At my dialysis center I currently use a permacath due to my graft that I've had for 6 years stopped working. Tried having it declotted. But, they don't last forever. The Charge Nurse keeps hounding me about a new access. I've had 2 PD pumps before both after the graph. The first one placed on the left side eventually started to erode due to the fact the dialysis solution is dextrose (sugar) based. The second one placed on the right side had yeast growing in it. Seeing that sugar breeds yeast. So, that was removed. My Vascular suggested another PD Catheter. My Nephrologist says NO. The Charge Nurse at my clinic is aware of this information. So, for now my Nephrologist says we will use the permacath. Mind you the Charge Nurse has been hounding me for months. I know the risk of the catheter and so does my doctor. I'm young and otherwise healthy and I know my body. So if I felt strange I would just csll my foctor and get bloodwork and a chest xray. As of Friday now her and the other nurse have gotten together obviously and now mysteriously now my catheter doesn't flow properly all of a sudden. But, I always get to finish my treatments. We all know the machines are sensitive to movement and i was moving around a bit more than usual on Friday. I feel as though I'm now being harrassed. I feel as though they're trying to make me do something to my body that my doctor has said NO to. Am I overreacting about the situation? I honestly feel uncomfortable there now. Should I transfer and report them to their home office and to the SE Kidney Council? I want my treatments not harrassment.
Dialysis Nurses Trying to give unsolicited... - Kidney Dialysis
Dialysis Nurses Trying to give unsolicited medical advice
Does your nephrologist interact directly with the nurses in your center, eg, send them your dialysis prescription, see you for appointments at the clinic, review regular updates on your dialysis treatment outcomes from the clinic? And finally, have you talked directly with your nephrologist about all of this? If not, that is where I would start.
You do need to feel comfortable at the clinic. And you definitely shouldn’t experience undue pressure or harassment from anyone at the center, especially the center staff. It’s time to advocate for yourself🐶
Let us know what you decide to do.
Marj
This is not right. Staff have no right to hound you the way they are. Get in touch with the administrator or better yet board of directors and report them. I've dealt with similar problems with my dialysis unit. And if you have to get in touch with cooperate. Those are the people businesses don't want to deal with. I tell ya if it were me somebody would be getting fired. Do all you can to resolve this don't let them push you around. You are your own boss no staff at any center is your boss your their boss. Sorry for what your going through.
Hi! This is Michael! I am sorry you are going through all of this. It is bad enough that we are on dialysis; who needs aggravation!!
It is my experience that the most important persons caring for you are the nurses! It is hard for me to believe that they are conspiring against you. Your nephrologist knows exactly what is going on with your accesses and he needs to be the one to meet your needs. I am sure he and the vascular are very concerned about you!
Everyone is different; I would not even think about REPORTING your dialysis center staff or anyone else. With all the procedures you have had your nephrologist and primary care physician must come up with solutions for you.
Get your PCC more involved. My last thought is to trust your dialysis center staff. They know what they are doing. If you still are unsure about the direction they (Doctors, nurses) are taking you the only alternative is select a new nephrologist and possibly a new center! I will you keep you on my prayer list!
Hello, I had this same situation before I got my transplant last year (Yay!!). I had a fistula in my left arm go bad, had another fistula go bad in left arm and had a graft in left arm which went bad also. They ended up putting in a catheter in my upper chest which I had for eight months with no problems. As soon as I got the catheter, the manager of the clinic started calling me at home about getting another type of access because of the risk for infection. I said that I understood this but was on two transplant lists and was near the top of the lists. (I was on dialysis 4 1/2 years). Because of this I did not want to even attempt to put something in my right arm since I have very small veins and didn’t want to mess it uo like my left arm. And my nephrologist agreed with this. She ended up calling me every month asking the same thing!!! It was very frustrating and I always told her no. I later found out that the clinic does not like patients to have catheters and are always pushing for fistula’s. It looks bad on their records for the company as this is one of their goals. They are just doing it to make their clinic look good, like it is a contest. I would definitely tell your kidney doctor and maybe he can do something about it. But it is your body, your decision!!! Good luck!!
I am on my dialysis center's QAPI committee and this is one of the issues the centers must report to CMS (Medicare and Medicaid). The center does get penalized by Medicare if there is too high a percentage of patients with catheters as opposed to fistulas and grafts, due to the higher possibility of infections. Bloodstream infections and hospitalizations and repeat hospitalizations (regardless of what they are for) are also reported to CMS. I believe the nephrologists and nurses are trying to do the best for their patients by suggesting that more patients get grafts or fistulas, but if the patient feels he/she is getting harassed continually they do have options to file grievances. I wonder if ReedNovember has talked to his clinical manager. If not, I would start there and if the problem isn't resolved, file a grievance.
My doctor and I both are aware of the risk of a catheter. But my Nephrologist that I've had for 6 years knows my complete medical history and the nurses don't. So my doctor has medical reasons as to why he doesn't want me getting another access. Seeing that I've had 2 PD Catheters and a lower arm graft. They simple need to follow the prescription he gave and leave me alone. Thanks for the info.
You're welcome. You definitely don't need to feel harassed at your center. Let us know what happens. Good luck to you!
Surely the pressure should be backwards from the clinic to Medicare etc. (wrt inflexibility) and not forward to the patient, as long as the patient understand the risks and is willing to take them. Btw, I have been a transplant patient for 3 decades and seen many instances of nurses putting pressure on patients, purely for their own convenience, especially on dialysis. They are human, the same as us, many nice, some not, and the bad ones can unduly pressure their colleagues, leading to a poor overall clinic culture. Unless managers and boards are able to observe without staff knowing, this is difficult to uncover (especially if they are unwittingly friendly with the main protagonists). I've had a great experience overall, but also some very bad ones. I'm in the UK, but likely US is similar. Managers and boards need to be very wary/sceptical and survey patients regularly and anonymously (in terms of reporting back) on the patients' part, face-to-face. Patients are in a very vulnerable position to complain and need advocates.
In the US dialysis patients are surveyed yearly by CMS about the quality of care they receive from nephrologists, other professional staff and their satisfaction with the dialysis center, amongst many other things. It is a six page survey which some patients complain about, but it is what it is! Also, the dialysis center I attended has also done in house surveys from time to time and always meets to discuss patient grievances monthly. I am still on the QAPI committee even though I have received a transplant. I also serve as a Patient Facility Representative (PFR) on the IPRO ESRD Network, which is a further source of help with grievances if nothing is done at the local dialysis center. The ESRD Network has regular calls and contact with CMS and reports to that agency.
I believe that is between you and your doctor. Nurses can inform you about options but they need to follow the orders not prescribe treatment and she shouldn't be doing it so much as to make you feel uncomfortable or harrassed. I would suggest that you make a complaint with your dialysis center. The information should be readily available to you or made readily available to you upon request. Good luck.
Chances are your clinic has an investment and the corporate office pushes their staff to send patients their way. In Warren Ohio we have an access center owned by several Fresenious doctors. So every month an access nurse shows up pestering patients to make appointments. I've seen several other examples of the same behavior. You might just wanna resist and tell those nurses you're content as you are.
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