The UMC Utrecht is like a clock: the activities continue 24 hours a day and that is only possible when the parts of the cogwheel mesh exactly together. We will highlight a few of them in a summer series. This time: dialysis nurse Mark Jordaans. “The beauty of this profession is the special combination of tasks: clinical reasoning, handling machines and building a bond with the patient.”
New, but experienced. Specialized, but ambitious to also mean a lot in other areas. These characteristics apply to Mark Jordaans. He is relative new in our organisation, because he made the switch from Amsterdam UMC four months ago. The 27-year-old is experienced in specialized, given the two years he has been working as a dialysis nurse. And ambitious in other areas Finally, Mark is due to his involvement in introducing a new therapy for patients with sickle cell disease.
Flexible
“An important reason for joining UMC Utrecht was that I can not only be a dialysis nurse here, but also be a day coordinator once a week,” says Mark. “That is an interesting new challenge. In short, it means that I then have to ensure that things run smoothly in the dialysis department.”
Keep track
He explains: “On that day I am responsible for the planning of the patients and the division of tasks within the team of dialysis nurses. A lot can happen in the department; for example, a patient develops complications or someone is brought in who needs urgent dialysis. Then it is important to keep an overview. On behalf of the department, the day coordinator is also the first contact person for, for example, doctors. For example, together you discuss any details of patients who have been admitted.”
Filter waste
Patients whose kidneys are not working properly go to the dialysis unit. A dialysis machine – an artificial kidney – takes over the function of these organs as much as possible. Healthy kidneys filter waste products from the blood. They also regulate the amount of water and salts in the body and the excretion of excess substances. Plus minus 45 fifty hemodialysis patients, for whom waste products are filtered through the blood, receive treatment at the UMC Utrecht three times a week, each time for an average of three to four hours.
Bond with patients
“As dialysis nurses, you regularly see the same patient,” says Mark. “This often creates a bond, and that is one of the attractive aspects of the profession for me. I remember a man who was about my age. Because we were more or less the same age, I was able to put myself in his place extra well and I sympathized with him very much. He was in the middle of life and making a career when he was told his kidneys were not working properly and that he needed dialysis several times a week. Later, a donor kidney was transplanted into him, after which dialysis was no longer necessary. During check-ups in the hospital, he would always visit me to catch up.”
Slice of lemon
A dialysis nurse also coaches patients. Mark: “An important rule for a kidney patient to maintain optimal health is not to drink too much. Otherwise, the excess fluid cannot be extracted from the body and the blood pressure becomes too high and a person can become short of breath. I tell the patient how to deal with thirst. For example, suck on an ice cube. Or put a slice of lemon in your mouth or in a little bit of water, because citric acid stimulates the production of saliva.”
Monitor pressure and blood flow
Besides the contact with the patient, technique and clinical reasoning appeal to Mark. He says about technology: “We not only work with a dialysis machine, but also with a shunt flow meter to monitor the blood flow in the shunt. A shunt is a subcutaneous connection between an artery and vein in the arm. This connection is necessary to get enough blood to and from the dialysis machine. The shunt must be punctured before dialysis. We can use an ultrasound machine as an aid for this. On a screen you can see the course of the blood vessel and suitable places can be found to puncture the shunt. A vascular surgeon applies the shunt.”
Preventing cramps
Clinical reasoning means that the healthcare provider observes the patient, interprets his observations and links all this to his medical knowledge. Mark: “What are the patient’s blood values? And does he or she have any complaints? You are constantly observing and considering whether you need to act on something. If too much fluid is withdrawn from the body during dialysis, the patient may develop low blood pressure and cramps in, for example, a foot, leg or arm. Then we stop extracting moisture. If the complaint is more serious, we can administer fluids.”
Quality of life
A dialysis nurse takes care of one to three patients during the shift. Mark: “My goal is that the dialysis ensures that the treatment contributes to their quality of life. What is quality of life? That differs per person. One is happy if he can continue to practice his hobby, the other if he can walk with his grandchildren.”
New treatment
One part of the day a week, Mark focuses on a new challenge. The UMC Utrecht wants to add a treatment to the care for people with sickle cell disease. This is a hereditary and serious form of chronic anemia. Mark has a coordinating role in setting up the treatment and sees the plans through a nursing lens.
Training nurses
He says: “This treatment is called erythropheresis. A machine replaces abnormal blood cells with donor blood cells. The erythropheresis and plasma filtration techniques are not renal replacement treatments. Yet they are performed in the dialysis ward. This has to do with the nature of the treatment: blood that flows outside the body is treated and returns to the patient. For this project I work closely with internist-nephrologist Sabine Meijvis. We are in the middle of the preparatory phase. For example, it is important that nurses are properly trained in working with the machine, so that we can start treatment safely and responsibly.”
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