Renal Rolling Handover
A guide for JMOs in Renal Medicine at Concord Hospital
Introduction
This is a ‘living document’ and will be updated by the Junior staff each term.
Checklist for new starters
 Orientation from Term Supervisor/s
 Review Renal Term Description and Rolling Handover
 Renal eMR training – Haemodialysis Medical Note; Renal Biopsy procedure note, set up
renal department lists, learn how to use the dashboard, learn how to order service category
changes.
 Obtain access to the renal consults list (maintained by Dr Ritchie)
 Subscribe to CRGH Renal calendar (through the Concord Renal website, see below).
Top tips
1. Protect veins for future dialysis access. For any patient who possibly needs haemodialysis in
the future try to protect the veins of their non-dominant arm – no venepuncture,
cannulation or BP checks. Use a coloured band similar to lymphoedema warnings.
2. Admit patient direct to ward wherever possible to avoid ED.
3. Aim to have most DC out of the ward before lunch – use the DC lounge where suitable.
4. Get patients out of ED quickly – accept obvious admissions over the phone if you cannot
attend immediately.
5. CRGH Renal website http://concordrenal.wikispaces.com/
6. Ensure discharge summaries are comprehensive and concise. Funding is linked to DC
summary detail and guidelines are available on the intranet for the standard required
http://intranet.sswahs.nsw.gov.au/SSWAHS/ClinDoc/ (inTRAnet).
a. General guidelines (inTERnet)
http://concordrenal.wikispaces.com/file/view/Casemix_General.pdf/380328816/Cas
emix_General.pdf
b. Specific renal guidelines (inTERnet)
http://concordrenal.wikispaces.com/file/view/Casemix_Renal.pdf/380328738/Case
mix_Renal.pdf
Staff
Medical staff
Associate Professor Martin Gallagher – Head of Department, Staff Specialist 0.5 FTE
Associate Professor Charles George – HMO, pager 60557
Dr Roger Wyndham – VMO 0.5 FTE
Dr Meg Jardine – Staff Specialist 0.5 FTE, Director Clinical Trials
Dr Mona Razavian – Staff Specialist 0.5 FTE, manages Vascular Access database
Dr Shaundeep Sen – Staff Specialist 1.0 FTE, Concord DPT, Director CKD Services
Dr Angus Ritchie – Post-Graduate Fellow 0.5 FTE (in Renal), pager 60740, x 77409, Med Super.
Dr Steven Kalowski – Nephrologist in private practice in Burwood ph 9745 2296, fax 9744 6736
Dr Anas Natfaji – Nephrology VMO Canterbury, private practice in Burwood ph 9745 2296, fax
97446736
Nursing Staff
Hannah Bannell – Renal NUM, pager 60234, x 77471
Glenn Stewart – Renal CNC, pager 60259, x75723
Jane – acting nurse in charge, CRGH Satellite dialysis, x77770
Allied Health Staff
Cindy Wu – Renal Pharmacist, pager 60832, x 76470
Adminstrative Staff
Magdalena Bosman – Renal Department Secretary, x 76447
Maggie Thiagarajah – Satellite Dialysis Unit and Renal Clinic Secretary, x 77718, fax x 77719
Eileen – Renal Ward Secretary x76422
Lina Floridia – 4N Dialysis Secretary (Mon/Wed/Fri)
RPAH Contacts
Jane Nicholson – Renal Case Manager x p81037
Kim Grimley – NUM Building 12 x 9515 3504
Rose Musumeci – Renal Office Manager x 9515 7648
Youn Park – CNC Building 12 x 9515 3529
Building 12 PD Office – x 9515 3525
Building 12 Satellite Dialysis Unit Front Desk (Billa) – x 9515 3500
Building 12 Home Haemodialysis Unit – x 9515 3505
Consultants – Eris (HOU), Snelling, Chadban, Gillin, Wyburn, Gracey, Saunders, Foote
MO Roles & Responsibilities
General Information
Usually the team is made up of the consultant on call for the wards, consultant on call for consults,
one or 2 ATs, 2 or 1 BPTs (wards and consults), two residents and one lucky intern. Usually one
resident will cover dialysis, the other resident and intern will cover the wards. The residents swap
the dialysis role mid term. Also the BPTs switch their roles in the middle of their term.
Consultant cover runs on a 2 weekly rotation basis. The consultants cover the ward (regardless of
who the patient is known to) at 2 weeks at a time, but they will still follow up with their own renal
physician. Bosses generally round about 3 times a week at any time. (Often Mon, Thurs, Sat).
Ward rounds start at 0830, meet in 4north doctor’s room. They can go for varying lengths,
sometimes all day.
Glenn is the CNC, she follows the renal outpatients and inpatients very closely, and is very
knowledgeable and approachable. If you have any questions she will help to answer them and help
arrange things.
Hannah is the NUM. She is also very knowledgeable and helpful. If you need to organise dialysis for
patients she will help you. In return she likes to know the EDD (estimated date of d/c) for the
inpatients (target is 100%)!
There is a chart on the dialysis ward which says which pts will be dialysed that morning and night. It
lives on a clipboard at the nurse’s station. There is also a handover book where the nurses
handover relevant info for pts getting dialysis to ensure pending jobs get handed over. Ask them
about the book so you can help them update jobs e.g. “needs fbc with next dialysis”.
The benefits of home therapies (home haemodialysis and peritoneal dialysis) should always be
emphasised to any patient contemplating RRT or those on RRT who may be suitable candidates to
switch.
Junior Medical Officers
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Ward rounds at 8.30, meet at the doctors room on level 4 - pass code 76420.
Consultants take fortnightly turns in looking after the inpatients and being the admitting
officer
It’s helpful to know who the patient is originally known to, which may not be who they are
under that particular admission
Multidisciplinary meetings are held on Thursdays at 11:00 am in the 4 west room. Interns
usually present the discharged patients for that week, at the end (just the follow up plan).
The discharge list will be handed over by the registrar on Wednesday. To make things easier
we were recording the discharge plan of each patient in the discharge book
For restricted s100 medications (e.g. Aranesp, Cinacalcet, Renagel and Fosrenol) a special
form needs to be filled out by the consultant when the medication is started. Go to
http://intranet.sswahs.nsw.gov.au/SLHN/, click on pharmacies on the right then Concord,
you will get to the pharmacy website, go to the left and scroll to s100 restricted drugs. Chose
the type of drug. For subsequent prescriptions, a code needs to be obtained from the PBS
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website www.pbs.gov.au, it’s not something the intern does regularly, the Pharmacist will
give you a little tutorial if need be.
Pharmacy now requires S100 medication scripts to include the following information before
they are accepted:
o The number of syringes you require of the order (e.g. 4 syringes)
o The streamline authority code (can be looked up on the PBS website)
o Your prescriber number
o As mentioned earlier this assuming a previous initiating prescription has been
provided by the consultant
o A new white script pad has been provided by pharmacy for these S100 medications
such that it will be easier to remember include the above information.
Fax discharge summaries to Dr Kalowski’s rooms for his patients or Dr Natfaji’s patients (Dr
Kalowski’s locum). Write attn: respective physician on top of discharge letter. Fax number
97446736
Glenn is the renal CNC and she is so helpful. She tracks all vascular access procedures. She
also provides dialysis education for the patient and their family.
If you need to swap someone’s dialyses days, start them on dialyses or dialyse someone
urgently, talk to Hannah.
Regular consults are vascular consults. They almost always ask for a Doppler of the fistula if
we suspect is not competent. They will need vascular mapping for a new fistula, always do
both arms, they might also ask for saphenous vein mapping if they are using it for avf vein
graft. To order these studies, go to power orders, type diagnostics and chose vascular.
Interventional radiology. Make friends with interventional radiologist, you will need them a
lot. They do the vascaths for haemodialysis access. Vascaths can be tunnelled or non
tunnelled. Non-tunnelled ones only last about 5 days then they have to be removed.
Tunnelled vascaths have to be removed in interventional radiology (or sometime by the AT
or Dr Ritchie) while non-tunnelled ones can be removed on the ward. To order these online
go to INT radiology then chose either insertion or removal. Keep in mind, we don’t like
patients going home with tunnelled femoral vascaths because of risk of infection, so if the
plan is to send someone home, avoid femoral. Patients with temporary femoral lines should
be on strict bed rest.
To get follow-up appointments with renal physicians:
o Prof George likes to be paged directly, he will give you an appointment date
o Call Dr Kalowski’s rooms for f/u with himself or Dr Natfaji.
o For the rest, ask Magdalena, the lovely renal secretary
o For clinic and other appointments, you can safely rely on Eileen, the lovely ward
secretary.
All admitted patients require a discharge summary. Ensure that a copy of the summary goes
to the patient’s usual Nephrologist, who may not be the Nephrologist caring for them in
hospital. If you are not sure – check with the patient before discharge. If you need help then
again, ask Magdalena.
As for bloods:
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In general don’t just order bloods for every patient every day. Think about what you
are ordering, why and how it will change management. If you can’t answer these
questions, ask the registrars.
o Sick patients: daily bloods
o Dialysis patients: bloods three times per week on dialysis (ask the dialysis nurses to
collect them). This will save additional venepunctures.
o Minimise weekend bloods.
o Use your judgement for everything else.
The tutorials by Dr.Sen and Dr.Ritchie are very helpful, a talk on dialysis was very helpful.
Dialysis Resident
It is the responsibility of the Dialysis resident to look after all dialysis patients at both 4-North dialysis
as well as Satellite Dialysis Centre (level 3 of the Medical Centre building, above Medicos).
The dialysis patients that need close observation are dialysed on 4 North Dialysis unit. Those that are
“more well” get dialysed at the satellite dialysis unit, located in the Medical Centre on level three.
Take your swipe card!
Incidentally, there’s another group of haemodialysis patients on home HD. You don’t have much to
do with them unless they have a particular issue (e.g. illness that precludes them from setting up
their own dialysis or carer illness) and need to come in for dialysis.
This position can fluctuate in work load but with a broad range of duties, can be quite challenging
and rewarding. The consultants are very approachable and keen to discuss and keep up-to-date
with each of their patients if issues arise. Nurses are also a good point of call as they know the
patients well and are familiar with their vascular access.
Common issues:
 Vascular access for dialysis
o Blocked/stenosed/thrombosed fistulas
 Emergency if acute thrombosis – potential to save fistula with emergency
surgery, consult vascular surgery urgently.
 Glenn is very knowledgeable and is a good point of call with fistula
problems. You can also ask the nurse who notifies you of a problem why it’s
significant, if you don’t understand yourself.
 You will often need to liaise with vascular team about these issues. You will
spend a lot of time liaising with the vascular team this term!
 Common issues include high fistula pressures or difficult cannulation. These
will usually need further investigation with fistula doppler studies organised
through the vascular lab. Sometimes Glenn will request these herself an ask
you to sign off on the request. High pressures can often be caused by
fistula stenosis or clots. If these are present the vascular team will need to
be called to organise further management (fistuloplasty or declot).
o Blocked vascath
 Poor flows on dialysis, high venous pressures
 Can sometimes be unblocked with urokinase in radiology you need to order
as a “catheter check” and notify the interventional registrar of this, it needs
to be done that day
o Tunnelled vascath insertion – Radiology
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Pts often have vascaths when they have a new fistula that is waiting to
mature (usu. about 6-12 weeks post formation, vascular will advise when
ready). They may also have one if the fistula is blocked or there’s some
other issue that means the fistula is out of action.
o Non-tunnelled vascaths (short-term) – Anaesthetics usually
Fluid status on dialysis
o How much fluid removal? (ultra filtration)
o Hypotension on dialysis, ?excess fluid removal. Common cause for MET calls.
o Adjusting ideal body weight – discuss with consultant/advanced trainees
Septic on dialysis
o Rigors and fevers
o Bacteraemia from line sepsis, or even from process of dialysis is common
o Will often require gram positive cover
Chest pain on dialysis
o With haemodynamic shifts, cardiac patients can be susceptible to ischaemia
Otherwise acutely unwell on dialysis
Medications/scripts:
o Warfarin dosing - in pt’s blue book. This sounds obvious but don’t forget to check
target INR range.
o EPO/iron scripts. It’s your job to write scripts for the patients to receive these
medications during the dialysis session. It doesn’t hurt to recheck relevant results
when writing the script, as the dose may no longer be appropriate (e.g. Hb and Fe
levels). See “Monthly bloods” section for more on working out doses.
Whenever you see someone in dialysis, it is a good idea to document it on the powerchart system
now, rather than writing it into the dialysis book as there are often two separate copies of the book
(one in 4N and one in satellite) since the patient may swap back and forth. Writing it in powerchart
keeps it centralised:
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Go to “Clinical Notes”, select “Add new note”, select “Haemodialysis Medical Progress Note”
under the drop down menu and add your entry.
Often you may be called to assess a fistula either because it is not flowing well or its appearance has
changed. There are some materials you can obtain from Hannah which tells you about the warning
signs of a fistula that may rupture. It is also a good idea to ask the consultants (Dr Ritchie or Dr Sen)
during one of their tutorials about the basics of fistula assessment.
In dialysis, if a patient’s ideal body weight is in question, consider using the BVM (blood volume
monitoring) device on some machines to see how well they respond to fluid removal.
For patients who have PO4 levels not responding to oral medications consider possible causes
including:
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Inappropriate diet containing high PO4 foods
Incorrect taking of the phosphate binder medications- especially caltrate (they are supposed
to take a tablet with the first mouthful of food or crush it and sprinkle it into the food)
Inadequate dialysis – check flow rates and urea clearance pre and post dialysis (done 6
monthly)
Dialysis patients often present with a range of medical issues given multiple comorbidities and if
requiring medical treatment, will often need admission. Even if patients are keen to return home,
and the logistics are not always straight forward, do not be put off admitting a patient if there is
medical concern.
A lot of the patients will request that you help with more minor chronic or non-urgent issues e.g.
skin lesions, haemorrhoids, referrals. Sometimes it’s easy to help but other times a GP referral may
be more appropriate. If in doubt discuss with the AT.
There is a hospital podiatry service available if any dialysis patients have issues regarding their feet.
The podiatrist’s name is Georgie and her contact details can be found in the address book in the 4Ndialysis unit
When you review dialysis patients don’t forget to look at trends in the dialysis folders or renal eMR,
where nursing staff record their weight, BP, and how much fluid is taken off each session. The
dialysis machine will also show you information about the current session including how much fluid
has been taken off already, and the running duration of the dialysis session. These are things the AT
or consultant will ask when you call them (and are good for you to know when assessing the patient
yourself).
When doing dialysis, it is a good idea, if you have time to spare, to create a list of the patients in
dialysis and satellite clinic and create an up to date medication list for them. This will make any
conversations with consultants as well the monthly bloods much easier. A list can often be found at
the back of their dialysis folders – just ensure that it was recently updated and if you change
anything, to update it accordingly.
Blood Collection for Haemodialysis patients
Nurses will tend to take EUCs +/- other bloods depending on the patient, prior to the dialysis session.
Very handy! Ask them kindly to do other things you may require such as blood cultures, G&H etc, as
this will save the patient from being venepunctured more than necessary (and save time!). Better to
do the bloods pre-dialysis, which is usually more accurate, unless the team specifically want to see
what’s happened post-dialysis (e.g. to check the dialysis sessions have been effective).
Note that blood results in renal patients are quite different both pre-dialysis, immediately post
dialysis and then and hour or two post dialysis also (as the intra- and extravascular compartments
equilibrate following dialysis). Ask about what to expect with these results, Dr Sen gave us a good
tutorial on this and basic intro to HD which was very helpful.
Monthly Bloods
Outpatients get bloods taken monthly (for both satellite and 4N Dialysis patients). PTH/Fe stores
and a couple of other bloods are usually taken 3rd monthly unless otherwise specified. Once per
month you will be required to go through each patient’s results at the 4-North centre ensuring they
are meeting the dialysis targets, adjusting medications where required.
Nurses will record the blood results in their monthly bloods book, but you can just check them on
eMR.
Dr Sen will explain to you what to look for when checking the bloods, what results to accept in renal
patients and when it’s appropriate to make adjustments to meds. In general it’s expected that you’ll
follow available guidelines, but Prof George tends to like all changes to be discussed with him before
any changes are made. The other physicians should be advised of any change once made by phone
or email
The CARI Guidelines are used to guide dose adjustments for erythropoietin and Ca/PO4 controlling
meds. They’ve been put in a folder for your reference (the folder lives in the Dr’s room with any
luck). Also Dr Ritchie’s “Nephrology Made Easy” book will help you to understand what’s going on.
Some pages have been printed out and left in that same folder.
If you can’t find the folder, the CARI guidelines are readily available at www.cari.org.au
ERS (External Renal Services)
Provided to dialysis (and other) patients who need a specific issue monitored, usually on discharge
from inpatient ward. The aim is to allow close follow up on d/c, in some cases facilitating earlier
discharge than may have otherwise been possible. You must maintain the ‘ERS CRG’ list to ensure
only active patients are on the list.
Usually there will be a specific question e.g. check K levels are stable, or is the patient’s fluid status
stable. Your role is to review the patient to answer that specific question, not a full lengthy clinical
review. Once you have reviewed, call that patient’s consultant with an answer to the question. They
will advise accordingly.
All ERS pts have a note in the ERS folder. If you’re referring a pt to the service then create a new
note. Once the patient is discharged, the old notes can be added to their medical records. That way
you don’t have to send for the medical records each time a patient comes in to be reviewed.
Basic Physician Trainees
Ward Job
 Responsibilities are to do daily ward round and update consultants regarding patient progress
after ward round.
 Specific to dialysis patients:
o Encourage nursing staff to weigh patients daily
o Inform dialysis nurses early if there are any changes to dialysis prescriptions or volumes,
and whether any patients require extra ultrafiltration sessions
o Hand over to dialysis nurse in charge regarding any unstable patients whom the dialysis
nurse on call could potentially be called back to dialyse
 Update Professor George regularly regarding his patients who are admitted
 Ensure on discharge that Dr Kalowski receives a copy of the discharge summary for his patients
(rooms phone 9745 2296); update him regarding progress of his patients if significant changes.
Consult Job
 You should keep track of all dialysis (HD and PD) and renal transplant patients who are admitted
to hospital regardless of the reason for admission.
 Review all new consults and liaise with consultant on service for consults
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Requests for take-over of care are reviewed by consultant on service for consults, and if
accepted, hand over to ward BPT and consultant.
o Hand over unwell consults who require review over the weekend to the registrar doing
weekend ward rounds
o Review dialysis patients who are admitted under other teams, once aware of their
admission. Liaise with dialysis nurses regarding any changes to dialysis
o Maintain a tally of new consults and the number of individual visits to consults each
week – report at the weekly multidisciplinary meeting for activity based funding
purposes.
o Maintain the ‘Renal Consults CRGH’ patient list.
Review all ED admissions and call consultant on service for wards
o Hand over to ward BPT once patient is admitted from ED.
o Accept ED referrals quickly. If the patient will obviously need to come in then accept the
admission over the phone if you cannot attend promptly. You do not have to review
every admission and talk to the consultant before accepting an admission. Learning to
assess over the phone with limited information particularly if tied up with sometime else
that is pressing.
Meetings/ Presentations
 Alternate Monday 1pm: radiology meeting
o Prepare list of patients to be reviewed at radiology meeting and bring list to radiology
registrar by 9AM on Monday morning
 Alternative Monday 1pm: journal club
o BPTs allocated to one journal club presentation each
 Thursday 11AM: Renal MDT 4W tutorial room
o Ward BPT presents brief summary of all in-patients, focusing on current issues
o On Wednesdays, collect discharge list from Magdalena’s office and prepare list of
discharged patients’ follow up arrangements to present briefly at the meeting
Advanced Trainees
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Renal OPD clinics M/W/F AM
Renal ward-rounds , managing BPT and JMOs
Managing dialysis RMO
Supporting dialysis nurses
Organise renal biopsies:
o For urgent renal biopsies discuss with sonographers who are usually very helpful!
o For urgent results, discuss with designated Anatomical Pathologist directly
o All biopsies to be recorded using renal procedure note in renal eMR – discuss with eMR
trainers if you need to be shown how to use it (page 88778)
Update Renal biopsy list – AT laptop file
Radiology meeting (every alternate week on Monday) – list to be provided to designated
radiologist in advance. Ensure this is done by one of the JMOs or BPTs
Pathology meeting (every alternate week on Thursday) - provide a renal biopsy list for the
meeting by Tuesday. A template form is on the Concord Renal wiki
(http://concordrenal.wikispaces.com/Junior+Medical+Officers ).
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Journal club (every alternate week on Monday) – present when rostered, see list from Dr Sen
Renal department clinical meeting/ handover meeting (weekly on Thursday 11 am) BPT presents
inpatients + AT r/v discharge planning/ follow ups
Renal teaching meeting Thursday afternoons 15:00-17:00 – case presentations when rostered
Teaching role – make sure the JMOs leave the term with a good understanding of common areas
of hypertension, AKI, CKD, GN, haemodialysis and peritoneal dialysis.
Clinical trials recruitment – you share an office with the trials coordinator. Talk to Meg Jardine
regarding current trials and how you can get involved.
Meetings
Mondays
Journal club
 These meetings are held at 1.30pm in the 4 West Tutorial Room every second Monday (they
alternate with the Radiology Meeting). One registrar (AT and BPT) and one consultant are
allocated to critically appraise an article and present it to the meeting. Lunch usually
provided.
 Starting 4th Feb 2013
Renal Radiology meeting
 Held at 1:30pm in the Radiology Conference Room every second Monday (alternate with
Journal Club). Prepare list of patients to be reviewed at radiology meeting and bring list to
radiology registrar by 9AM on Monday morning.
Wednesday
JMO Teaching
 Interns and RMOs are expected to hand over or divert their pagers to SRMO or BPTs so they
can attend the compulsory JMO teaching without interruption.
Thursday - major meeting day
Renal Department weekly meeting
 11am in 4W conference room. Multidisciplinary meeting chaired by the consultant on wards
that week. Given the number of frequent flyers, it’s great for the inpatient/ward staff to
hear about what’s happening with the outpatients and vice versa. It will give you a head
start as you will end up getting to know most of the patients regardless of whether you’re
doing wards or dialysis.
Grand Rounds
 1230pm each week – attend if you can, especially if the renal department is presenting
o the renal unit presents ~ 3 times per year, and the BPT/ATs are expected to present
on behalf of the unit.
Renal Pathology meeting
 2nd & 4th Thursday of the month @ 1:40pm in Anatomical Pathology Conference Room,
ground floor
 Renal advanced trainee must send list of biopsies to review at least 2 days in advance
 Proforma for biopsy list (on Concord Renal wiki) - fax to 9767 8427 or
email Karen.MacKenney@sswahs.nsw.gov.au
 Criteria for biopsy review:
o Case has diagnostic or educational aspect (this will be most biopsies)
o Treating Nephrologist will be present or has expressly asked to have the case
discussed in his/her absence.
Renal Education meeting
 Held at 3pm each week.
 Combined with RPAH renal unit 1st Thursday of the month at RPAH (Scott Skirving LT), and
3rd at CRGH (Clin School LT). Food provided.
 2nd and 4th (+/- 5th) weeks at CRGH 4W tutorial room
 Dr Razavian will assign trainees for case presentations from time to time
Friday
JMO specific teaching
 8am in Medicos. Dr Ritchie teaching session (he will advise when it is on)
 Dr Sen 1-2 weekly – please call to confirm time (x76447)
Other Clinical Issues to Remember
Haemodialysis
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Get to know how the machine works – ask Lian in 4W dialysis to show you how the machines
are set up early in your term
Confirm with HDx staff each morning who is on the list for the day, and what time they are
expected on (i.e. morning or afternoon)
Inpatient HDx patients need dialysis orders confirmed for each dialysis session
o Try and do this before dialysis starts
Examine HDx inpatients dialysis access every day
o If access is compromised, action needs to be taken urgently
Bloods are normally taken on dialysis – consider if bloods really need to be taken on nondialysis days
HDx patients should not be prescribed “maintenance” IV fluids – most will be on <1L/day
fluid restrictions, unless there is a specific reason for fluid loss
If a HDx patient has a significant surgical procedure, urgent EUCs should be performed postop to rule out hyperkalaemia.
Do not give HDx patients potassium supplementation on the basis of immediate post-dialysis
bloods (these will rebound up quickly).
Remember to alter medication doses as appropriate for eGFR < 10ml/min
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On discharge, confirm with the patient’s “home” dialysis unit any outstanding medical issues
and ongoing dialysis orders
o 4N
o CRGH Satellite
o Building 12 RPAH – Satellite
o Building 12 RPAH – Home Haemodialysis Unit
Peritoneal Dialysis
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Get to know how CAPD and APD are set up – ask Glenn Stewart to show you early in your
term
PD orders need to be written for each PD patient every day – beige sheet in med chart
o If any difficulties with orders, speak with Glenn or the consultant on call
PD peritonitis is a major risk for these patients – PD fluid and Tenckhoff catheter exit sites
should be examined regularly.
There are multiple reasons why PD may not be working well. Consider the following
(amongst others):
o Constipation
o Catheter tip migrated (?get plain xrays – upright AP and Lat abdo)
o Serum blood sugar levels
o Patient fluid status / blood pressure
If a PDx patient has a significant surgical procedure, urgent EUCs should be performed postop to rule out hyperkalaemia.
On discharge, confirm with Building 12 home peritoneal dialysis unit any outstanding
medical issues and ongoing dialysis orders
PDx patients should not be prescribed “maintenance” IV fluids – most will be on <1L/day
fluid restrictions, unless there is a specific reason for fluid loss
Remember to alter medication doses as appropriate for eGFR < 10ml/min
Transplant Patients
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If fasting, Tx patients should almost always have supplemental IVT
Infections and other significant medical conditions may not manifest with major clinical signs
– if you consider it, look for it
Make sure immunosuppressive medications are continued in hospital