Peritoneal dialysis bags, water and stick catheters.
In the early 1980s peritoneal dialysis at the Austin Hospital in
Melbourne was very different from the 2000s. It involved many bags,
stick catheters and frequent dialysate leaks.
history, renal, nursing, peritoneal dialysis
|Article Type:||Personal account|
Continuous ambulatory peritoneal dialysis (Methods)
Peritoneal dialysis (Methods)
Health services administration (Evaluation)
van Bakel, Chris
|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:||Temporal Scope: 1980s (Decade) AD|
|Product:||Product Code: 8089010 Dialysis Clinics NAICS Code: 621492 Kidney Dialysis Centers SIC Code: 8092 Kidney dialysis centers|
|Geographic:||Geographic Scope: Australia Geographic Code: 8AUST Australia|
Often the trickling dialysate effluent could be seen and squelched
down the hallway
Chris graduated in 1981, completed a three month rotation at the Austin Hospital Renal Unit and then returned as a graduate in 1982. Meredith had been working as a registered nurse on night duty for eight years. We both finally worked together on Ward 3, located in the now demolished A Block. Nursing was very different in those days; patients all had a daily rest with no interruptions, no-one entered the ward without permission from the staff member in charge, and it was the nurse's responsibility to create a very tidy and clean environment for the patients. The ward was run with 'military precision' and the Director of Nursing at that time regularly conducted ward rounds without notice.
The haemodialysis unit was located on the balcony of Ward 3. There were six chairs and the main form of communication between the ward and the dialysis unit was via a window!
The first treatment option for those patients with acute renal failure was acute peritoneal dialysis via a 'stick catheter' The nursing staff on duty would receive a call from casualty that a patient with acute renal failure would be coming to Ward 3. At this point the 'action plan' was implemented. Into the steri-room or Room 14 if available, we went. We collected all the equipment and machine which often had a mind of its own when wheeling it out to set up. Supposedly it was a very simple machine but 'not user friendly'. Equipment consisted of a 'stick catheter', basic tray, dressing towels, local anesthetic, gown, gloves and mask, betadine, tape, peritoneal dialysis fluid, peritoneal dialysis lines with a 'Y' line and a heating coil and link sets. When we say peritoneal dialysate fluid we are talking 20 two litre bags.
Somehow we managed to line all the peritoneal dialysate bags up, pierce them, detangle the link sets and then you were ready for 'action'. If you happened to puncture the sides of the bags you had to start all over again. We were often reminded about wasting supplies and making a mess! You can imagine the sticky floor. It took two staff to actually 'hang the bags and link sets' in order. This process usually took 20 minutes.
Inserting the stick catheter was usually done by a consultant nephrologist with a registrar in attendance. No ultrasound technology in those days just good old fashioned 'touch and feel technique'. If the fluid return after in insertion was clear, you knew you were successful however, if it was stained brown, (faecal fluid) you knew the patient was in trouble.
Taping of the peritoneal dialysis stick catheters was an 'art form' and only a selected few were chosen to perform this task. Once connection to the machine was completed, you held your breath, until the fluid all flowed in and out with no leaks. The heating bath was a peritoneal dialysis line coiled and inserted into a container of warm water. The temperature of this bath had to be maintained exactly at body temperature which was not always easy to achieve. The drain-out bags were emptied into drums which were measured 12 hourly and ongoing fluid calculations were completed and the orders for the next 12 hours were given. We tested the initial drain out volumes into a cylinder which only had approximately a five litre capacity. You can imagine the floor when busy nurses forgot to empty it or re-attach the drain out bags to the drum. Often the trickling dialysate effluent could be seen, and squelched, down the hallway. Even though this form of treatment seems archaic, patients did very well and usually survived their acute episode of renal failure.
Ward 3 nurses were a great team and delivered five star quality care. The order of the day was, physiotherapy at 10am, rest period 11-12 am, sitting out of bed 9am--11am, no visitors until 2.30pm and best of all hair washing and nails to be done on Sundays. These were some of the rules that patients adhered too sometimes reluctantly but invariably were very appreciative when they were discharged. Todays patients can only dream of receiving such care.
Submitted January 2009 Accepted May 2009
Chris van Bakel at Chris.Vanbakel@diaverum.com
van Bakel, C. & Jose, M. 2009 Historical Reflections: Peritoneal dialysis bags, water and stick catheters Renal Soc Aust J 5(2) 79-80
Chris van Bakel is Nurse Unit Manager at Diaverum Diamond Valley Dialysis Unit and Meredith Jose is a retired Registered Nurse and a Pastoral Care Chaplain.
Great friendships remain from those days on Ward 3.
|Gale Copyright:||Copyright 2009 Gale, Cengage Learning. All rights reserved.|