Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 10:13 am Post subject: Educational Questions, Part 50.
To our Readers and Posters,<
>The best defense in any fight against a disease is education. <
>This column of questions and answers is an attempt in that direction. Anyone is welcome to ask questions. <
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> What I want to reiterate again is that my answers to your questions DO NOT and SHOULD NEVER take the place of your Dr.'s advice. I am not a Dr. and my answers are based on my many years of experience in the dialysis field. What works for one patient may not work for another. EVERY Patient needs to schedule and attend regular visits with your Dr. in their office.<
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>This column is for dialysis and dialysis related questions. Please be aware that clinics and companies, machines, policies and procedures vary from place to place. <
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>I hope that we can help in furthering your dialysis education.
>Thank you!<
>Founding RN <
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>P.S. I work full time so I may not be able to answer your questions right away. But I will get to them ASAP!<
>
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patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Fri Jan 30, 2004 10:30 am Post subject: SM assessment
For some reason, my machine has diferent starting conductivity rates. This is before SM is turned on. One tx it will be 13.8 and the next tx it will be 14.2. <
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>When the SM 145 linear is used with a base sodium of 140, the cond goes up to about 14.2. I have found that when the cond drops to 14.0 about 2 hrs later , if I reset it, I have a comfortable tx throughout. <
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>But when my starting cond is 14.2 rising to 14.5 with SM, when the cond drops to about 14.1 one hour from the end I start to feel bad. <
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>Last tx, I waited until 30 min from the end of the tx when the cond was 14.1 to reset it, but by that point, eventhough the cond went back up to 14.5, it did not help.<
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>This tx, if I start feeling bad at one hr from the end I am going to go by feeling and reset the SM then and see if it helps. <
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>Do you have any thoughts on why the starting cond. affects the two txs differently and how I can guide the settings?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Fri Jan 30, 2004 3:07 pm Post subject: Patient
Are you able to try the SM starting at 148 or even 150? If so, try that. Will the unit allow you to set the base for 142 instead of 140? I think you will need to also talk to your Dr. about this and if you can try this.<
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>Unfortunately you are dealing with some things that we can't change. That is the inner settings of the machine, (only the bio-med person can change those settings and they are set per the recommendations of the manufacturer) and how the bicarb is mixed up and the way the machine combines it inside. <
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>Humans mix the bicarb, unless they buy it already mixed from a company, so there is always a certain amount of variation there. Keep experimenting with the settings to find what works for you.
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Irene
Joined: 09 Feb 2004
Posts: 2
PostPosted: Mon Feb 09, 2004 8:19 pm Post subject: Sodium Modeling and bp
I used to run a straight 140 sodium and my bps would be about 120-135 when I came in and would decline in a downward way so that by the end of the tx my bps would be close to 100. Now that I am on sodium modeling, my bps are higher when I get to tx at about 130-150 and end at about 120-140. Why the change in my bp pattern with SM? I've heard that SM keeps bps up.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Tue Feb 10, 2004 10:21 am Post subject: Irene
Sodium modeling helps support the BP throughout the run so that your BP doesn't crash as fluid is removed. If fluid is removed too fast, your BP will fall and you could pass out. With sodium modeling, your BP will lower slowly throughout the run as fluid is removed and the sodium drops to the base of 140. If you don't use it, your sodium will drop rapidly to 140 as sodium and fluid are drawn off and there goes your BP too!
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Irene
Joined: 09 Feb 2004
Posts: 2
PostPosted: Wed Feb 11, 2004 5:06 am Post subject: BP
Why is my standing and sitting bp pre dialysis higher now that I'm on sodium modeling?
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newbie
Joined: 16 Nov 2003
Posts: 2
PostPosted: Wed Feb 11, 2004 5:12 am Post subject: terms
Please define dialysate, bicarb and acid and how they work. Also why does the machine have a setting for bicarb, acid and dfr?
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Mark
Joined: 03 Sep 2003
Posts: 4
PostPosted: Wed Feb 11, 2004 5:21 am Post subject: Dialyzer
My company went to a new line of dialyzers for the single use patients. Since they changed my dialyzer my kt/v has gone from 1.8 to 1.4. I have been having symptoms I didn't have before like, I find it very hard to get through the weekend and feel nauseated on the third morning of the day I go back to dialysis. And my sleep is different now as I usally feel restless and wake up earlier than I should. Are these signs of poorer clearance? Is my mortality going to be shortened if I remain on this dialyzer?<
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Cindi
Joined: 11 Feb 2004
Posts: 1
PostPosted: Wed Feb 11, 2004 5:27 am Post subject: weakness
What cause weakness in the legs? I notice by the end of the day my legs feel weak. I wondered if it's due to fluid build up, toxins or both.
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Traci
Joined: 11 Feb 2004
Posts: 1
PostPosted: Wed Feb 11, 2004 5:32 am Post subject: fistula
I've had my fistula for a number of years now. It has developed and become very full so that is is difficult for me to bend my arm at times. It still has a strong thrill. Do fistulas keep maturing or do they finally grow so big and then stop? Because my arm feels somewhat uncomfortable now and I hope the maturation of the fistula has stopped now.
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patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Wed Feb 11, 2004 5:38 am Post subject: conductivity
It used to be that my startng conductivity was always the same rate. But now my starting cond frequently changes. I can understand that this is due to how the tech is mixing the bicarb. But I'm wondering why the starting cond was always the same for so long?
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patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Wed Feb 11, 2004 5:45 am Post subject: Myron Meter
Our conductivity is measured with a Myron Meter. I read that Myron meters must be carefully and routinely cali
ated to be sure they are accurate. It seems the cali
ation of the Myron meters could easily be overlooked and the cond on the machines would not be accurate. Is this a valid concern or are there other safeguards to be sure cond is accurate?<
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>We use strips to measure pH. Can there be problems with the srips too?
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Ben
Joined: 11 Feb 2004
Posts: 2
PostPosted: Wed Feb 11, 2004 5:52 am Post subject: sodium bicarb
I am to take 3 sodium bicarb tablets a day. One month my labs say my CO2 is 20 and the next month they come up at 30. Why is this? I have a different dilyzer now. Used to be high flux and now on low flux.
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Ben
Joined: 11 Feb 2004
Posts: 2
PostPosted: Wed Feb 11, 2004 5:55 am Post subject: High flux vs low flux dialyzer
What is the difference between a high flux and a low flux dialyzer? Which is better?<
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Carolyn
Joined: 11 Feb 2004
Posts: 1
PostPosted: Wed Feb 11, 2004 5:58 am Post subject: dialyzers
Are some dialyzers
better than others or are they all similar? Because if some are better wouldn't it be essential for a patient to have the best dialyzer he could?
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hd patient
Joined: 22 Nov 2003
Posts: 4
PostPosted: Wed Feb 11, 2004 6:01 am Post subject: dialyzers
My doctor told me he could get me less time on the machine with a better dialyzer called an Optiflux.
patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Wed Feb 11, 2004 6:24 am Post subject: FMC's Online Clearance
With FMC's online clearance program, they can tell your kt/v at all times. What advantage is this? <
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>Do you know anything else about this program and its advantages?
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patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Wed Feb 11, 2004 6:44 am Post subject: Sodium Modeling
I have found that if I reset the SM as soon as I start to feel like the sodium is depleting, that it gets me through the tx feeling fine. I may reset it about 3x during the tx at 2hrs, 2hrs and 45 min, and about 30-45 min from the end. <
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>Since I run on 145 linear with a base of 140, that means the sodium is reset all the way up to 145 starting the last 30-45 min., but I am not thirsty at all eventhough I have not come down to my base sodium. However that may not really be the case as like I said, I go the first 2 hrs feeling fine, but then i reset as I feel the sodium depleting. But then I can not go for two more hrs, because in just about 45 min, I feel the sodium depleting again. Likewise it happens the last 30-45 min. that I feel the sodium depleting again so I reset for the final time.<
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>So, all I know is, this works for me and I wonder what the sodium is really at and what sodium rate I am really ending on. Because when I have let it go down to 140 sodium I experience sodium depletion and feel terrible, but doing it like this I feel great.<
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Fri Feb 13, 2004 7:45 am Post subject: Patient
The only way to know what your sodium level is at the end of your run is to draw a sodium level just before rinse back.
