Hemodialysis Nurse FAQs

Common Questions & Answers for Hemodialysis Nurses on NutriRite™ IDPN Therapy

Hemodialysis Nurse FAQs

QUESTIONS

What if I have to hang Vancomycin?

ANSWERS

Vancomycin and NutriRite™ IDPN are compatible and can be run together via Y-site administration. Begin Vancomycin infusion in the last hour of dialysis.

What if I didn’t start NutriRite™ IDPN on time?

That’s ok, we understand things happen. Just look at how much time is left on the machine and subtract 15 minutes.

What if I have to give iron?

Iron and NutriRite™ IDPN are not compatible. We recommend to give the iron first; give the line a good flush with saline and then administer the NutriRite™ IDPN.

What if I have to give medication while NutriRite™ IDPN is running?

Press start/stop button on the machine, give the medication, flush with saline, and then press start/stop button to resume therapy.

Patient is complaining of nausea and vomiting, what should I do?

If it’s the 1st bag then reduce by 50 percent; don’t stop the treatment- lower the rate. The patient needs time to adapt to the amount of protein being infused. We would rather start slow then go too fast and have the patient feel poorly. Notify our pharmacist of the intolerance.

The pump keeps beeping, what do I do?

It’s time to troubleshoot: Check and see if anything is clamped. Is the tubing straight and not going against gravity? Try opening and re-threading the tubing. Alcohol swab the tubing as needed.

What are the most common side effects?

Nausea, vomiting, diarrhea, flushing, headache, feeling of fullness.

What temperature should I set the refrigerator?

36 to 46 degrees

Do I have to check blood sugar?

We no longer recommend checking blood sugar pre, mid, and post IDPN infusion. Our bags are low in carbohydrate. However, if your clinic policy is to check blood sugar- follow the clinic policy.

I can’t find the rate button, help!

The Vista pump does not have a “rate button”. When you press NO to prime set- the next screen reads: enter rate.

The NutriRite™ IDPN shipment did not arrive. What should I do?

Call the pharmacy and they will send out new bags immediately.

I ran out of tubing. What should I do?

Throw the bag away. We provide enough bags for the week. If the patient is in hospital, contact the pharmacy and let them know to place the patient on hold.

What if the patient doesn’t come in for treatment and the bag has been sitting out. What do I do with the bag?

Time to troubleshoot: Is the tubing straight and not going against gravity? Open the door, re-thread the tubing, close the door and press start.

If pump screen reads: downward occlusion. What should I do?

Check and make sure you have the right tubing. Lipid tubing is labeled lipids and has a blue filter. Tubing with a 1.2 micron filter (blue) must be used with lipid formula.

While hanging lipids, it won’t prime and gets clogged. What’s wrong?

Yes, it’s already connected. No need to attach a separate filter.

Is the filter already connected to the tubing?

The size: White is for amino acids (0.2 micron) and blue for lipids (1.2 micron).

What’s the difference between the blue and white filter?

The size: White is for amino acids (0.2 micron) and blue for lipids (1.2 micron).

This is the 3rd bag. The patient is reporting nausea and headache, what do I do?

Go back to the last tolerated rate. You may need to progress slowly to get to the 3rd bag rate or the goal rate. Please inform pharmacy of any intolerance right away.

Oral nutrition packets didn’t arrive with the shipment?

Confirm oral nutrition is indicated for this patient on the order form. If not, call the pharmacy to enroll the patient for 90 days and they will ship the oral nutrition packets.

How do I chart this in EMR?

Usually under Prosol, Clinisol, IDPN or Amino acids. For every treatment given, you may insert grams of protein and volume in the notes or comments. Hypoalbuminemia is usually the nursing diagnosis that’s chosen.

How long will it take to see results?

Every patient is different. Expect to see a slow increase in Albumin over 3-6 months. However, you will likely see improvement in energy level, appetite and overall quality of life sooner. It takes time to replete a depleted patient. (Other factors to consider when evaluating results: Patient may not be getting NutriRite™ IDPN 3x a week, the patient may come late or leave early and not receive the entire treatment, and/or, the patient has other comorbidities/inflammation.)

Do I have to fax anything once a week to your pharmacy?

No.

What kind of special labs do we need to draw?

Just your normal labs

How often will I hang a NutriRite™ IDPN?

Every treatment in most cases- check the label on the bag.

When would a patient start on the lipid formula?

Usually in the third week if on the order.

Do we need to get a triglyceride level before starting lipids?

No, but it is recommended to check the most recent level to make sure it is <400.

What food allergies would contraindicate addition of lipids to the patient’s formula?

Soy* and Egg

*In rare instances, patients with a peanut allergy may react to the soy in the lipid emulsion. For these patients, we recommend consulting a pharmacist prior to adding lipids to their formula. To contact a pharmacist, please call 866-348-0441.

Is liver disease or liver cancer contraindicated for NutriRite™ IDPN?

No, but the amount of protein should be lowered if hepatic encephalopathy is present. Ask to speak with our pharmacist for more information.

Do we have to do preventative maintenance on the pumps?

No, Patient Care America is responsible for preventative maintenance.

What do I do with this paper taped to the pump?

Please give to your biomed person to keep for your records should the State surveyor ask to see it./div>

How do I clean the pump?

1% bleach and wipe in between patient use.

Refer a Patient

Simply complete and submit PCA’s Referral Form and submit online or fax to 1-888-503-6982.

Our Patient Care Coordinators are also ready to assist you with referrals at 866-348-0441.

Refer Now