Machine "blood warmer" temp?

[Joe Paul]

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.

[JerseyGirl]

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...

[Black]

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?

[JerseyGirl]

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.

[BigSky]

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".

[Black]

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!!!!

[Ohio Buckeye]

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. 

[Rerun]

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.

[Black]

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?

[Joe Paul]

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.

[kevno]

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.

[kitkatz]

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.

[Joe Paul]

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.

[Black]

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. 

[Rerun]

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.

[angieskidney]

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!!!

[kevno]

I aways knew you were COLD Rerun The way you pick on me

[Joe Paul]

I did not go Wed., but am going in today. Thats a good idea Kevno, ill try that too.

[angieskidney]

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?

[Joe Paul]

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.

[angieskidney]

No problem! Isn't that what we are here for? Support and community? 

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

But what I want to know is .. how did turning up the temp on the blood warmer go?

[Joe Paul]

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.

[angieskidney]

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!

[Joe Paul]

Went well today, they bumped the temp .5, and it made a world of difference.

[Black]

Went well today, they bumped the temp .5, and it made a world of difference.

That is wonderful news!!!  Good for you.