Question: Is it appropriate to ask staff to address problems and not wait for the machine alarms go off. Example: Patient's arterial pressue was up. This was second day after angioplasty. The staff said if it got too high the alarm would go off. However, my understanding is that when the AP goes up it is an indicator of several possible problems. I would think that if the staff notice, before the alarm, that the AP is elevated and it usually is not as high, that they would trouble shoot to find out why? As a family member/patient is this appropriate to question and ask, or should we just wait for the alarm to go off,,, then get reset.

thanks.

When I dialyze, I have my machine turned towards me. I set my pump speed, check to see if conductivity settins are correct, double-check rarely problematic settings like temp, and control my pump speed to match the flow of the venous and arterial lines. I have to add my own saline each hour, because as well-meaning as my techs might be, they will forget. Throughout TX I watch the TMP levels - a sign of possible clotting, and act accordingly. The techs don't respond to an empty jug until it alarms, or really, anything else until it alarms - but I think this is a matter of training.

It sounds like you do self dialysis? The patient is not able to do this. The unit is busy and finding barely time to ask questions.

You would need to be more specific on the question. If the arterial pressure is continually climbing causing an alarm, there might be cause for troubleshooting (needle placement, kinked line,etc). If the art pressure is only higher than the last treatment that could be due to needle placement, the needle stick, catheter position or problems, the simple fact is that arterial,venous, and tmp will vary slightly from treatment to treatment. So it may not be appropriate for the staff to troubleshoot each time. Hope this 2 cents of info helps.

thanks,

actually, when I pointed out to the nurse that the AP was rising, before the alarm went off, she repositioned the needle, which was good, as the vessels were in spasm from angioplasty that had been performed.
at times, the staff don't look at the rise, only when the alarm goes off,, however, problems can be averted if caught

Alarms are a safety machanism. Staff can not possibly stand there and watch arterial pressures on 4 patients at a time. Alarms and parameters are utilized in EVERY health care setting - ICU/CCU, Telemetry, SICU, Emergency room - all these places use hi tech equipment set with alarms to alert staff of a need for intervention. As for arterial pressures - they can be affected by needle placement, stenosis in vessels,etc. When your alarm went off someone responded quickly, correct? An an intervention was made as well. That's a good thing. Alarm parameters are set automatically or the staff on most machines once they recognize the patients art pressure after a few minutes on. Yes of course it would be ideal to be able to sit there and notice upward trends but in today's dialysis clinics they are understaffed and pretty busy but it is not a 1:1 pt/staff ratio. Nice thought, however!

It would be great if there were, as you stated, an intervention, instead of just silencing alarms.

I am very glad that you asked this question . It is the biggest misconception out there of what exactly alarms are and how they relate to direct patient care.
1) Patient alarms have two sets of parameters on a dialysis machine Soft alarms and hard alarms example Arterial and venious pressures are set 120 apart and when they alarm those soft alarms are what you here and are merely and indication of attention and not patient hazard. Another example of this is conductivity and temp your machine will not run if cond limits below 13.0 yet you can run safely depending on prescribed bath at 13.1
2) There are two major things that could occur in a dialysis machine that are not immediately alrming . UF removal can occur of a UF pump fails and begins to take to much fluid off a patient thus causing complications and the reverse putting weight on.
3) The fact is if a machine doesnt alarm i would be much more worried than when it does .

I would strongly suggest you have a friendly conversation with a often unused source in your clinic for direct patient care its your chief technician ask him to explain all the alrms and functions of the machines and the staffs responces and interactions as they occur , great question and stay involved :-)