How it was before computers.
Abstract: This account details early memories of dialysis in Adelaide. The role of the nurse was assisting with shunt de-clotting and individually specialling the person receiving dialysis. Peritoneal dialysis was performed using glass bottles and temporary catheters.

Key Words

history, renal, peritoneal dialysis, haemodialysis, nursing
Article Type: Personal account
Subject: Registered nurses (Personal narratives)
Registered nurses (Practice)
Hemodialysis facilities (Evaluation)
Author: Kruger, Ann
Pub Date: 07/01/2009
Publication: Name: Renal Society of Australasia Journal Publisher: Renal Society of Australasia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Renal Society of Australasia ISSN: 1832-3804
Issue: Date: July, 2009 Source Volume: 5 Source Issue: 2
Topic: Event Code: 200 Management dynamics
Product: Product Code: 8043110 Nurses, Registered; 8089010 Dialysis Clinics NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners; 621492 Kidney Dialysis Centers SIC Code: 8092 Kidney dialysis centers
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 230959992
Full Text: It was a time when there was plenty of nurses and few vacancies

I completed my registered nurse training in the early seventies. It was a time when there was plenty of nurses and few vacancies. Imagine that!

There was a job available in blood transfusion. It was a technical type job, grouping and matching blood for patients at the Royal Adelaide Hospital and various private hospitals around the metropolitan area. It was also the place for old nurses to take the weight off their feet and wait for retirement age. There was no superannuation then!

After a year or so of that work, I saw the need to update my nursing skills as we were planning to buy a home in the southern suburbs of Adelaide. I asked for a ward placement and got the renal unit.

Talk about hit the floor running! I lost 6kg in a month! There was no time to eat! There were so many really sick patients. Dialysis happened for some of them and if their kidneys switched back on, that was good, or otherwise the situation was explained and patients chose to go home and die amongst their family. The Queen Elizabeth Hospital in Adelaide had a few long term dialysis patients but they were the young ones. I don't recall us transferring any patients to them for maintenance dialysis.

Access for dialysis was by way of a shunt. The shunts were put in at the patient's bedside. I couldn't bear it! Surgery was never my thing! The patient was sedated with intravenous pethidine. Local anaesthetic infiltration was used and a tourniquet was applied. An arm board supported the arm and as the assistant I was in charge of tourniquet pressure, sedation of the patient and cutting the stitch ends. I tried not to look. Bill Chan was the registrar and he held my concentration on the job by clamping my knees with his as we sat either side of the patient's arm. Shunts were prone to clot and de-clotting was a regular occurrence. It was a painful procedure for the patient.

Dialysis happened with the technician running the machine and the nurse specialling the patient. Very regular observations were taken--five minutely, I recall. The machine was a huge stainless steel bin of water with additives that the technician had mixed up with a large paddle. A plastic lid covered the bin when in use. It was so heavy he needed help to manoeuvre it to the patient's bedside. When the bin was empty, dialysis was finished.

Renal failure patients were subjected to the Giovanetti diet. They got rice bubbles with a tub of cream for breakfast, plenty of sugar and black tea or coffee. Consequently their appetite and nutrition was abysmal!

At 4pm every day the doctors congregated in the nurses' station to await the biochemistry results. The laboratory phoned and the nurse wrote them into a large book with the doctors looking over the shoulder of the writer. They then could make decisions for the next day.

Later, when I worked at Flinders Medical Centre there had been excellent progress in a few short years. Dialysis machines had been made more user friendly with closed circuits. However, the peritoneal dialysis with Travenol glass bottles had a nasty habit of breaking and the sticky fluid took some time to clean up. Peritoneal dialysis was by way of temporary catheters which were removed after 48 hours of therapy and treatment comprised of one hour cycles of 20 minutes fill, 20 minutes dwell and 20 minutes drain.

Thankfully there have been significant changes to the equipment and procedures which have lead to a safer environment for both patients and nurses.

Submitted January 2009 Accepted May 2009

Kruger, A. 2009 Historical Reflections: How it was before computers Renal Soc Aust J 5(2) 78-79

Author Details:

Ann Kruger RN is Renal Anaemia Co-ordinator, Flinders Medical Centre, South Australia

Correspondence to:

Ann Kruger at Ann.Kruger@health.sa.gov.au
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.