We started off our day with a drive from Santa Maria, California to Long Beach, California to board the cruise ship sailing to Cabo San Lucas, Mazatlan, and Puerta Vallarta.
Actually, our story began a few months before when we hear about a company that allowed passengers to bring their loved ones that required kidney dialysis along on the cruise, and it would be provided to them. Because Carol Ann and I had worked together for many years in a dialysis unit where we dialyzed acute patients as well as some new first-time patients (often in critical condition requiring dialysis in the middle of the night). We both felt confident that we could handle anything, but we had no idea what we were about to face!
So, we submitted the necessary paperwork, licensure, experience, and recommendation from the nephrologist we worked with.
When we arrived at the ship, we were assigned to our "free" staterooms. We were just above the engine room, so when they started the engine, it shook our beds ever so gently, lulling us to sleep each night. When we met with the two nurses from New York who had done this cruise several times and so were experienced with the "dialysis at sea" company, their explanation of how things worked was very brief. Although the dialysis center was just four doors down from the ship's physician's office, we never saw him or his nurse during the entire cruise. The first evening we were scheduled to dialyze two of our patients, we changed into our scrubs, entered the ship's dialysis unit and checked the water quality, set up our machines, and unpacked a few of the saline boxes, tubing, and dialyzers. We ran the machines through their QA testing, and we were ready to go! Our first patients arrived, a woman in her seventies in a wheelchair and a gentleman in his mid-sixties. We greeted the patients and their family members that had escorted them to us. We asked about their individual preferences and proceeded to access their fistulas. We went to locate the wheelchair scale only to discover - there was none! Because the individual plan of care for dialysis treatment is determined by the patient's water weight, we panicked! But then we came up with a plan to look at their files and determine an average weight gain between dialysis treatments and calculated that it was somewhere between 2-3 kg. of fluid gain. Based on this, we worked the numbers into a four-hour treatment.
Within the first half hour of treatment, the machines were alarming that there was a drastic drop in blood pressure, and panic set in again as we checked and rechecked their blood pressure. It was then that we determined that we had been provided with high flux dialyzers - that should only be used on high flux dialysis machines! The dialyzers were removing an excess amount of fluid from our patients. We immediately turned off the dialysis machines and gave boluses of saline to our patients to maintain their blood pressure. We monitored their vitals every fifteen minutes and tried to keep them talking as much as possible in order to better determine if we were losing them. Four hours felt like an eternity, but we made it through! We went on to dialyze them two more times during the one-week cruise. There was one episode of rough seas that pitched us and the machines back and forth.
Scary? You bet! As we exited the ship on the last day of the cruise, we high-fived each other!
For more stories like this one, pick up a copy of Off the Chart A Nurse's Journey
of Heart and Humor at https://amzn.to/3RHn0nm
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