Mary
Joined: 24 Oct 2003
Posts: 2
PostPosted: Fri Oct 24, 2003 8:04 am Post subject: URR
My URR usually runs an average of 80. I had two months where is decreased to 76 and then to 71. This month it is back up to 80. What were the possible reasons it dropped, but then came back up?
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Vonda
Joined: 24 Oct 2003
Posts: 2
PostPosted: Fri Oct 24, 2003 8:10 am Post subject: art. pressure
My art pressure runs -120- -160. If it is way down at -220 at put on, I know its a bad stick. I have seen it stay steady at -220 or get a little better as the tx goes on. But I have also seen it get worse if it's low to begin with and get lower going to -280. When is the time to intervene if it is going too low? If it becomes too low during the tx should it be restuck then, or should it only be restuck at put on?
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Vonda
Joined: 24 Oct 2003
Posts: 2
PostPosted: Fri Oct 24, 2003 8:13 am Post subject: pressures
Also, when I get a bad stick at my art. the venous pressure will also rise. My regular ven is about 100. It will go to about 200 if the art is bad. I've heard the art "sucking" on the vein can damge the access and a high venous means recirculation.
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debbie
Joined: 27 Jan 2003
Posts: 11
PostPosted: Fri Oct 24, 2003 8:19 am Post subject: dental work and heparin Reply with quote
Do hemo patients have to get one or more heparin free txs in preparation for tooth extractions?
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Hey you
Joined: 25 Oct 2003
Posts: 1
PostPosted: Sat Oct 25, 2003 6:30 am Post subject: Fonding RN
Is it true that you have to like your staff? If they are meanies what can we do.?D">
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Sat Oct 25, 2003 12:33 pm Post subject: Mary
Reasons that a URR drops.<
><
>Blood flow rate is decreased for any reason at all. <
>Dialysate flow is decreased for any reason.<
>Any reduction in the amount of time spent on dialysis, even a reduction of 5 min for several runs can show up in a reduced URR.<
>Miscalculations of the URR in the lab. <
>
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Sat Oct 25, 2003 12:43 pm Post subject: Vonda
A new needle can be put in at any time during the run, provided that you have room to put another one in. If you have already been given heparin, it is best, if possible, to leave the original needle in and place another. Removing the original needle after reciving heparin will result in bleeding and a long time to clot.<
><
>Bad sticks can result in higher pressures, esp. if the needles are place closed together. The tips of the needles should be at least 2 inches apart to help prevent recirculation of the blood. <
><
>Any time a needle sucks up against the wall, vessel damage can occure. That is why we don't like to see Art. pressures consitently below -240. If it stays down there, then there may be a problem with the access, or if a new fistula, then a lower pump speed is needed until the vessel has developed enough to support a higer blood flow rate. Be aware that you may see pressures at this level towards the end of a run if the patient is very close to their Dry Weight. If so it may be better to turn off the fluid removal on the machine.<
><
>A high venous pressure does not always mean recirculation though that can happen. What it can mean is that there is a narrowing of the access above the area that is stuck for the venous and it needs to be looked at by a surgeon. If not you risk letting your access clot due to the closing of that narrowing.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Sat Oct 25, 2003 12:54 pm Post subject: Debbie
No, you do not have to have heparin free treatments. <
><
>Try to schedule your dental appointment on a non-dialysis day. <
><
>TELL YOUR DR. ABOUT THE DENTAL APPOINTMENT. AND TELL HIM IF YOU ARE ON A BLOOD THINNER LIKE COUMADIN. You may need to hold your coumadin the day before and the day of the dental appointment.<
><
> If you get all your heparin at the begining of your run, ask that only 1/2 -2/3 of it be given to you. Do include in your goal normal saline flushes for the last 2 hours of your run. What I find works best is 100 cc's every 30 min. <
><
>If you are someone who bleeds alot, then talk to your Dr. about having some heparin recirculated in the system and then dumped out before you go on. This coats the fibers and helps to reduce the chance that you will clot the system. You will still need to add in 100 cc's of saline every 30 min to help prevent clotting. You may still need a little heparin given to you at the begining of your run, but it should be pretty much gone from your system by the next day.<
><
>The next run after your dental appointment you should be fine unless you had teeth pulled or oral surgery. If so, again follow the above suggestions and you should be o.k.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Sat Oct 25, 2003 12:57 pm Post subject: Hey You, AKA Little Red Hen,
In your case, yes, you HAVE TO LIKE THE STAFF! The rest of us don't!
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patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Sat Nov 01, 2003 8:31 pm Post subject: tx problem
I am having the same tx problem I have had before. I run on a straight 140 sodium (not sodium modeling). I have no problems tx after tx on my regular machine that has a conductivity of 14.0. <
><
>The problem occurs when my machine has to go for maintenance repair, so I'm put on another machine. If the conductivity of the other machine is around 13.7 or less I will become very symptomatic.<
><
>I've looked into this and found articles on conductivity. They state that too low a conductivity can cause serious sypmtoms for some patients. <
><
>I told my staff and doctor this and they do not believe it. They say conductivity has nothing to do with it. My doctor insists that all I need to do is raise my dw. I told him how can that possibly be correct if tx after tx on my good machine, I have absolutely no problems and feel fine? It is only when I am switched to a machine with low conductivity that I get very sick on the tx.<
><
>The lower the conductivity of the machine I am switched to, the sicker I get. I have spoken with other patients who have encountered this same problem so I am not the only one who has noticed the effects of low conductivity. <
><
>One patient has solved her problem by turning off her sodium modeling, restarting sodium modeling and resetting the tx time that is left when she sees the conductivity on her screen drop below 14.0. This causes the conductivy to rise again as if the tx was just starting giving her the sodium she needs. <
><
>As I said, I do not run on sodium modeling and do not have this problem at all when I'm on my good machine. The conductivity stays at 14.0 and feel fine. Previously, my machine ran at 14.3 conductivity and I felt even better. So, I know higher is better for me.<
><
>I understand that the machine manufacturer sets limits for conductivity and as long as the conductivity is within those limits, supposedly the machine will deliver a safe tx. And this is what staff are taught and believe. But as a patient, everytime my conductivity is too low, I am hurt terribly. <
>The limits for my machine are 13.5 -14.5, but I can not run less than 14.0 without becoming symptomatic. Have you had any other patients who have complained of this? Surely I can't be the only patient who has noticed this. Like I said, I know of a few patients who say they've experienced it, too, and have had to find ways to adjust for it. My other friend is in home hemo and can always keep his conductivity high.<
><
>Apart from this one problem, I like my doctor and staff very much. This is the only problem I have and wish they would believe me. I asked my doctor if I could
ing him an article on the effects of low conductivity and he just laughed at me and said there is no such thing and it's medically
impossible. He refused to read the article. <
><
>Can you think of anything I can do to solve this problem? I am continuing to have hurtful txs everytime my machine goes for maintenance and can't get anyone to listen to me.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Sun Nov 02, 2003 9:52 am Post subject: Patient
Start using sodium modeling when you are on a new machine. Ask what the policy is at your unit as to how high you can go and use that. Try a linear which starts out as say 150 in the begining and slowly decreases over your treatment until the last 15-30 min of your run when it shuts off. <
><
>If that doesn't work, then try a step program. That keeps the sodium at say 145 straight across until the last 15-30 min of your run and then shuts off. Also the tech can go in and see if the machine baseline is set at 140. My understanding is that all machines should be set at a baseline of 140. This means that the sodium does not drop below this. I work with the Fesinuis H machines and I know that this can be looked into and changed. <
><
>If you can use a 150, do so and then make sure it is shut off the last 15-30 min of your run. This gives the sodium in your blood time to drop down to the 140 level so that you don't have increased thirst because of it.<
>Good luck.
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patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Mon Nov 03, 2003 9:40 am Post subject: changing machines
FRN,<
>Your suggestion sounds good and gives me hope of something I can try.<
><
>I am still unclear, however, on the various sodium modeling programs. <
><
>The time I tried step, it started high and stepped down in increments, I thought. But you say it stays high and doesn't step down until the very end?<
><
>The way you describe linear, is more like what I thought step is. <
><
>Do you have any material you could paste that clearly explains each program or could you send me to a site where I can see this info?<
><
>Also, you say that the tech sets the baseline sodium which should be 140. Are you referring to the machine tech when he works on the machine or the pct at put on? What is the reason why, for ex., one machine, when set at 140 straight sodium shows a starting conductivity of 14.0, while another machine when set at 140 will have a starting conductivity of 13.5? With my machine the sodium is always set at 140. I am on a FR too. Is baseline sodium a different setting then setting the tx for 140? Which screen is it on? <
><
>I've read that the machine tech, by internally altering conductivity cells, altering the flow of solution from the wall etc and the bicarb used can change settings that affect the conductivity.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Mon Nov 03, 2003 3:41 pm Post subject: Patient Reply with quote
Have your Tech or who ever puts you on show you the sodium modeling programs. It's on the SVS screen (SVS is on the lower left when looking at the main screen on the H series) and at the bottom of the screen it should show a base of 140. Have the person who puts you on show you the step and linear programs as there should be a little diagram of the program when it is dialed in.<
><
>As to what the machine tech does on the machines, you will have to ask them. I think that once you find which of the sodium modeling programs works for you, that will be your best bet. How the bicarb is mixed up does have an affect on conductivity. And there are different types of bicarb made by different companies and the machines have to be set and programed for the ones they are going to use. Where I work we have been using Cobe bicarb and are now switching to FMC bicarb and that will make a bit of difference and machines will have to be set for that particular bicarb. <
><
>I think I may have some material on Sodium modeling, but it is not something I can post here. I will look for it and if you really want it and I can find it, I would be happy to make a copy and send it to you. The material is very long and involved and would take up too much space here. Send your name and address to Arlene and when I find it, I will be happy to send it to you.
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Morey
Joined: 04 Nov 2003
Posts: 1
PostPosted: Tue Nov 04, 2003 10:38 am Post subject: Kt/v
What is the correct procedure for drawing Kt/v? Should there be a waiting time before it is drawn, what line, what day of the week etc.?
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student
Joined: 04 Nov 2003
Posts: 1
PostPosted: Tue Nov 04, 2003 10:56 am Post subject: Dialysis Manuals
Could you suggest 3 of the most well written dialysis manuals in order of technical difficulty? I would really like to educate myself. I have heard of some dialysis titles. They are rather pricey. I am willing to invest, but want to be sure I am selecting the best there is and in order of technical knowledge. <
><
>Would you say the CNN is the best course in dialysis as far as understanding the tx and the theory behind it? How extensive a course is it and where could I get info about it? <
><
>Also, what are the best sources to keep a
east of continuing education?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Tue Nov 04, 2003 10:56 am Post subject: Morey
KT/V is the formula used to figure out adequacy of dialysis. What you are referring to is the drawing of the pre and post BUN. There is not set way to draw either or set day. No standard on this at all so each company does what they want.<
><
>From what I understand, the most accurate way to draw a post BUN for the KT/V would be to draw it 30 min after you are off the machine, but that would mean you would have to get poked again. So it is drawn at the end of your run. <
><
>The most common way I have seen it done is to turn the BFR down to 100 for 30 sec, then draw it out of the ARTERIAL line, not the Venous line! But you will find variations of this all over the place. This is an area that we need set national standards on.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Tue Nov 04, 2003 11:15 am Post subject: Student
The manuals out there are hit and miss and usually have an industry slant. Your best bet is to take college classes in anatomy, chemistry, biology and the other health sciences. (Nursing classes) This will help give you the background to start putting it all together. For an overall view that will not cost you an arm and a leg, "Review of Hemodialysis for Nurses and Dialysis Personnel" is fairly good. <
><
>ANNA would be the organization that you want to contact about the CNN stuff. Personally I am not impressed with it, but the textbook would be a good reference source. <
>Dialysis Issues and Transplantation is one journal out there and there are others. That is more a mater of personal choice. Also keep an eye out for conferences and continuing education offerings. Most Dialysis units get notices and post them about these meetings. <
><
>And talk to patients! Find a Dialysis Nurse mentor who has worked in dialysis for a while and make sure it is someone who's practice is one you want to emulate. They are going to be your best teachers in helping you put what you have learned into reality! They have been my greatest teachers and even after all these years, still teach me something new each week!
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Marion
Joined: 07 Dec 2003
Posts: 1
PostPosted: Sun Dec 07, 2003 6:44 pm Post subject: Calcium
My calcium is up to 10.8 this month. I have been on 5 Zemplar. What are the symptoms of high calcium and is there a way to catch calcium before it rises too high? I got a lump on my hip area with a blood
uise all around it. Could this be a calcium deposit? My phos was in range.
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Claire
Joined: 07 Dec 2003
Posts: 1
PostPosted: Sun Dec 07, 2003 6:50 pm Post subject: Potassium
My K was 5.7 last month and 5.8 this month. Should I be concerned and take a dose of kayexelate to get it down?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Mon Dec 08, 2003 7:35 pm Post subject: Marion
Hypercalcemia-
High Calcium<
><
>We don't like to see the Calcium go over 10.5. I hope that your Dr. has stopped your Zemplar, if not, ask your Dr about stopping it.<
><
>Symptoms of Hypercalcemia:<
>Weakness<
>Loss of appetite<
>Weight loss<
>Nausia and vometing<
>Contipation<
>Kidney stones<
>Frequent Urination<
>Dehydration<
>Mental Status Changes<
>Mood swings<
>Irregular heartbeat<
>Coma<
><
>The monthly lab draws include calcium levels. Your Dr. and the dialysis staff should be monitoring these labs and should catch this before it gets too high.<
><
>As to the lump, that would be hard to tell until the hematoma is gone. If it is still there, consult with your Dr.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Mon Dec 08, 2003 7:40 pm Post subject: Clair
Those labs are drawn pre dialysis so after your run, it will be lower. <
><
>I would advise that you go over your diet with your dietician first to see if you need to decrease a high K+ food. Then if that is all o.k., you may need to see about going to a lower K+ bath. <
><
>Kayexelate should not be used frequently and only under a Dr's supervision. Too much and you could kill yourself!
