I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Centers => Topic started by: Joe Paul on August 08, 2006, 01:38:56 PM
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Anyone ever ask to have the "blood warmer" temp turned up at the clinic? All the machines seem to be set at 37 Celsius, but since my operation on my teeth, I cannot stand the cold,my upper roof of my mouth, nose and lip freeze, and asked the nurse on duty, if she could turn the machine temp up a bit. She said no, and that I would have to have my Neph order that for me, as she told me the red blood cells could burst if it is set any higher. That don't sound right to me, but did call my doctor to request it. I will not be going back if this cannot be changed, even blankets do not help me, over the head and all. I been waiting all day for the Neph to call back, and if he doesn't, like I said, I will not be going back for dialysis, too much misery to handle.
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She is correct - the nephrologist must write the order to increase the dialysate temperature on the machine. If the temperature is too high hemolysis will occur meaning the red blood cells will burst and you will become hyperkalemic ( increased potassium). Not a good situation...
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She is correct - the nephrologist must write the order to increase the dialysate temperature on the machine. If the temperature is too high hemolysis will occur meaning the red blood cells will burst and you will become hyperkalemic ( increased potassium). Not a good situation...
How high is too high? 37 degrees is normal body temp (98.6F) Since there has to be a small amount of cooling which takes place as the blood flows back to the body, couldn't it be raised even a little so that the patient is NOT getting blood back at a temp lower than normal body temp? Being cold constricts blood flow to the extremeties; doesn't that make dialysis less effective?
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At the rate the 300 cc blood in the extracorporeal system returns to the body, which has a total of 5 - 6 L blood, that 300cc gets warmed up pretty fast! How high is too high? I'd have to look that one up. However, I'd bet the neph doesn't take that chance, as too much fiddling with the dialysate temp can lead to errors that can prove fatal. Plus when the vessels constrict it raises blood pressure. If the temp is too high the vessels will dilate and blood pressure will fall. Not a good scenario on HD.
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How high is too high? 37 degrees is normal body temp (98.6F) Since there has to be a small amount of cooling which takes place as the blood flows back to the body, couldn't it be raised even a little so that the patient is NOT getting blood back at a temp lower than normal body temp? Being cold constricts blood flow to the extremeties; doesn't that make dialysis less effective?
Dialysis patients tend to have a rise in body temperature in the process of dialysis itself even when the dialysate temperature is set at body temperature (pre, post temps). Studies have shown patients who have dialysate set at lower temperatures 34-35.5 degrees C have improved cardiovascular stability during dialysis. Fewer crashes because of drops in BP and that it is easier to remove excess fluid. Lowering the temp has not shown to have any negative affects on URR.
There have been a few studies done on it. Mostly under the term of "cool dialysis".
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Anyone ever ask to have the "blood warmer" temp turned up at the clinic? All the machines seem to be set at 37 Celsius, but since my operation on my teeth, I cannot stand the cold,my upper roof of my mouth, nose and lip freeze, and asked the nurse on duty, if she could turn the machine temp up a bit. She said no, and that I would have to have my Neph order that for me, as she told me the red blood cells could burst if it is set any higher. That don't sound right to me, but did call my doctor to request it. I will not be going back if this cannot be changed, even blankets do not help me, over the head and all. I been waiting all day for the Neph to call back, and if he doesn't, like I said, I will not be going back for dialysis, too much misery to handle.
Are you underweight, or anemic? Have you had your thyroid checked? If your adrenals are not working properly your thyroid levels may be off. Hypothyroidism can make a normally healthy person feel cold. Is your body temperature usually low? If so, try asking to have your FreeT3 and FreeT4 checked. They should be in the top 1/3 of normal -- if not, you may need to take some natural thyroid to replace what your body is not producing. Do some on-line research on hypothyroidism or join a yahoo thyroid group for a few weeks. You don't need to be missing dialysis!!!!
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Is there any possibility that you can change from hemo to pd dialysis?
Maybe that would solve the problem. I'm glad I chose pd.
Are you allowed to sip on some hot tea during dialysis?
Don't miss your treatments. Allow some time to work on this.
There must be a solution.
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Take some rice and fill one of your white tube socks with it. Tie a knot in the end and throw it in the microwave for a couple of minutes. Put this on your lap during dialysis and put at least one hand in it. If my hands and feet can stay warm then I do okay. Nothing more miserable than being cold on dialysis and having the air conditioning blowing on me. Yes, sip some hot tea. Ask to be moved to a warmer place.
Your Nephrologist is the one to talk to. She will make the clinic make some adjustments so you are more comfortable.
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How high is too high? 37 degrees is normal body temp (98.6F) Since there has to be a small amount of cooling which takes place as the blood flows back to the body, couldn't it be raised even a little so that the patient is NOT getting blood back at a temp lower than normal body temp? Being cold constricts blood flow to the extremeties; doesn't that make dialysis less effective?
Dialysis patients tend to have a rise in body temperature in the process of dialysis itself even when the dialysate temperature is set at body temperature (pre, post temps). Studies have shown patients who have dialysate set at lower temperatures 34-35.5 degrees C have improved cardiovascular stability during dialysis. Fewer crashes because of drops in BP and that it is easier to remove excess fluid. Lowering the temp has not shown to have any negative affects on URR.
There have been a few studies done on it. Mostly under the term of "cool dialysis".
Thanks, really interesting information. I did a little on-line looking and found the following:
"...It is concluded that differences in vascular response between i-UF and UF + HD disappear when treatment modalities are matched for the extracorporeal ET [energy transfer], suggesting that this is the single most important factor for the divergent vascular response between UF + HD and i-UF. Prevention of the increase in CT [core temperature] during hemodialysis significantly improves the constriction of the peripheral resistance and capacitance vessels, although vascular reactivity even appeared to be somewhat more pronounced with a further lowering of CT. Prevention of the increase in CT by adjusting the dialysate temperature during UF + HD appears to be mandatory for the optimization of hemodynamic stability during dialysis. This might be even of more clinical importance in the treatment of hypotensive-prone cardiac-compromised patients." http://jasn.asnjournals.org/cgi/content/full/11/8/1512
Does that mean that the depleted volume of blood in the machine/outside the body, and the usual increase in core temperature, and resulting vasodialation, predisposes many patients to experience low blood pressure, especially at the end of dialysis as the removal of excess fluid further depletes the volume? and that's why the dialysate is cooled to cause the vasoconstriction to push blood to the core of the body and keep BP stable? Especially when patients have cardiac issues, weak heart, etc., or a history of hypotensive episodes, the dialysate being cooler causes further vasoconstriction and helps prevent the low BP problems? Did I understand that correctly?
If that is correct, then in cases where the patient has a low CT, or just feels miserably cold, couldn't saline be used to replace at least part of the blood volume temporarily in the machine, and the dialysate temp be slightly elevated? Wouldn't that be a way to raise the CT to a comfortable level for the patients? Even though it would prevent the vasoconstriction couldn't it still keep the BP stable until toward the end of the session when the dialysate temperature could be dropped, and the excess saline gradually removed? -- especially for those who do not have a problem with low blood pressure.
"... The amount of heat removal should be tailored to each patient because there are wide interindividual and intraindividual variations in baseline body temperature and ultrafiltration requirements. ..."
http://www.blackwell-synergy.com/doi/abs/10.1046/j.1525-139X.2002.00061.x
When the chill factor is such that a patient would chose not to have dialysis, wouldn't the above be a better alternative. Do nephs not do that? I mean, tailor a prescription to a patients individual needs?
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Black, not anemic (has been in the "normal" range last couple blood tests, WITHOUT epogin) lost weight due to having my teeth removed for transplant work-up, about 14 pounds, but have been gaining that back slowly.My Neph did not call me back yesterday, so I didn't go in this morning for my treatment. Rerun, there is no "warmer" place in the clinic, its a small room, 10 chairs. I have asked them to turn the ac down, but they (techs+nurses) say they sweat too much, so the room stays at 70 degrees. Ive said above in my post, I cane handle the cold arm / hand, its my upper mouth, lip and nose that gets to me.
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I usually set mine, depending how hot are how cold I am. It is unbelievable what that 0.5c makes. To hot turn the temp down to 36c to cold turn up to 37c all the machines in our unit are set at 36.5c.
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There is a head nurse at our unit who will turn the heat up on the blood a tiny smidge if you are freezing cold. It does help quite a bit.
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My Neph said he was really busy, but did call today. He gave the OK to turn up the heat a bit, I hope it helps.
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My Neph said he was really busy, but did call today. He gave the OK to turn up the heat a bit, I hope it helps.
Did you go today? If so, how was it?
Have you tried wearing a mask? It might warm up the air you're breathing and keep your mouth and nose warmer. Besides, it might also make the techs think you're contagious and more careful with their sterile procedures. ;D
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That is so funny! Sometimes when I freezing I put the mask on to warm up the air I breath. Otherwise it hurts to breath in cold air for 3 hours.
Today the air conditioning broke. You should have seen the Techs running around trying to fix it. They don't do a thing if we are too cold.
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That is so funny! Sometimes when I freezing I put the mask on to warm up the air I breath. Otherwise it hurts to breath in cold air for 3 hours.
Today the air conditioning broke. You should have seen the Techs running around trying to fix it. They don't do a thing if we are too cold.
Ya no kidding! I mean sometimes I am so frickan cold that i feel chilled to the bone and they actually think that we are HOT just because THEY are!!!
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I aways knew you were COLD Rerun ;D The way you pick on me >:D
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I did not go Wed., but am going in today. Thats a good idea Kevno, ill try that too.
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I did not go Wed., but am going in today.
How are you feeling since you didn't go in Wed? Aren't you supposed to go M/W/F like I do?
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Yes Angie, you are correct, same schedule. I feel fine for only having 1 1/2 hours treatment since Monday, and haven't gained anything at all. I know when they do my blood work, my absence will show up, and Ill be preached to, But, its been a welcome change getting out of that "rut". Thanks for asking how I am doing.
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No problem! :) Isn't that what we are here for? Support and community? ;D
I could never skip a day of dialysis... I drink too much in between. It is something ... I can keep my phosphate perfect (but it is VERY hard .. I have to be good with my binders and not touch any "no no foods" .. and basically not over eat ... and yet .. I can't control my drinking :( Is that bad? I think I will talk more about this in a new post so don't say anything about this here .. just look for my new thread ;) I don't want to upset Epoman :P
But what I want to know is .. how did turning up the temp on the blood warmer go?
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I will have to let you know that later today, (Friday). This morning, as you know, will be my first run with the temp a little higher, we will see.
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I will have to let you know that later today, (Friday). This morning, as you know, will be my first run with the temp a little higher, we will see.
Good luck! :)
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Went well today, they bumped the temp .5, and it made a world of difference.
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Went well today, they bumped the temp .5, and it made a world of difference.
That is wonderful news!!! Good for you.
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That is good news.
Am so glad for you.
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It always seems to work for me. Happy it as worked for you too Joe Paul ;)
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So your willing to die because of being cold? :-\ Our machines are set at 34-36 and it does get rather cold. I usually have a blanket on and the staff are usually happy to turn the air con down if its too cold. Surely there is something causing this excessive coldness. I wouldnt think you would be so cold that you are willing to not dialyse.
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Yes, id rather die than be cold. (if you read the first post, that explains why).
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Tell the truth I rather be that bit cooler than to hot 8) Too hot makes me itch because my phosphate is a bit high. That drives me crazy :o Like today the first thing I did when I walked into the room was turn off the heating, and open the window. Good job I am in a room on my own, would not be popular with the other patients :)
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You know, its crazy..I hate being hot too, AC has been going most of this summer. Its just that cold from the dialysis I cant take, its just, say "different"
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How old are you Joe if you dont mind me asking? At times I have wanted to give everything up as well but I dont want to die. We have very hot summers here and we have no aircon and in those times I really dont cope with the heat, but again, I dont want to die. Can you have a heater near you during dialysis or something? Would that help? Geez surely they can do something for you? Can you change over to PD?
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Amber, thanks for the concern, but my Neph did OK raising the temperature up .5, which helped alot. I am 45 years old BTW, and don't want to sound like I don't value my life, I do, its just there are limits to what I can take, and that kind of cold isn't within those limits. I am still learning to cope with all this change, keep in mind, I am a newbie to this, just over 4 months on dialysis.
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I didn't even know about the blood warmer temp as I am still pretty new to hemo (I was always on PD). They are supposed to teach me but honestly I learn every little thing right here! There were a few times I was so cold I felt like my bone marrow was ice cold! There were times when I was so cold I was shivering and the nurses noticed and asked, "Are you cold?" No I just like to sit here shaking. Didn't you know? It is the latest hemo-dance? I mean, come on! The 2 times I remember being so unreasonably cold it turned out that I had a fever. They would never have known except that I took my temp afterwards (there is a thermometer at dialysis which we take our temp but only have to before we are hooked up. We take our temp at the same time we weigh ourselves.
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I always check my temp at the beginning of dialysis and at the end. Our BP is taken three times at the beginning in the middle and at the end. Too make sure we are not crashing our BP.
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We have our temp taken at the beginning and the end and our BP is taken sitting and standing at the beginning and then every 1/2 hour through the treatment and then sitting and standing after the treatment is done.
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We have our temp taken at the beginning and the end and our BP is taken sitting and standing at the beginning and then every 1/2 hour through the treatment and then sitting and standing after the treatment is done.
That is exactly how it is done at our centre. The machine is set to do it every ˝ hour. They also do some extra BP tests if there are any abnomalities (too high or too low).
[holding down the ALT key and inputting certain numbers can get you all kinds of nifty symbols, e.g. ALT 171 = ˝ ALT 172 = ź. As a teacher of a foreign language I had to learn them to be able to write 'tęte' and 'mańana', for example]
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I am on a machine with no BP machine, thats why I get my BP done half way it's a Gambro AK200. Most of the other patients are on Fresenius 4008 with a BP machine so they get their BP done every hour.
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Mine is a Fresenius 2008K machine and it takes BP every 30 min and also the standing/sitting at the beginning and end.
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Okay...first of all...Joe...I'm glad you got your temp problem straightened out. It is miserable to be bone cold. Covering your head will also help tremendously. Either with a knit cap or something like it. I have one patient who is always freezing, but she never brings a hat. I cover her head with the sheet she puts on the chair and it really helps her. Sure, she looks like Mother Teresa, but she is a warm Mother Teresa ha ha. Another thing you could try is to have a tech or nurse give you a glove filled with very warm water. Just be careful with the temp of that water...if you have neuropathy or any loss of sensation, you could be burned if not careful. Hold this glove over your chest and you'd be amazed how the heat radiates out. I use this trick myself when some of our fellow (menopausal) nurses try to freeze me out. Their hot flashes give me frost bite ;D
Lots of good tips and tricks here.
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Thanks needlebearer, things have been good with that temperature change, and a new blanket from the wife. Seems, since my gums are finally healing, thats helping too. BTW, thanks to all for your concerns and your tips, you all are wonderfull! Joe
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I somehow missed responding to this thread. I know that on our machines (2008K), all the machines are supposed to be set for 37 degrees unless the neph orders otherwise. I have never seen the temp raised only lowered. The other thing besides killing your blood cells that the temp can do is that it also changes the bloods viscosity. The higher the temp, the thinner the blood, and the lower the temp the thicker the blood. The few patients I know that have the temp down (35 instead of 37) have it that way because they have thin blood and the lower temp thickens it up a bit. It helps keep the machine from alarming all the time. They are calibrated to read a certain way, and when the blood thickness doesn't match up it causes alarms.
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I use the 2008k also .. the temp is set at 36.1 .. works for me.. ;)
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I use the 2008k also .. the temp is set at 36.1 .. works for me.. ;)
Shiver my timbers, LOL, just kidding. As to what Hawkeye says, they use Baxter machines at my clinic, no alarms with the temp at 37.5
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I use the 2008k also .. the temp is set at 36.1 .. works for me.. ;)
How can I find out what my 2008k is set to?
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I should be up on the screen somewhere angie, or you may need to press a button to find it. Just ask whoever sets you up.
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I should be up on the screen somewhere angie, or you may need to press a button to find it. Just ask whoever sets you up.
Every time I ask any of the nurses (we don't have techs like the American units do) they always ask "why would you want to know that?" or "You don't need to know that". I am supposed to learn everything about this unit but because most of the nurses go back and forth to the other unit they tend to just do everything themselves and never teach you anything. That is why I thought I would ask here .. especially since at least 2 people are on the same machine as I am.
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They sound like snooty bitches then lol It would take them 1 second to find out. If I knew how Id tell you.
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I would tell them you are just checking. Also make sure that the dialysate flow rate is at the right level. Some people dialyze at 400 and if you are at 800 and it isnt set to that you get inferior dialysis.
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I would tell them you are just checking. Also make sure that the dialysate flow rate is at the right level. Some people dialyze at 400 and if you are at 800 and it isn't set to that you get inferior dialysis.
How do I know that? They just ran a test on all of us and said something about how I can get a flow of 700.. does that sound right? But with my fistula having problems ... until I get that Fistulogram I will stick with the 400 that they run me at for now. Is that test that tested me at 700 .. is that the flow rate? So much I still have to learn
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How do I know that? They just ran a test on all of us and said something about how I can get a flow of 700.. does that sound right? But with my fistula having problems ... until I get that Fistulogram I will stick with the 400 that they run me at for now. Is that test that tested me at 700 .. is that the flow rate? So much I still have to learn
Dialysate flow rate is the flow of the dialysis solution. It is the rate at which the solution flows in the opposite direction of the blood in the kidney. Lower flow rate means less dialysis being done.
The test they did was to measure the Blood flow rate of your fistula. I do not know what the desired minimum level of blood flow rate of a fistula is but will check at my unit to see what they desire.
Blood flow of the fistula---They measure the flow of the blood through the fistula itself.
Dialysate flow rate--- Is the rate at which the dialysis solution flows in the artificial kidney.
Pump Speed--- Rate at which the pump itself is going.
Blood flow rate while on the machine. Is the rate at which the blood is being pumped out and back in during your treatment.
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How do I know that? They just ran a test on all of us and said something about how I can get a flow of 700.. does that sound right? But with my fistula having problems ... until I get that Fistulogram I will stick with the 400 that they run me at for now. Is that test that tested me at 700 .. is that the flow rate? So much I still have to learn
Dialysate flow rate is the flow of the dialysis solution. It is the rate at which the solution flows in the opposite direction of the blood in the kidney. Lower flow rate means less dialysis being done.
The test they did was to measure the Blood flow rate of your fistula. I do not know what the desired minimum level of blood flow rate of a fistula is but will check at my unit to see what they desire.
Blood flow of the fistula---They measure the flow of the blood through the fistula itself.
Dialysate flow rate--- Is the rate at which the dialysis solution flows in the artificial kidney.
Pump Speed--- Rate at which the pump itself is going.
Blood flow rate while on the machine. Is the rate at which the blood is being pumped out and back in during your treatment.
So does this mean if I wanted to I could bring up the number from 400 to 700??? or would that be too much and very bad??
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I would go with whatever flow they are doing as obviously thats whats on your dialysis prescription. Are there any other fresenius users here?? Surely theres some others who can tell this poor girl what buttons to press!! :)
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So does this mean if I wanted to I could bring up the number from 400 to 700??? or would that be too much and very bad??
The dialysate flow rate is set by prescription from the doctor based on your labs.
Machines vary. We have some machines here where the default is a dialysate flow rate of 800. Other machines have a default rate of 400. The nurses are suppose to set what rate the dialysate is suppose to be but they are only human and forget from time to time.
Its always best to know what your prescription is and make sure its done everytime.
IMO people should always make sure their temp of dialysate is set to their satisfaction, dialysate flow rate is set at correct level, and you are hooked up to the right bath, and if on reuse make sure its your kidney and passed inspection. ;D
I do not know how it is in Canada but in the US patients can request to see their medical records at anytime.
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How can I find out what my 2008k is set to?
On the 2008K if you are looking at the Home or main screen the Temperature that your running is the second box from the top on the right hand side. The reading you see there is what the machine is running at, not what it is set for. To find out what it is set for you have to press the screen on that box and it will turn a darker yellow color with a different number. That number is what the machine is set for. If the 2 number are more than + or - .5 from each other the machine is not calibrated properly and needs to be pulled. For Example if it is supposed to be running 37 than anywhere from 36.5 to 37.5 is acceptable.
I would tell them you are just checking. Also make sure that the dialysate flow rate is at the right level. Some people dialyze at 400 and if you are at 800 and it isn't set to that you get inferior dialysis.
How do I know that? They just ran a test on all of us and said something about how I can get a flow of 700.. does that sound right? But with my fistula having problems ... until I get that Fistulogram I will stick with the 400 that they run me at for now. Is that test that tested me at 700 .. is that the flow rate? So much I still have to learn
As far a the flow rate you are talking about I am assuming from the numbers you are giving that it is the dialysate flow rate not the blood flow rate. I have never seen anyone run over around 450 on a blood flow rate, but 800 and above is normal for dialysate flow rate depending on what features your machines have. You can see what the dialysate flow rate is by looking at the Home or main screen and looking at the number that is in the first box on the right hand side. If your clinic has the autoflow feature it may say A500, A600, A700, or A800. For autoflow you get either 1.5x the blood flow rate or 2x the blood flow rate depends on what you are perscribed for. If no autoflow is enabled it should read 400, 500, 600, 700, or 800 depending on your perscription. The blood flow rate however is found on the blood pump itself, and what it says it what it is. You can find what you are supposed to be running at on your treatment sheet. All information about you treatment is included on that sheet and it is your right to look at it if you wish. Different companies have different layouts for their sheet so you will just have to look it over, but if your sheet says one thing and your machine says another your not getting your perscribed treatment and that can cause you problems.
EDITED: Fixed Quote tag error - Epoman, Owner/Admin
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I just checked my temp today .. the machine said 37 Celcius.
If your clinic has the autoflow feature it may say A500, A600, A700, or A800. For autoflow you get either 1.5x the blood flow rate or 2x the blood flow rate depends on what you are perscribed for. If no autoflow is enabled it should read 400, 500, 600, 700, or 800 depending on your perscription. The blood flow rate however is found on the blood pump itself, and what it says it what it is. You can find what you are supposed to be running at on your treatment sheet. All information about you treatment is included on that sheet and it is your right to look at it if you wish. Different companies have different layouts for their sheet so you will just have to look it over, but if your sheet says one thing and your machine says another your not getting your perscribed treatment and that can cause you problems.
oh THAT is what that is?? Thanks Epoman!! Ya 700 was the dialysis flow rate, the blood flow rate is always at 350 - 400 and my fistula has gotten stronger lately because they have to run me back the "old way" .. infact I will make a new post about that because today was the first time I heard of that. Thanks for your help in helping me understand my machine :)
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Dialysate flow rate is the flow of the dialysis solution. It is the rate at which the solution flows in the opposite direction of the blood in the kidney. Lower flow rate means less dialysis being done.
The test they did was to measure the Blood flow rate of your fistula. I do not know what the desired minimum level of blood flow rate of a fistula is but will check at my unit to see what they desire.
Blood flow of the fistula---They measure the flow of the blood through the fistula itself.
Dialysate flow rate--- Is the rate at which the dialysis solution flows in the artificial kidney.
Pump Speed--- Rate at which the pump itself is going.
Blood flow rate while on the machine. Is the rate at which the blood is being pumped out and back in during your treatment.
How about the total amount of blood processed from a single treatment ( 100+ liters in some cases. )? That's on the 2008K as well. Just hit the KT/V in the bottom row of square buttons (far left button is HOME). You can also have the nurse set up the machine to measure an approximate KT/V. However, they may not have received training to do it. :-\
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That's on the 2008K as well. Just hit the KT/V in the bottom row of square buttons (far left button is HOME). You can also have the nurse set up the machine to measure an approximate KT/V. However, they may not have received training to do it. :-\
Ah okay, thanks! I am aware of those buttons :) I will look at it on Friday!