Again, I’m a little late to the party, (this aired in May) but have you seen this story?
It is a truly shocking report. it confirms our worst fears: US dialysis is in crisis. The most expensive dialysis service in the world has the highest dialysis mortality rates.
Two for-profit giant companies (DaVita and Fresenius) deliver 70% of the care, overwork and underpay staff while making enormous profits. From this report, it is clear that the industry is overwhelmed by bad incentives, poor oversight, and profiteering.
Any wonder why over 70% of the fistula rupture stories on this blog are from US readers.
The one small light at the end of the tunnel is the California Dialysis staffing bill.
But first, have a look at the report (Language warning!).
Medscape has a great article about\ the California bill, (it’s free, but you may need to log in), that has attracted a huge number of comments, all in favor.
For example, one nurse wrote:
…The problem arises when you take care out of patient care. By this, I mean that the monetary value of running a clinic outweighs the quality of care provided by the staff. You can not expect Staff to give the quality of care when they are overloaded with 4+ patients to care for and only have 15 minutes between each patient to rinse back, take VS, close up their access (be it a catheter or a access (graft or AV Fistula)) and put another patient on by doing their VS, quick assessment, cleanse their dialysis catheter/ graft/av fistula, start their treatment, document on the patient and give report to a charge nurse.
…I was tired of on-call and went to work in-center and my ratios in New Jersey were 3 patients per tech, nine patients/RN. I had to assess 9 patients and put on 3 every shift and when you have techs they may put the patient on the wrong bath, not do vital signs timely, with no time between shifts if you had a patient hypotensive, it was insane. A patient died on that unit, but not assigned to me that day because the techs did not do their vital signs and the nurse was busy doing something else. The B/P kept on dropping and no one assigned in that area ever told the nurse assigned there. You still have to do care plans, monthly notes, give blood, give meds, and get yelled at because you are not doing turn over fast enough.
How the No boosters keep a straight face is beyond me.
One interesting thing from the video: when these companies are sued, they settle.
Food for thought for anyone who has had a loved one die from a fistula rupture in one of their units,
Here we are, just a couple of weeks after posting the Fistula Health training program, and Daquon writes this:
Hi Greg. My mom is 42 she been on dialysis for 5 years. Recently her fistula had been getting big and the Dr. at dialysis told her she should be careful because it was thin and she could bleed to death. From me reading your responses on everyone else, they are supposed to fix her fistula when they noticed it was swelling up.
But lo and behold they didn’t, and a week later she woke up and blood was squirting out her arm. I call ambulance, they took her to the hospital. She got surgery done on her arm but she came home yesterday and she told me she had to change the bandage twice a day and when I help her take the bandage off it was a big hole in her arm leaking blood to the white meat. We had to stuff the hole with bandages and wrap it back up. (more…)
This week the Fistula Health Education for Patients package, developed by Julie Tondello at Diaverum and me is now available for anyone on dialysis.
The Package has been prepared for use on a one-on-one basis by dialysis unit nursing staff, educating patients.
Dialysis Unit staff
- Print out the two-page education sheet and keep it handy for reference during each education session
- Print two color copies of the poster:
- One on an A3 or similar sized page
- One on an A4 or letter sized page.
- Laminate both posters
- Attach the large poster to the unit noticeboard so that all patients can see it
Schedule brief (5-10 minute) education session (more…)
You may recall that in April last year, Julie Tondello (from Diaverum in Greensborough) and I developed a Fistula Safety training course and poster for dialysis patients. The main aim of this 10-minute course was to keep people safe from fistula ruptures and bleeds, both by knowing what to look out for to prevent it from happening and by Pressing and Lifting to stop the bleeding if it happened.
Julie ran the training as a one-on-one session for all patients at Greensborough and North Melbourne dialysis units. Surveys before and after indicated that it was universally well-received and effective.
But as always, the proof of the pudding is in the eating. (more…)
The key to slowing or stopping your fistula from bleeding (whether it’s after a needle has been removed or (God forbid) a rupture) is to understand why it spurts in the first place.
Our fistulas are created by connecting a high-pressure artery, full of oxygenated blood coming at a great rate from our heart, to a vein, which is usually returning de-oxygenated blood at a leisurely rate (about 80 mL/min) from our body back to our heart (more…)
I have just returned from the Renal Society of Australia’s annual conference, held on June 20 t0 22 this year at the Gold Coast, Queensland. The conference is for renal professionals, nurses, clinicians, doctors and consultants. I went along because I was a co-author on one of the presentations.
The other author and presenter was Julie Tondello, a renal Associate Nurse Unit Manager at my Diaverum dialysis clinic in Diamond Valley, Victoria. The paper was called “Can your fistula rupture?” and was triggered by the ongoing posts, comments and queries about fistula rupture deaths on this blog. (more…)
In February 2010, I wrote Dialysis: death via a damaged fistula, which was about Maya’s father, who died when his sore and swollen fistula burst in bed and he bled to death. At the time I asked some of the experts I knew about this and all said it happens, but was very rare.
However, over the following 18 months I had a steady flow of posts about other people who had died or came close to death from a leaking or haemorrhaging fistula, and it started to look a lot less rare. (more…)
This post is about fistulas, the dialyser’s lifeline. It’s about how and why they can haemorrhage, signs and symptoms that indicate a potential problem and action to take to prevent it.
We BigD-ers need a fistula to make it easy to insert dialysis needles. The needles are reasonably large, and cannot be inserted into normal veins. If you don’t have a fistula and you need to go on dialysis, you usually get a Perm Cath (permanent catheter) or central line that is connected directly to one of several large veins in your neck. If you can’t grow a fistula on one or both arms because the vein has too much scar tissue, (more…)