Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Fri Mar 28, 2003 7:05 am Post subject: Educational Questions, Part 45.
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. <
><
>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.<
><
>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. <
><
>I hope that we can help in furthering your dialysis education. If you wish to ask a question in private, I can be reached by E-mail at FRN2DE@yahoo.com.<
>Thank you!<
>Founding RN <
><
>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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debbie
Joined: 27 Jan 2003
Posts: 11
PostPosted: Thu Apr 03, 2003 4:14 am Post subject: needles
hi,<
>Can you please give me some advice on where to find some good advice/information on needling my own fistula. I am seriously considering this at the moment. Do you think I should read up on it or just do it?!<
>thanks
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Thu Apr 03, 2003 7:02 am Post subject: Debbie
The only way to learn is to do it. Have a staff person who you trust work with you on this. As the saying goes, practice makes perfect! <
> <
>My only piece of advice is to position the needle at a 45 degree angle when you are ready to puncture. As soon as you have a back flash, level out and thread the needle in.<
><
>Good luck!
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Lucy
Joined: 17 Apr 2003
Posts: 1
PostPosted: Thu Apr 17, 2003 10:05 am Post subject: Ferritin
My labs were excellant this month except for ferritin which was about 1500. My doctor said its due to iron and discontinued iron. Why is ferriten checked only quarterly when it can get much too high? Is letting it get too high like this harmful? Are there any other reasons for high ferritin?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Thu Apr 17, 2003 12:47 pm Post subject: Lucy
Medicare reimburses for Ferritin/ Iron studies quarterly and that is usually why they are drawn only quarterly. Personally I think they should be drawn monthly as it can drop very fast and EPO MUST have adequate Iron/ Ferritin levels to work its best with the least amount of EPO. Some companies/ clinics like to keep your Iron/Ferritin levels low as they make most of their profits from selling EPO to you, the patient. And if you have private insurance, they can make even more profit on EPO. Look at your bills to see how much they charge for EPO.<
>Most dialysis patients do not have problems with the Ferritin staying up too high as they utilize it fairly fast. There is a hereditary disease that causes a person to retain high levels of iron in their blood. For specifics if you suspect such a problem, then please consult with your Dr.
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Sally
Joined: 24 Apr 2003
Posts: 1
PostPosted: Thu Apr 24, 2003 3:48 pm Post subject: Bleeding Post tx
What are reasons for extended bleeding post tx? What is normal clotting time?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Fri Apr 25, 2003 5:43 am Post subject: Sally
Normal clotting time varies from person to person. But most dialysis patients should clot in 8-10 min normally. <
> Extended bleeding times can be caused by various things.<
>Too much Coumadin.<
>To much heparin.<
>Heparin not turned off when it should be.<
>Scar tissue build up at puncture site.<
>Tearing of skin as needle is pulled out.<
>Various blood diseases that affect a persons clotting.<
>The list above is the most common causes.<
>
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realdialysisethics
Joined: 06 Jan 2003
Posts: 41
PostPosted: Sun May 11, 2003 4:27 pm Post subject: Julie
Blood Volume Processed<
>--------------------------------------------------------------------------------<
> What is considered to be a adequate amount of Blood Volume Processed per treatment. Most patients run 4 hrs but there is a big difference between the amount of BVP that can be obtained through a catheter as compared to a well working fiscula. Do the centers set goals for BVP?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Sun May 11, 2003 4:35 pm Post subject: BVP
Julie,<
> The centers do not have goals for BVP. How much BVP is dependent on how fast your Blood flow rate is and how long you run. This varies from person to person.<
><
>The theory is that the faster the blood flow rate and the longer you run, the better cleaning you get. In that case someone who runs at 450 blood flow rate and runs 4 hours will have a higher BVP than someone who runs at 400 for 4 hours.<
><
>Catheters usually run at a slower rate than an arm access. The higher the blood flow rate on catheters, the more recirculation you can get, esp. if you have to reverse the lines on the cath. (Blue to red and red to blue). <
>So as you can see, there are many variables in this.
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Billie
Joined: 12 May 2003
Posts: 1
PostPosted: Mon May 12, 2003 9:03 am Post subject: drop in Kt/V and URR
My labs were right on target this month as they usually are. My Kt/V abd URR both dropped however. What causes this? I ran all my txs and didn't have any machine problems.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Mon May 12, 2003 2:14 pm Post subject: Billie
Do you have any kidney function at all? Are you producing any urine? If you are or were and it decreased, this could account for the lower KT/V and URR. <
><
>Also if your Pump speed decreased anytime during your runs, or the dialysate flow changed, this also could influence the results.<
><
>And last but not least, the lab could have screwed up the results and it was all figured wrong.
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debbie
Joined: 27 Jan 2003
Posts: 11
PostPosted: Thu May 15, 2003 7:04 am Post subject: self needling Reply with quote
Hi,<
>followed yours and a lovely member of staff (who use to needle herself before she got a transplant) advice and I have done it! much easier and less painful than I expected. Thankyou, debbie
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Thu May 15, 2003 10:55 am Post subject: Debbie
<
>Yeah!!!!!! Good for You! So glad that you were able to do it. It wasn't so bad was it? <
> Now you can mentor someone else!
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Isabel
Joined: 11 May 2003
Posts: 25
PostPosted: Wed May 21, 2003 4:04 am Post subject: Why Fever?
Isabel<
>Unregistered User<
>(5/21/03 6:21:38 am)<
>Reply Why fever????<
>--------------------------------------------------------------------------------<
> After dialysis my mother felt weak, dizzy, depressed and she complaint that her heart hurt too much. She normally received 3 hrs of dialysis. Yesterday she was onthe machine 4 hrs., at night she had fever....what's going on, this "called dialysis supposed to help her, instead of giving her those complications.
Pls advise!
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed May 21, 2003 4:16 am Post subject: Isabel
It is normal to feel those things after dialysis. Taking off extra fluid and waste products in a short amount of time makes one feel bad. Most patients get used to it after a while. <
>The headache is most likely from the fluid shift in the
ain as fluid moves out of the
ain tissue into the circulatory system so the machine can remove it.<
><
>The "heart" pain is most likely from fluid being pulled from the chest area as that is where most of our elderly patient seem to store it. It usually is not the kind of chest pain that would be serious.<
><
>You do not say what kind of access your mother has. If she has a catheter in her chest that she is using right now, then a fever is may be a sighn that it is infected. Call her Dr. and report any fever and chills she may be having. It is called sepsis or getting septic. This is very serious and if not treated, could result in death.<
><
>Is your mother on reuse? This means that the artificial kidney she is on is reprocessed and used for her each dialysis. The fever could also indicate that she is having a reaction to the chemical they use to process the kidney. She may need to get a
and new kidney each time.<
><
>If your mother is gaining more than 3 liters of fluid between runs, she may need to run 3 times a week. this may help her not feel so bad and she will get better dialysis. You need to talk to her Dr. about this. <
>Remember, your kidneys work 24 hours a day, 7 days a week. Your mother is not getting anywhere near as much with only 2 times a week dialysis.
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Isabel
Joined: 11 May 2003
Posts: 25
PostPosted: Wed May 21, 2003 6:16 am Post subject: what is reuse????
Have not idea what is reuse. All I know is that Dr told me that he will reduce her dialysis to 2 times a week because her test results were fine. How should I know if they are doing everything to her. I asked the center for her test and all I got was the treatment log. I am totally confused, my mother is only 69 years old, she never had a problem with her heart, except for her kidneys function were 24%, and she retained water in her lungs. <
><
>I would like know what will happen if she goes back and takes her water pill. Meaning since her kidneys are still working and being dialyzed for a month can this result in her passing????<
>
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed May 21, 2003 7:22 am Post subject: Isabel
Reuse is the practice of taking the artificial kidney that is used to clean your mother's blood, and cleaning it with a chemical like Renalin, so that your mother can use it again and again. Some companies require that the kidney be used up to 30 or more times. This is a way for the companies to make a profit by not having to provide a
and new artifical kidney each time she does dialysis. Medicare pays for a new kidney each time, it is included in the composite rate that is paid to the company for your mother to dialize. <
> Each time the artifical kidney is used, the cleaning effect goes down. Also Renalin is thought to inhibit the asbsorption of esential nutrients needed by dialysis patients. Basically it boils down to the fact that each time the artificial dializer is used, your mother will get less and less efficient dialysis. She has the right to not do reuse and most companies will not tell the patients of their rights. I would suggest that you get your mother off reuse if they are reusing her artificial kidney.<
><
>Some patients also have a reaction to the chemical Renalin, but what you want most is the best dialysis for your mother, the best cleaning of her blood each time she runs. To do that she should have a new dializer (artifical kidney) each time.<
><
>It sounds as if your mother's kidneys are failing. Taking a water pill only makes the kidneys work harder and if they can't do the job, the water pill won't work either. Kidneys can still work as they fail. They just are not able to filter out all the fluid and waste products that they normally would. Dialysis can help, and that may be why she is only on 2 times a week. As her kidneys fail more, she will need to go to 3 times a week. This is where her Dr. will monitor her monthly labs and will be able to tell her when she needs to go 3 times a week. You and your mother will need to face the fact that this is for the rest of her life. <
><
>Renal failure is no respector of age or race. Your mother is lucky that she did not go into renal failure at an earlier age. As the kidneys fail, extra fluid will back up into the heart first as the heart muscle tries to push the extra fluid around. Then it backs up into the lungs, then the tissues. If it is not removed either by the water pills or dialysis, your mother could go into congestive heart failure. If you are asking if your mother stopped dialysis and relied soley on the water pill, would she die, I would have to say that she may. It all depends on how much kidney function she has, as to how soon that might happen. This is nothing to fool around with. By stopping dialysis without consulting a Dr., you could be doing irreparible harm. <
><
>Labs are drawn only once a month, unless the Dr. asks for something specific. Each dialysis a log sheet is filled out as this is the monitoring sheet that should have a blood pressure, heart rate, and specific machine measurements written down every 30 min. <
><
>Isabel, the only way you will know what they are doing to her is to educate yourself. ASK QUESTIONS. Write them down. There is a lot to learn and I know that you will feel totally overwhelmed. Take it one day at a time. Get the book that was recommended to you. You can get it on Amazon and it is very inexpensive. Type in ESRD, Renal faliure, ect on Yahoo and read all you can. I am here to try to answer your questions, but it will take time to learn everything. Do not panic! Talk to her Dr. and ask for information. An educated family does the best and adjusts the best to Reanl failure in the family. Good Luck. <
>
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Isabel
Joined: 11 May 2003
Posts: 25
PostPosted: Wed May 21, 2003 8:28 am Post subject: Urinary Infection
I took my mother to her PCP for the fever last night and the Dr tested her urine. He prescribed an antibiotic because she has an infection. Is this because of the reuse machine? <
><
>I will get the book as soon as I can...Thanks for your help! Isabel
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed May 21, 2003 10:02 am Post subject: Isabel
The urinary tract infection was most likely not a result of dialysis.
