Why wounds are hard to follow in a dialysis population
Diabetes and peripheral artery disease are common among people on dialysis, and both raise the risk of foot and leg wounds. Kidney disease can slow healing as well, which our guide to kidney disease and wound healing explains for patients. In-center hemodialysis usually means three sessions a week plus travel, and many patients are worn out afterward. A separate wound clinic appointment competes with treatment and usually loses.
Wound care coordination for dialysis patients means building wound visits around that schedule instead of on top of it. Gateway Wound Care arranges mobile wound care visits from partner clinicians where the patient lives, across Greater St. Louis and the Metro East, and coordinates the details around each visit.
What your team sees from the chair
Dialysis staff see the patient more regularly than any other clinician does. Many units already do periodic foot checks for patients with diabetes. Between those checks, staff are often the first to notice:
- A sock or shoe with new drainage, or a shoe left off because the foot is swollen or sore
- A dressing that looks unchanged since the last session, or one that is wet, loose or soiled
- A new limp, or a patient who now needs a wheelchair from the lobby
- Odor, or redness spreading beyond the edge of a dressing
- Dark, discolored or very painful areas of skin on the toes, heels or legs
- A patient who mentions a sore they have been watching at home
Those observations go through your unit’s usual channels to the nephrologist and to whoever is treating the wound. If no one is treating it, that is the moment for a referral. A diabetic foot ulcer or a wound on a leg affected by peripheral artery disease should not wait for the patient to bring it up again.
Scheduling around treatment days
At intake we ask for the treatment schedule: which days, which shift, how the patient travels and how they usually feel afterward. Visits are then requested for non-treatment days, or for a time of day the patient can tolerate.
For nursing facility residents who travel out for dialysis, we coordinate with facility nursing so that wound rounds at the facility do not land while the resident is at treatment. Patients on peritoneal dialysis or home hemodialysis have their own daily routine, and visits are planned around it in the same way.
If the treating clinician orders a vascular study or an outpatient procedure, we coordinate the transportation arrangements and ask for a slot that does not collide with a session. Families can use our guide to planning transportation for wound care.
What Gateway coordinates
- The request and the first call to the patient or family
- Records from your unit, primary care, podiatry and any vascular specialist
- Delivery of the treating clinician’s orders to whoever does dressing changes
- Wound supplies and equipment tied to those orders
- Specialist referrals and outside appointments the clinician asks for
- Updates to the contact your unit names, such as the social worker or charge nurse
What stays with nephrology, the unit and the treating clinician
Access is yours. Concerns about a fistula, graft or catheter exit site go to the nephrologist and the access team, not to Gateway.
The dialysis prescription, fluid targets and the renal diet stay with the nephrologist and the renal dietitian. Healing has nutrition needs of its own, and any advice has to fit the renal diet, so that conversation belongs to the wound clinician and the dietitian together. Our nutrition and healing page covers the general picture.
The treating wound clinician makes the clinical decisions about the wound: assessment, diagnosis, orders and treatment. Medication questions that touch kidney function are settled between that clinician and the nephrologist. Our part is getting each of them the other’s contact information and the current medication list.
How nurses and social workers can refer
A nurse or social worker can call 314-325-0126, fax 314-786-7966, or use the referral request form. Keep clinical information to the fax or the phone call, because the web form collects contact details only. Patients and family members can also call us directly, with or without a referral.
Visit availability is confirmed by location and care setting. Gateway is not an emergency service. For an emergency on the treatment floor, follow your unit’s procedures and call 911.
Common questions
Can wound visits happen at the dialysis center?
Visits are arranged where the patient lives: a private home, assisted living or a nursing facility. That keeps the treatment floor for dialysis and lets the clinician see the patient’s shoes, bed and supplies. If your unit needs a different arrangement for a particular patient, call us.
Who do we call about a problem with a fistula, graft or catheter site?
Not Gateway. Access problems go to the nephrologist and the access team under your unit’s own procedures, and bleeding that will not stop is a 911 call. The wound care team’s role is limited to wounds the treating clinician has been asked to manage, such as foot, leg and pressure wounds.
Does a referral need a nephrologist’s order?
No order is needed to start the conversation. A nurse, social worker, dietitian or the patient can call. We do ask for the nephrologist’s office so records can be requested and the treating wound clinician knows who is managing the patient’s kidney care. Coverage requirements vary by plan, and we raise those questions before a visit is scheduled.
What should our unit send to the wound care team?
Recent labs, the current medication list, the treatment schedule, the nephrologist’s contact information and anything staff have observed about the wound or the patient’s feet. A note about fluid or diet restrictions helps the treating clinician plan around them. Tell us who at the unit should receive updates. Send records by fax to 314-786-7966, not through the web form.