass of ice. 

[twirl]

I never brought in much food - just something so the last hour I was not straving - a fellow patient brought in boxes of donuts a couple of treatments before Christmas - the patients and the staff all got a couple of donuts - no one complained then and after an hour of treatment the staff took all the left overs to the lounge room and ate them - the staff thought I brought them but I only helped carry in some boxes so I kept telling them who brought them in-- she has hardly any money and I thought thas was so nice of her -- I gave her all these hurricane free meals we got and she eats them for dinner and so does her son------- got to go to church ----- see ya later

[Rerun]

YOU had better PRAY that your situation changes!

                                                                                 

[BigSky]

BigSky, you should not talk about diabetes unless you have dealt with it for a long time. Apparently you do not know anything about diabetes and it's complications that effects every aspect of the body.

Actually I am quite aware.

As for the main contention I don't think ANYONE condones taking in whole pizzas or fried food or whatever.

Its such a controversy because I part ways and agree with the units on such a policy and am not on the old one for all bandwagon and upset their us against them complex that seems to be displayed time and time again.

You say no one condones taking whole pizzas etc etc. 

However if people are allowed to take food in the unit,  the unit has no justification to limit what someone else might want to bring in to eat. To do so will would be discriminatory.

The same argument people try to use to justify why food and drink should be brought in can be used by others wanting that pizza ,Chinese, or BBQ instead.



Maybe that is the future.  Let everyone do dialysis at a buffet.

[BigSky]

The effects of food intake during hemodialysis treatments

 Barakat, M.M., Nawab, Z.M., Yu, A.W., Lau, A.H., Ing, T.S., & Daugirdas, J.T. (1993). Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. Journal of the American Society of Nephrology, 3(11), 1813-1818.

Grodzicke, T., Rajzer, M., Fagard, R., O'Brien, E.T, Thijs, L., Clement, D., Davidson, C., Palatini, P., Parati, G., Kocemba, J., & Staessen, J.A. (1998). Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension. Journal of Human Hypertension, 12(3), 161-165.

 Mon, C., Vazquez, A., Sanchez, R., Fernandez-Reyes, M.J., Alvarez, U de F. (1999). Significant reduction of delivered Kt/V by food intake during hemodialysis. Journal of the American Society of Nephrology, 10, 334A.

Shibagaki, Y., & Takaichi, K. (1998). Significant reduction of the large-vessel blood volume by food intake during hemodialysis. Clinical Nephrology, 49(1), 49-54.

Yu, A.W., Nawab, Z.M., Barnes, W.E., Kai, K.N., Ing, T.S., & Daugirdas, J.T. (1997). Splanchnic erythrocyte content decreases during hemodialysis: A new compensatory mechanism for hypovolemia. Kidney International, 51, 1986-1990.

 The search for the following research articles originally started an effort to understand why some of outpatients had symptomatic hypotensive episodes. We also knew when we implemented "No Eating and Drinking on Hemodialysis" in our unit, both our patients and staff needed to understand the rationale for this new policy or from the compliance perspective we would fail. When I surveyed our Renalpro listserv, the overwhelming reason for not eating or drinking on hemodialysis was for infection control purposes. The other reason mentioned was the need to protect the patients from aspiration when they vomited due to their drop in blood pressure.

As we know, there have been major technological advances in dialysis, especially in the last 10 years. Yet, we still see our patients becoming symptomatically or asymptomatically hypotensive during hemodialysis treatments. Initially, practitioners" felt this phenomenon was due to patients' reactions to nonbiocompatible filter membranes. We now have biocompatible membranes, this being indicated by patients maintaining some residual renal function long after hemodialysis treatments start. This suggests that biocompatibility is not the complete story. Another suggestion is, maybe we are trying to remove too much fluid too quickly. This is definitely a factor, but patients who have minimal fluid removal of 1.0 to 2.0 kg have hypotensive episodes when they eat during hemodialysis treatments.

There are a number of published articles demonstrating that postprandial hypotension is prevalent in elderly nondialysis patients, and this prevalence increases with age. The observed effects of eating on dialysis have long been known. Several studies e documented significantly faster decreases in blood pressure when hemodialysis patients were given food on dialysis. It was noted that patients who ingested food on dialysis required infusions of saline for their hypotensive episodes more often than those patients who remained NPO during hemodialysis. This information led many in the dialysis community to allow some patients to eat, yet restrict others. The following articles highlight the relationship between food consumption and the redistribution of blood from the large vessels to the splanchnic organs. Extrapolating this further; if the splanchnic circulation remains contracted when our patients stay NPO, then these patients should have a better total body clearance of nitrogenous wastes as a larger volume of blood is available for filtration.

One question we needed to ask was: "Are we doing our patients any favors allowing them to eat on hemodialysis?" Are we trying so hard to improve outpatients' nutritional intake that we feel we cannot allow 4-6 hours without nourishment 3 times per week? Maybe we should be looking at this from a different perspective. If dialysis efficiency improves, will appetite improve to the point where they can enjoy their meals in the comfort of their home? Also, hemodialysis is a physiologically stressful treatment: Are our patients receiving any nutrient value from the food they eat during the dialysis treatment?

The following journal articles try to answer some of these questions. They also highlight areas for further research and discussion. It would be interesting to perform some of these studies with larger populations of patients. With the new technology of blood volume monitoring becoming easier and less" expensive, we will be able to assess outpatients" blood volume first hand.

Barakat, M.M., Nawab, Z.M., Yu, A.W., Lau, A.H., Ing, T.S., & Daugirdas, J.T. (1993). Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. Journal of the American Society of Nephrology, 3(11), 1813-1818.

Summary: It has long been documented that some patients have hypotensive episodes with food ingestion during hemodialysis. The mechanisms for this have not been clear. There has been a suggestion that it could be due to decreased cardiac output. This decreased cardiac output could be due to shifting of blood volume from the central circulation to the splanchnic circulation or to the vasorelaxation of the sphanchnic vessels. The splanchnic/splenic vascular bed is composed of the blood vessels supplying the liver, intestines, and the spleen.

It has also been demonstrated that caffeine blocks postprandial hypotension in the elderly with autonomic insufficiency in the nondialysis patient population. These researchers, using a double blind crossover trial, studied the effects of: placebo/no meal, placebo/meal, and caffeine/meal. Ten reasonably stable (non-hypotensive prone) chronic hemodialysis patients were studied. The researchers monitored the cardiac output of 10 hemodialysis patients who ingested a meal 1 hour into hemodialysis using thoracic electric bioimpedance. To standardize the treatments as much as possible, all ultrafiltration occurred within the first 2 hours of the treatment This also maximized the hypovolemic stress during and after the period of food ingestion. Bicarbonate dialysate was used

 During the treatments accompanied by ultrafiltration where food was ingested, the blood pressures were found to drop sooner and to a greater extent when compared to the smaller blood pressure drops when food was not ingested (e.g., at 30 minutes after food ingestion, percent change in mean arterial pressure [MAP] was -12.4 + 1.8 mmHg versus -2.4 + 3.5 mmHg when food was not ingested). Essentially, the mechanism for food ingestion-related hypotension was related to a drop in systemic vascular resistance (SVR). The caffeine pretreatment of 200 mg resulted in intradialytic plasma caffeine levels of 4 micrograms/mL at the time of food ingestion. The caffeine appeared to have no effect on food-associated drops in blood pressure or SVR. The researchers felt the results suggested that food ingestion during hemodialysis caused hypotension mainly due to the decrease in SVR. The ingestion of caffeine did not appear to have any effect on either the MAP or SVR during the hemodialysis treatment.

Commentary: This article evaluated the effects of caffeine on postprandial hypotension in dialysis patients. It has been shown thai caffeine can block the postprandial effects in elderly nondialysis patients through its theoretical vaso-constrictive activity. In hemodialysis patients, caffeine failed to block the accelerated drop in MAP following food ingestion and did not block the SVR observed following food ingestion during their treatments. The researchers did wonder if sufficient caffeine may have been dialyzed out in the first 2 hours of dialysis, leaving insufficient caffeine to exert an effect. It appears that the ingestion of food during dialysis caused an accelerated fall in blood pressure. This study showed that the fall in MAP was due to a decrease in SVR. The results of this research confirmed the results of earlier studies by Sherman, Tortes, and Cody (1988) and Zoccali, Mallamaci, Ciccarelli, mad Maggiore (1989). The results also demonstrated that the mechanism for the hypotensive episodes was related to a decrease in SVR.

Grodzicke, T., Rajzer, M., Fagard, R., O'Brien, E.T, Thijs, L., Clement, D., Davidson, C., Palatini, P., Parati, G., Kocemba, J., & Staessen, J.A. (1998). Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension. Journal of Human Hypertension, 12(3), 161-165

[del]

Bigsky my husband always had fluid gain of between 1 and 2 kg between treatments.  he always had something to drink and a snack on dialysis and never ever had a problem with b/p because of it!!!   I really don't agree with dialysis units banning drinking and having a snack. Some people need to eat or have something through out the treatment so that their b/p won't drop or they won't get sick because they are hungry.

[kitkatz]

Most studies done and publishes of dialysis patients take a small number of patients, like 9 and extrapolate to the entire population. And it ain't necessarily so for everyone.  Remember such studies can be interpreted any way they want to interpret them.  We have no way of knowing ages or illnesses of those patients in the study.

[Rerun]

Big Sky you are probably right.  It may not be the best for dialysis patients to eat and drink during the procedure.  But, in the real world they are not trying to make our lives normal again like we are ever going to get well.  They are keeping us alive.  Who CARES if we don't get the maximum treatment because some of our blood is down processing food.  It isn't going to change the end result.  We are not going to get well or feel better because 2 cups of blood don't get clean.  For crap sake..... OK YOU WIN, but that doesn't make it comfortable for us.  It probably isn't good to have a blanket on either.  I'm sure if they did a study it is not good to have everyone's blankets drug in and out of the clinic with all the germs, cat hair etc.... 

The point I'm trying to make is we don't have much to live for or look forward to.  Let me have my pop-tart and milk.

[monrein]

From Bill Peckham's site

April 10, 2008

Eating during dialysis: Good or bad?
RenalWEB links to a Controversies in Nephrology Nursing article on ANNA: Should Patients Eat During Hemodialysis Treatments? by Helene Christner and Monica Riley. They list the pro and con arguments. I've heard it all before - this has to be the subject of 100s of discussion board and listserv threads.

Sure. Sure. I support the conclusion of the article - we need more research into the actual dialysis treatment but I think we can sort this one out without a double blind study. I think those who put forward the con argument are talking about blanket policies. One size fits all rules that accommodate the lowest common denominator amongst a unit's dialyzors. I think a willingness to adopt blanket policies does not speak well of the unit.

Obviously some dialyzors have no problem eating during treatment. However, I've been to dialysis units across the globe, I know sandwiches are often served. Most dialyzors - if well dialyzed, do not have a problem eating . I know most other countries in the world - the sandwich serving countries - have much better dialysis outcomes. I know that a blanket no food policy is not justified in most cases (if a unit is running all of their patients for less than four hours, a no food policy may be neccessry but it will be the least of their patients problems).

As far as the threat of novel lawsuits? In my experience the threat of a novel lawsuit is the last refuge for a weak argument.





The research article that BigSky posted is an important one because it is the result of a search for articles in "an effort to understand why some of outpatients [sic] had symptomatic hypotensive episodes".  The word some is as important as it is instructive.  For those patients who experience hypotensive episodes, symptomatic or not, eating during dialysis sounds like a bad idea.  For those who do not experience problematic drops in BP such a policy seems rigid and in fact rather punitive.  Patients have differing requirements for all sorts of things; for medications, for dialysate composition, for binders, for blankets during treatment etc.  Common sense would be welcome in this area as in many others. 

[Chris]

BigSky, you should not talk about diabetes unless you have dealt with it for a long time. Apparently you do not know anything about diabetes and it's complications that effects every aspect of the body.

Actually I am quite aware.

And??? Explain how you are aware. It still appears like you have no clue first hand and of other diabetics. So far it seems you are only going by what you have seen or what you can see at your unit which doesn't give you insight to the rammifications of diabetes at all.
I could make a political joke of the short answer given, but I digress.

[RichardMEL]

As for the main contention I don't think ANYONE condones taking in whole pizzas or fried food or whatever.

Its such a controversy because I part ways and agree with the units on such a policy and am not on the old one for all bandwagon and upset their us against them complex that seems to be displayed time and time again.

You say no one condones taking whole pizzas etc etc. 

However if people are allowed to take food in the unit,  the unit has no justification to limit what someone else might want to bring in to eat. To do so will would be discriminatory.

The same argument people try to use to justify why food and drink should be brought in can be used by others wanting that pizza ,Chinese, or BBQ instead.



Maybe that is the future.  Let everyone do dialysis at a buffet.

The problem is you are pushing this to an extreme with your examples. I would say 95% of the dialysis population are smart enough to know what is appropriate. It is all about common sense (and let's face it, some courtesy - who wants to see some other patient scoffing down a pizza when they're sitting there for five hours staving? I know I wouldn't deliberately do something like that.. it would be like going into a unit post transplant to visit and swigging from a litre bottle of water in front of them).

As usual in this sort of situation it seems that, at some units where this policy has come in, it's because of a tiny MINORITY of people who are selfish, insensitive and/or stupid who ruin it for everyone else.. and that's sad.

As I said earlier in our unit I only eat what is provided by the unit (which is a hospital unit) though I also have a small jar of sweets to up my BP a bit in the last hour. Nobody blinks an eye and as I said sometimes the staff like one or two themselves. For special occasions like birthdays or christmas then sometimes cakes or other goodies will be brought in, but it's more an exception than a general statement.

As for the argument about patients having problems with BP going down. This is a well known effect of eating on dialysis. Now if a patient has a regular issue with their BP going too low and a crash or cramp that can be linked to eating.. fine, suggest they don't eat for their own well being.. should that affect the rest of us? I've been going 2.5 years and can't think of a single time that eating has affected my BP that badly. Indeed usually we have a cup of tea with sandwiches, and I find the hot tea raises the BP a bit anyway so it sort of evens out in the end.

I also noted in the study you posted all the dates were in the mid-late 90's. We're 10 years on from there and I bet a study done now might find something different. Go figure.

[twirl]

I do not want a buffet at dialysis but if that ever happens I will be the first in line saving places for Kitkatz and Rerun....
I would like 1/2 a sandwhich, a fruit cup, hot tea and 6 soft Cheeto's...... that is it

when my blood pressure is low at the end of dialysis they make me drink chicken broth
it has happened two times in 4 years

[mikey07840]

I hate to interrupt, but I have noticed a pattern with a certain member who enjoys being argumentative.

Now that the political thread is closed, this member may find it pleasurable to pick a fight on another thread.

I don't think any response will be acceptable as this member's goal is simply to argue and show that you are wrong.

[monrein]

Well well Mikey, your observational skills are as sharp as any sword or tongue in the land.  Please feel free to interrupt at any time.   

[paddbear0000]

BigSky, you should not talk about diabetes unless you have dealt with it for a long time. Apparently you do not know anything about diabetes and it's complications that effects every aspect of the body.

Actually I am quite aware.

And??? Explain how you are aware. It still appears like you have no clue first hand and of other diabetics. So far it seems you are only going by what you have seen or what you can see at your unit which doesn't give you insight to the rammifications of diabetes at all.
I could make a political joke of the short answer given, but I digress.

Even if you know a diabetic, or even work with them in the medical field, you will never be "aware" unless you are actually a diabetic. I absolutely hate it when people tell me they know how I feel, or how i have to plan every little thing I do, every second of my life. NO, they do NOT know! And they never will.

[Chris]

BigSky, you should not talk about diabetes unless you have dealt with it for a long time. Apparently you do not know anything about diabetes and it's complications that effects every aspect of the body.

Actually I am quite aware.

And??? Explain how you are aware. It still appears like you have no clue first hand and of other diabetics. So far it seems you are only going by what you have seen or what you can see at your unit which doesn't give you insight to the rammifications of diabetes at all.
I could make a political joke of the short answer given, but I digress.

Even if you know a diabetic, or even work with them in the medical field, you will never be "aware" unless you are actually a diabetic. I absolutely hate it when people tell me they know how I feel, or how i have to plan every little thing I do, every second of my life. NO, they do NOT know! And they never will.

Paddbear, I agree wit you, but I just want more of an answer from him. Quite aware doesn't mean a thing. It's an illicit answer that a politician would use in a press confrence to avoid answering. And no that was not the political joke I was going to use.

[paddbear0000]

I realize you want an explanation from him. So do I. I just wanted to put my  in on the subject.

[paris]

My husband has  diabetes and I am the one with kidney disease.  I have no idea how hard it is for him to not reach for a cookie or a candy bar.  He doesn't pretend to know exactly how I feel.  I hate that he has to be so careful with food, especially when family is together and everyone is eating all the different desserts, etc.  Diabetes is a hard disease;  but it is much harder for him than for me. I  just have to watch what groceries I buy for him. 

[nursewratchet]

Not eating for four hours is not a big deal if you are say... driving a car or at work.  How many people do you know that drive for four hours without a coffee or water or a snack.  How many people do you see at work that don't get 15 minutes every 4 hours by LAW that deserve a break and a snack and something to drink.

Let alone if you are on dialysis and all the protein is getting sucked out of your system plus other essential vitamins and minerals and fluid.

There is no question that a person will feel a little better if they get to replenish their system a tiny bit during a 4 hour session of dialysis.

The few times a nurse or tech has to clean up a mess is minimal. 

After my dialysis I have to wait 2 hours for the bus.  So the staff lets me sleep in the chair an extra hour.  So in turn I wipe down my chair and the floor around me, and empty the garbage.  Tit for tat~

I have seen techs sitting and talking on their cell phones, playing on the computer, and going on break during a three hour dialysis session.  I don't think it would be too much for them to help a patient who has spilled a glass of ice. 
  What a nice patient!  We clean up everything...  That's the job!

[nursewratchet]

BigSky, you should not talk about diabetes unless you have dealt with it for a long time. Apparently you do not know anything about diabetes and it's complications that effects every aspect of the body.

Actually I am quite aware.

And??? Explain how you are aware. It still appears like you have no clue first hand and of other diabetics. So far it seems you are only going by what you have seen or what you can see at your unit which doesn't give you insight to the rammifications of diabetes at all.
I could make a political joke of the short answer given, but I digress.

Even if you know a diabetic, or even work with them in the medical field, you will never be "aware" unless you are actually a diabetic. I absolutely hate it when people tell me they know how I feel, or how i have to plan every little thing I do, every second of my life. NO, they do NOT know! And they never will.

  Exactly.  I teach classes in Diabetic health, take care of my patients who are diabetic.  I am also "quite aware", but really, since I'm not a diabetic, I really don't have a clue. 

[wrandym]

I am inclined to agree with Mikey.

I also have to agree with the other diabetics in that nobody, but myself, knows how or what I may feel.

[RichardMEL]

BigSky I have a question... if you were in a unit that provided some sort of snack (so you would presume it was OK by the unit dietician etc to provide) would you object to that? Or are you just objecting to outside food being brought in (where it's true if you let someone bring in an apple what's to stop the pizza and sundae desert?). I could understand a "no outside food" rule since that would stop people bringing in their pizzas etc but also food that would be potentially bad for you (ever seen a dialysis patient with a banana??? ) but allow for snacks and drinks provided by the staff. That seems a reasonable compromise IMHO.

[Chris]

ever seen a dialysis patient with a banana???

That I have seen, both in the hospital and as an outpatient. Part of me is wondering why the hospital let that slip by while I wasn't allowed.  But at my center, at that person's age who was eating it, so what. Let them enjoy life, just don't be crying wolf later due to yur mistake. Then again I wonder how many of the elderly patients fully understood about what foods not to eat. It wa confusing for me for a bit as a diabetic with each change to the diabetic diet that about changed every 2 years at the time. However I do understand your point RM