I looked to my left and see Anthony finishing up talking to AW , and beside me Ashley is wiping down her machine to prepare for her next patient. I’m discontinuing Mr. Johnson’s treatment. As I noticed his CVC (Central venous catheter) / RIJ( Right Inter jugular) access dressing fell off, I quickly wash my hands, and gather my supplies to clean his access once more. This is normally done prior to initiation of treatment, but hey this happens. It’s healthcare. I gathered my supplies ( Cvc dressing, two normal saline syringes 10cc , two 3cc syringes of 1.8 volume bolus of heparin, 4 alcohol wipes, 4×4 gauze, 2 blue chucks , and an extra 4×4 slightly saturated in a cleansing solution. As I’m rinsing back my patient at a 150-200 blood flow rate, I’m typing my post documentation, retaking Mr. Johnson’s blood pressure. I can see AW out of the left corner of my eye watching me. It’s funny because as a Dialysis Technician we are always watching everything let alone we are always in a fish bowl. Meaning we are always being watched. I mean, AW’s body is extended so far out like a giraffe ( LOL). Once Mr. Johnson’s blood is returned, I took his sitting blood pressure which was 148/76 and as I asked him to stand, along with his venous ( blue),& arterial (red) lines still attached to his Cvc access….. AW’s eyes are wide as a deer in headlights . I can just imagine what questions she may have for me. After Mr.Johnson sits for a few minutes, I finish up by helping him button up his shirt. I walk with him to the scale to get his post weight. Coming back as I turned the corner to go back to the Jamaica Pod where AW is sitting, she is looking at me anxiously while waving her right hand for me to hurry up . “ Hey AW, how was your talk with Eric and Anthony? I must say your first 45 mins to an hour of your first treatment have been quite fulfilling!”, AW replies ,” It certain tee wus boy !@( in her Jamaican accent),” What you be doing to dat Mans chest down der, boy?”.” Me saw those tubes like they be close to his neck and heart!”, “ Well AW , Mr. Johnson has a CVC which stands for Central Venous Catheter- which is also known as a central line , Central venous line, or Central venous access catheter , is a catheter placed into a large vein. It’s known also as a venous access. He has this access because he is fairly new to Dialysis and awaiting for the maturity to use his new fistula. You may not have noticed , but he had a Fist Assist Device around his left arm. As I mentioned before, the device is used to dilate and mature veins. A vein enhancement/ strengthening device. It is also known that a Cvc is a temporary access for renal patients. ,” Hmmm Dwelyn , now that you say that I do remember having that type of thingy in my leg/ groin area while I was in the hospital a few months back and I believe I had Dialysis then. Come to think of it, I did but remember very vaguely. I was in ICU and almost near death!” ( says AW) . “ Well if that’s true, you were in a Acute setting and considered critical . It is also possible that you may have only needed Dialysis for a short period with the risk of becoming chronic maybe. I’m not sure. So now getting back to the explanation of CVC’s… As you noticed their weren’t any needles . And no pain.” I couldn’t tell too much from here , but I get it. ( says AW). So sounds to me he didn’t experience any pain when you started his treatment?!?”, Exactly AW, majority of patients whom obtained CVC’s for their Dialysis access , do not experience much pain. However they’re more prone to infection. So the proper procedure for keeping the access clean and free of infection is very particular and severe. Let me explain, as we here whom are taking care of patients who have CVC’s , we have to gather additional supplies compared to if my teammates and I were giving care to anyone who has a fistula or graft. Just a little more time consuming , but not by much. So as you saw me standing there. I returned his blood through both access sites( venous and arterial), once his blood was returned I took his sitting. Blood pressure., then his standing. That’s when you saw him sit down and me slightly standing over him. Once he was stable , I disconnected his arterial line first with my right hand , and placed the line in the holder slot next to the dialyzer. I then scrub the hub for 15-20 seconds. Once I finished , I took my left hand with the Cvc port between my gloved hand and held it up away from the blue pad across his chest at a 45-50 degree angle so it doesn’t touch the pad. As I continue , I take my right hand and attach a Normal Saline syringe, inject 10ccs, disconnect the syringe and then attached a heparin bolus of 1.8 ccs to pack the catheter port so it doesn’t clot . After that I attached the catheter caps, wrap both ports with 4×4 gauze with my name ,date, and time.
AW replies,” Oh I see. So , let me get this straight. You may have told me before , but certain people or patients can have different areas or ways to get dialysis? “
Correct AW. I can actually bring out a simulation device to explain to you once our turnover is done. You know after we finish putting our 2nd shift patients on. AW says ,” Okay that sounds like a plan. I guess I won’t be going anywhere soon , so I’ll be here. But Dwelyn , who’s that standing over there?
As Ashley sets up her machine , a young lady comes out to our floor with a startled and frightened look. As if she’s terrified. Nicole is her name and she’s a new Dialysis Technician that’s just started with us and has finished her computer work in the back office of the clinic. I do remember our Facility Administrator mentioning that I would have her shadowing me today. I totally got side tracked and forgot. But in my better judgment I can actually have her talk to Ashley since she’s coming up on her first year and if anyone can relate to a new hire or teammate , is someone who’s considered fresh on the scene. And whom can paint more of a vivid picture of how to cope within our profession.
Kidney Trails 