Isabel
Joined: 11 May 2003
Posts: 25
Posted: Wed May 21, 2003 2:06 am Post subject: Why fever???
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After dialyzed for 4 hrs my mother, felt tired, dizy, headaches, and had fever last night, what can be the reason??? why dialysis give to a pt a lot of complications instead of helping them??? pls advise!
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Fever
Joined: 21 May 2003
Posts: 1
Posted: Wed May 21, 2003 3:32 am Post subject: Blood cultures
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I would ask for blood cultures to insure that she isnt septic. This usually is an indication of an infection. but that is only my opinion.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Wed May 21, 2003 3:57 am Post subject: ...
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I would suggest to make sure she is getting a dialyzer each treatment, and the proper size dialyzer. When I got off the re-use dialyzer I felt much better after treatment.
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REUSE
Joined: 22 Feb 2003
Posts: 5
Posted: Wed May 21, 2003 5:28 am Post subject: GAVE ME FEVERS
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THE FEVERS TOTALLY ENDED WHEN I SWITCHED TO SINGLE USE. REQUEST A NEW DIALYZER EACH TX. THAT IS HER RIGHT. MEDICARE PAYS FOR A NEW DIALYZER EACH TX. REUSE IS FOR THEIR PROFIT. IT DOES NOT PROFIT THE PATIENT!!! GET HER ON SINGLE USE AND HAVE THEM RINSE THE DIALYZER WITH 2-3 BAGS OF SALINE PRIOR TO TX.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed May 21, 2003 6:48 am Post subject: No one
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should be running a fever during or after a tx.. I did, along with quite violent shaking and the blood cultures came back negative, but was told I had a pyrogenic reaction. The pt. on either side of me had the same thing. The same week a new water tx. system was installed. Ask staff about water sampling; if they are invasive about answering you make a well placed call to the state (you live in) board of health. The phone no. should be posted in the unit. Lin.
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Still do the cultures
Joined: 21 May 2003
Posts: 1
Posted: Wed May 21, 2003 7:47 am Post subject: They can at times be negative,the fever is gone
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Working in a laboratory for years, the fact that the cultures are negative are not suprising. However, you need to take 2 sites, and take them when the fever is spiked. This should not be just one set ever!<
>In the hospital you may have several negative's until one shows positive.
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Dept of Health
Joined: 21 May 2003
Posts: 1
Posted: Wed May 21, 2003 7:49 am Post subject: You said it
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Lin, you are absolutely right it could be the water. This seems to be a problem area all over the nation. It should be reported.
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Isabel
Joined: 11 May 2003
Posts: 25
Posted: Wed May 21, 2003 11:09 am Post subject: Water Sampling
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I am in the State of Florida....If I contact the Health Department they will probably check this water ofr me......or do I still have to get the water sampling, and what I am suppose to look for??? Please give me more details, I am new on this...Thanks
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Wed May 21, 2003 2:11 pm Post subject: Water testing
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There's two possible suspects in your unit's water treatment system, live bacteria and endotoxin (dead bacteria). There are a set of national standards that your unit has to meet called the AAMI (American Association of Medical Instrumentation) RD 62. And on a neat side note the ultimate responsibility for the water system lies with the doctor. So it's his behind on the line if something goes wrong.<
><
>Your unit has to test for bacteria monthly, and the water has to have less than 200 CFU (colony forming units). The dialysis fluid used in your machine (combination of acid and bicarb) has to be less than 2000 CFU. If your unit mixes their own bicarbonate, this is a common spot for bacteria to be introduced. They need to have records of all the testing done, although I don't know whether they have to show you or not, sorry.<
><
>The other suspect is endotoxin, which is basically parts of dead bacteria. The standerds do no state how often this has to be tested for, but the water does have to be less than 2 EU (Endotoxin units), whenever it's tested. This is a fairly new requirement, and if you have an older unit, this could be an issue.<
><
>The unit has to keep records wether they do the testing themselves or get someone else to do it for them. If they will not let you see the records, you can always remind your doctor that you can sue him (or her) for problems with the water at the unit. If you want more info let me know, I tried not to get to technical,<
>Coil<
><
>
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed May 21, 2003 11:21 pm Post subject: More than one
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culture was taken on the day I had a reaction, but the nurse mentioned that there still could be a false result because a dose of iv antibiotic was given. However, since water equipment was replaced I'm sure something was found wrong with water and equipment; it's a huge expense and they wouldn't have replaced it otherwise. A tech. told me on the sly that something was found but otehr staff was nearing and he couldn't elaborate! Some staff are willing to tell you things if you don't expose them. Lin.
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To Coil
Joined: 26 Apr 2003
Posts: 2
Posted: Thu May 22, 2003 3:49 am Post subject: Water
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coil can you explain the water system and if staff are trained?
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Thu May 22, 2003 2:56 pm Post subject: It could be an underlying infection...
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Or this could be something as simple as an infection, a urinary tract infection, or the beginnings of pneumonia. You have to remember that the elder patient does not present the way an younger person does. Often they do not even spike a temp. I agree with blood cultures, at two different sites, but also a UA, and a chest x-ray should be done. If she is residing in a long-term care facility, there is a greater risk for her developing a gram negative pneumonia simply because she exposed to more gram negative germs. While it could be related to the water, the water could be the "kicker" to an illness that is already present. <
><
>You also have to remember that you DO NOT need a positive blood culture to be diagnosed with sepsis. As long as you meet certain criteria, you can be diagnosed with sepsis. These include: 1) Either high or low WBC, 2) high or low body temperature, 3) mental status changes and 4) a source of infection. This is identified as Early SIRS (Early Systemic Inflammatory Response Syndrome), which can quickly
progress to sepsis and septic shock. Do not always rely on a blood culture to indicate that you have sepsis. Ask for a CBC and then look at the body temp, and mental status changes, then the most common causes are a UTI and pneumonia, so a UA and a Chest X-ray would be appropriate to ask for diagnostic testing as well. The quicker you catch sepsis, and begin antibiotic treatment, the quicker your recovery. Recently there was an excellent article in Medscape about this topic that identified the specifics of sepsis. If you have a central line, this is also a major source of sepsis.<
><
>Become knowledgeable about your disease process and what factors can make you ill quickly and ask for the right tests to lead to a quicker diagnosis and quicker treatment!
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our staff
Joined: 22 May 2003
Posts: 1
Posted: Thu May 22, 2003 4:52 pm Post subject: does not wash hands
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between patients. They do change gloves. How likely are we to contract sepsis?
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Thu May 22, 2003 5:19 pm Post subject: Washing hands
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is essential to good treatment, and they should wash their hands between each patient. Even though you wear gloves and they offer protection, there are still very, very small micro holes that some bacteria can pass through. Handwashing is essential and should be done between patients. Wearing gloves certainly reduces the risk, but to my knowledge there have been no studies done on sepsis and using gloves without handwashing. So I can not answer your question. The risk would be minimized because of the use of the gloves, but by how much I have no way of knowing. I would ask the tech or nurse to please wash their hands with either soap and water or the waterless cleaner before applying their gloves. If necessary, purchase your own bottle of waterless cleaner and ask the tech/nurse to please use this prior to applying their gloves. I would say it in a joking manner, something like, "OK, so, I know I'm becoming more and more paranoid with all this stuff, but would you mind using this to clean you hands before applying your gloves. All these buggy wugys are beginning to give me nightmares" and laugh as you say it. That way you are attempting to make a joke, and it it not taken as a "complaint." It has been my experience, that in that situation the nurse/tech will usually laugh and comply. I've gotten farther with humor with this type of situation than I have with being stern or demanding. Hopefully it will work for you as well.
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good
Joined: 22 May 2003
Posts: 1
Posted: Thu May 22, 2003 6:39 pm Post subject: suggestion
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But it's a different situation in dialysis. It would be different if it was a one time thing, but staff in units like this are not attuned to the patients -their loyalty goes to their Don. Their Don has them speeding so fast that anything that slows them down freaks them out and they become resentful. Yes, they'll comply, because not to would make them look really bad. But the next time they put the patient on, they'll already fail to wash again and the patient will have to go through it with them all over over again. They will spew resentment, dirty looks, make cocky statements, or run to turn another patient's alarm off while they are in the middle of working on you and not register that they need to wash and apply new gloves again. <
><
>It's an impossible situation unless they are mandated to observe asceptic technique by their Don, are thoroughly trained in what = a lapse and know it means their job if they cut corners. <
><
>In most instances, the staff doesn't cut corners without the Don's and the doctors' blessing. They are thoroughly aware it goes on, because they sanction it. Add to this, if a patient is firm about staff washing hands, no matter how nice or humorous he is about it, he becomes the unit's Public Enemy #1. <
><
>Staff are extremely sensitive to the slightest request a patient makes, because it takes just the slightest thing to slow them down. And then from then on out, anytime something happens in the unit, the finger points at the one, or two, educated patients. <
><
>I know it sounds hard to believe that the situation could be this intense, but this is how it actually does go. Been there, done that. The patient is constantly under a strain, something one with a chroinc illness definitely does not need, and he's always under the pressure of being dumped ditto. <
><
>Usually the Social Worker comes and says,"Maybe you would be happier somewhere else". If a patient bucks the system, he'd better be prepared for what comes next, and it can come very fast.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Thu May 22, 2003 7:24 pm Post subject: I still find
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it appalling that nurses/technicians who are taught the basic techniques of handwashing between patients are so lax. It makes my skin crawl to think that they actually treat patients this way. It almost makes me ashamed to say that I'm a nurse. I've always prided myself on the fact that my patient comes first. And no matter how tired I am, how many hours I've worked that day, or no matter who tells me to do what, I take care of my patient the way I was taught. I wash my hands between patients, I do not make snide remarks to them, I do not give them dirty looks, and I certainly do not play any part in instilling any additional fear into them. I'm ashamed that they are part of a field that is supposed to be a caring profession, and I apologize for their behavior to you. I wished they worked for me, because they would be looking for employment elsewhere (of course, I probably would be too, because they would fire me for not comply with their "rules" because I would not work under those conditions).<
><
>This treatment reminds me of the treatment many elders receive in many long-term care facilities. They are ignored by their physician's, they do not come to visit them as required by CMS regulations, when they become acutely ill, the majority of their illnesses are handled by "fax medicine" without the physician ever seeing a patient. Most physicians feel, that they are old and they have lived their life, what do you expect. I expect quality of life. I've walked into patient's rooms, and found that they can't even reach their water pitcher's and its 90 degrees outside and it's hot in the facility. I've seen the caregivers walk out to go get materials to clean them, and leave them completely exposed, and the patient begging to be covered up. It's only been in the last five years that things have changed for the elder patient in long-term care facilities. I raised enough h--- and got enough people fired that eventually in some facilities things finally began to change, which is what I hoping will happen with dialysis units.<
><
>DEO is a great organization that works very hard to ensure that the dialysis patient is treated fairly. I understand your fears, because I heard the same fears in long-term care, "If you do anything, they will just make it harder on me." I was able to affect positive change in several facilities and I hope that DEO will allow me continue to work with them to affect positive change with dialysis centers. NO ONE should have to live in fear when they are receiving any type of healthcare! Together as a unit, we all can affect change and make things better for everyone!!!!<
><
>
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yes
Joined: 29 Apr 2003
Posts: 5
Posted: Thu May 22, 2003 7:59 pm Post subject: The Dialysis Industry Scenario
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is just history repeating itself. Some don't like it compared to Natzi Germany, but I think it does and I am not offended, having ties to Judisam. Or look at slavery, nursing homes (as you said) or the mental institutions. But it didn't even begin there..it began at the beginning of Creation.<
><
>Will DEO allow you, aprnjam, to continue to work with them to affect change? I think I'm safe in answering for DEO that I don't think there's any question about that! You're the first person of your medical stature to really stand up for patients on this board and we can only
hope that through your example this criminal situation is fully exposed and your colleagues follow suit. I'm proud to be associated with true American heroes through this organization and I hope the medical establishment is reading this, because you obviously are a hero from their ranks.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Fri May 23, 2003 3:44 pm Post subject: I am hoping
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that DEO will allow me to continue to work with them. I still have a lot to learn about dialysis and I reading more and more everyday. I was lucky and got a reprieve from a nephrologist who apparently cares for his patients and is not interested in making money (see my post in Patient Stories).<
><
>I have volunteered my services to DEO to do anything that I can to help affect positive change in this industry. Everyone here has been of great help and moral support to me during a time when I didn't know whether I was going to need dialysis and a transplant or not. One neph telling me one thing. I was just happy that the neph my insurance company wanted me to see was the neph that originally diagnosed me in 1989. I trusted him and valued his opinion. When he said no dialysis or transplant and that I had 50% function, I wanted to do a happy dance in his office!! I knew that when I looked at the labs, it just didn't make sense to me at all, and to have him confirm my suspicions was so gratifying!<
><
>I'm here and if noting else, will provide moral support to everyone here! If you need to vent, then my all means, ask Arlene for my personal e-mail. Right now, I'm in the process of writing a book, and I'm using some of the personal experiences of people from the board, but writing it in the first person. If anyone has any stories that they would like to share that I can incorporate into the book, then contact Arlene for my personal e-mail. I have lots of previous writing experience, lots of published articles, books for continuing education. So this is a project that can be done and that can draw attention to the discrepancies in this industry. I hope some of you decide to help. I promise you anonymity will be protected. There is more than one way to skin a cat!<
>
