Low albumin=bad for the unit

[LifeOnHold]

I just got b*tched at on Tuesday for my low albumin level-- my nephrologist said, "When you have a low albumin, you make the unit look bad!"  (They have this self-imposed 'goal' to have everyone's albumin above 3.5.)

I was SOOOO close to saying, "So, I guess my surviving ten years in this unit doesn't mean crap? You get one bad test result and suddenly it's my fault your unit looks bad?"

Hey, lady, it's my 'goal' to stay alive... I could give a damn about making the unit 'look good.'


(I used the frowny-face icon because there's not an icon that describes just how p*issed off I am about this!)

[Epoman]

I just got b*tched at on Tuesday for my low albumin level-- my nephrologist said, "When you have a low albumin, you make the unit look bad!"  (They have this self-imposed 'goal' to have everyone's albumin above 3.5.)

I was SOOOO close to saying, "So, I guess my surviving ten years in this unit doesn't mean crap? You get one bad test result and suddenly it's my fault your unit looks bad?"

Hey, lady, it's my 'goal' to stay alive... I could give a damn about making the unit 'look good.'


(I used the frowny-face icon because there's not an icon that describes just how p*issed off I am about this!)

Yeah they also want everyone's KT/V (Level that tells how well your blood is being cleaned) at a certain level to or they will look bad to medicare. They have to have everyone's level within range or they WILL get in trouble, like not get paid. It's a regulation thing. But yeah I agree with you.

[Mom3]

Reading through these posts made me wonder....

At my son's former clinic (a DCI) his dry weight was never adjusted even though he was losing weight...He got in grave trouble that way! but the paperwork looked great. His lab sheet the month he went to the hospital as an emergency fluid overload admission (April 06) > GREAT LABS with two gold stars on them. (Yes, gold stars, like first grade.) AND acceptable fluid gains.

Meantime I could look at him and tell he was getting sicker and sicker. His ankles were swelling more and more, his lungs sounded terrible without a stethoscope but when I called clinic or doctors they insisted "he was fine". I assumed incompetence, but now I'm beginning to wonder if they didn't knowingly do this to keep their paperwork looking good to Medicare and Medicaid??? Is such a thing possible? What do other patients and families think?

He now goes 20 miles to another clinic (DSI) and they seem to be keeping up with his fluid. His BP drops a lot which is scary and it is something I don't completely understand. His new doctors (yes we definitely got new doctors!!) said this clinic has the best morbidity/mortality stats in our area...It HAS to be BETTER!!!

[kitkatz]

I do know that my PTH levels are not within the clinic standards and I get yelled at because I am screwing up the clinical goals.  I just watch out for myself and who gives a rat's butt about clinical goals.  It should be Personal goals, after all each dialysis patient is different.

[Rerun]

Reading through these posts made me wonder....

At my son's former clinic (a DCI) his dry weight was never adjusted even though he was losing weight...He got in grave trouble that way! but the paperwork looked great. His lab sheet the month he went to the hospital as an emergency fluid overload admission (April 06) > GREAT LABS with two gold stars on them. (Yes, gold stars, like first grade.) AND acceptable fluid gains.

Meantime I could look at him and tell he was getting sicker and sicker. His ankles were swelling more and more, his lungs sounded terrible without a stethoscope but when I called clinic or doctors they insisted "he was fine". I assumed incompetence, but now I'm beginning to wonder if they didn't knowingly do this to keep their paperwork looking good to Medicare and Medicaid??? Is such a thing possible? What do other patients and families think?

He now goes 20 miles to another clinic (DSI) and they seem to be keeping up with his fluid. His BP drops a lot which is scary and it is something I don't completely understand. His new doctors (yes we definitely got new doctors!!) said this clinic has the best morbidity/mortality stats in our area...It HAS to be BETTER!!!

You might consider getting him a wrist BP band.  I have one and when I feel clammy and light headed I take a BP and if it is low then I call someone to turn off my UF (negative pressure that pulls water off).  Otherwise the machine takes your BP every half hour which most the time is "too much", but there are those time when it is not enough.

[Panda_9]

I have my own BP machine and I always take it with me if I go to the in-centre Dx unit. They never take your BP during treatment which pisses me off, so I do it myself, and intervene myself (If Im on a gambro). Im not talking about the home training unit (they are fab), I mean the actual Dx unit.

[goofynina]

What do you mean they dont take your bp, isnt that standard procedure in EVERY unit,  cant you tell them to check your bp?  Something is fishy there at that unit...

[angieskidney]

I just got b*tched at on Tuesday for my low albumin level-- my nephrologist said, "When you have a low albumin, you make the unit look bad!"  (They have this self-imposed 'goal' to have everyone's albumin above 3.5.)

I was SOOOO close to saying, "So, I guess my surviving ten years in this unit doesn't mean crap? You get one bad test result and suddenly it's my fault your unit looks bad?"

Hey, lady, it's my 'goal' to stay alive... I could give a damn about making the unit 'look good.'


(I used the frowny-face icon because there's not an icon that describes just how p*issed off I am about this!)

Reading through these posts made me wonder....

At my son's former clinic (a DCI) his dry weight was never adjusted even though he was losing weight...He got in grave trouble that way! but the paperwork looked great. His lab sheet the month he went to the hospital as an emergency fluid overload admission (April 06) > GREAT LABS with two gold stars on them. (Yes, gold stars, like first grade.) AND acceptable fluid gains.

Meantime I could look at him and tell he was getting sicker and sicker. His ankles were swelling more and more, his lungs sounded terrible without a stethoscope but when I called clinic or doctors they insisted "he was fine". I assumed incompetence, but now I'm beginning to wonder if they didn't knowingly do this to keep their paperwork looking good to Medicare and Medicaid??? Is such a thing possible? What do other patients and families think?

He now goes 20 miles to another clinic (DSI) and they seem to be keeping up with his fluid. His BP drops a lot which is scary and it is something I don't completely understand. His new doctors (yes we definitely got new doctors!!) said this clinic has the best morbidity/mortality stats in our area...It HAS to be BETTER!!!

Are you serious?? Holy crap!! I can't believe that!! Is this typical for units in the States?? Here if a goal is off they might get upset at you but they work with  you to do better the next time around and they also go by past times ... if it is an odd occurance they just make a note of it but don't come down on you about it. The dietician will have a word with you though here.

What do you mean they dont take your bp, isnt that standard procedure in EVERY unit,  cant you tell them to check your bp?  Something is fishy there at that unit...

Ya I totally agree! It is VERY important for your pressure to be taken because that is one of the best ways to tell if you are getting too much or enough fluid taken off!

[bioya]

...its not that your making your unit look bad. The unit is rated by the Renal Network on a varity of things, one being albumin, etc. Also, in a very short period, if not already in some parts of the country, Dialysis facilities are going to be paid based on PATIENT OUTCOMES. In other words, the better your labs, (and the better you are physically), the more the unit gets paid. I thought it was suppose to start this past January but as of when I left nasty Duh Vita, nothing had been doine yet. Don't take it too personal. If they are caring docs and dialysis staff, they truly care about your labs. I hope that makes sense.

[sandman]

Are you serious?? Holy crap!! I can't believe that!! Is this typical for units in the States??

No Angie.  This is not typical practice in the states.  But it is a known fact that some places offer better care then others.  There are so many more trained medical professionals in the states vs Canada.  Mom3 was just unfortunate to find one of the lesser skilled.

[Mom3]

Thanks for the tip on the wrist band...I'll ask my son about that and have him check into it.

I really wonder if they were that unskilled...or if they just wrote that he was fine on those labs so they'd look better on paper and get more money for all those months. Meantime he got in grave trouble! Fortunately they seem to be really caring at his new clinic and keeping up with the problems.

Guess we'll never know for sure but what matters is his getting better care now! I do feel he is getting better care and he is not as happy with some things (no individual tvs, nurses "fuss" at him more etc.) but he has to admit they are keeping up with his dry weight now...

Mom 3

[Panda_9]

What do you mean they dont take your bp, isnt that standard procedure in EVERY unit,  cant you tell them to check your bp?  Something is fishy there at that unit...

Usually you do your pre and post BP yourself, which suits me. But of all the times Ive been there, which isnt a great lot, I can only remember on one occaision someone checking my BP. A few times Id ring the bell to ask them to check it if I felt off, but they never came and did it routinely. Im not at all knocking them, as they are nice people, but this is one thing I noticed was being slacked off on. I guess they assume because I am a home patient, I dont need them to monitor me?

[sandman]

Well, I don't know if they were unskilled or not.  I just didn't know any other way to put it at the moment.  But typically, people get into the medical profession because they care and want to do what they can to help the sick and injured but sometimes these people get corrupt and only see the dollar signs in health care and stop caring about what they originally got into that profession for in the first place.

[Panda_9]

I think if people are in the medical profession solely for the money, then I dont think they should be there. Especially when it comes to nursing, it takes certain people to do it.

[BigSky]

Its more than a self imposed goal to have albumin 3.5 and over.  But if the dr. addressed it that way I would of told him go go f*ck himself. 

Medicare does look to the numbers in how if funds and rates units but it also has to do with greatly increased death rates for albumin levels under 3.5.

As to dry weight and fluid, one really needs to be proactive. 

At the first sign of feeling that not enough or too much fluid is coming off then need have the dr. notified and problem corrected  before next treatment.

Most patients in my unit do not say anything but everytime I go to dialysis I tell the nurse if I need more or less fluid removed by how I felt and how much fluid may have been left in my legs from the prior visit.

 

[angieskidney]

Its more than a self imposed goal to have albumin 3.5 and over.  But if the dr. addressed it that way I would of told him go go f*ck himself. 

Medicare does look to the numbers in how if funds and rates units but it also has to do with greatly increased death rates for albumin levels under 3.5.

As to dry weight and fluid, one really needs to be proactive. 

At the first sign of feeling that not enough or too much fluid is coming off then need have the dr. notified and problem corrected  before next treatment.

Most patients in my unit do not say anything but everytime I go to dialysis I tell the nurse if I need more or less fluid removed by how I felt and how much fluid may have been left in my legs from the prior visit.

 

I agree ... I always communicate with my nurses on my care. I tell them if I think I gained or lost dry weight and how I am feeling. I notice from watching them that they know only so much and learn more by your communication on what is best for your care.

[Bajanne]

One thing I remember about my brother's stint on dialysis was that he would tell me how much he told the nurse to take off. I didn't pay much attention at that time, never knowing I would be in the same state.  At my unit, they pretty much just take off what was on since the last dry weight, and add anything you plan to take during dialysis.

[angieskidney]

One thing I remember about my brother's stint on dialysis was that he would tell me how much he told the nurse to take off. I didn't pay much attention at that time, never knowing I would be in the same state.  At my unit, they pretty much just take off what was on since the last dry weight, and add anything you plan to take during dialysis.

Ya same in my unit but if you say (in my unit anyway since it is a "self care" unit) you think you gained dry weight or lost dry weight then they know to watch it and maybe lower it. Even though I have noticed they don't like to lower it if you just had your weight adjusted only the last day.

[sandman]

I have noticed by watching over Angie in dialysis, that it can be very hard to find someones exact dry weight.  It's almost as hard as asking a blind man to tell me what a street sign says.  Are there any more exacting methods for calculating dry weight other then causing the patient severe discomfort from dehydration?

[angieskidney]

I have noticed by watching over Angie in dialysis, that it can be very hard to find someones exact dry weight.  It's almost as hard as asking a blind man to tell me what a street sign says.  Are there any more exacting methods for calculating dry weight other then causing the patient severe discomfort from dehydration?

Very good question

[Panda_9]

The easiest way to determine dry weight is to go by blood pressure. Take note of what BP is post Dx and work from there. If you come off and its higher than around 130/100, then you may have a bit more fluid. The safest way to reduce it is by reducing the dry weight by 200ml/gms each Dx, until BP is good. Generally BP is on the high side immediately post Dx. Perhaps check it later on and see if its come down. If your BP is good and you can notice fluid retention in the feet and ankles, then perhaps if you are on BP medications, they might be masking the effects of fluid retention. Also, some people dont retain fluid in the feet/ankles, which makes it harder to determine dry weight. If you still cant get your dry weight right, there are machines that do a Blood Volume Measurement (BVM), but not all doctors agree with this method. You should also get your neph to do a fluid assessment. They look at BP, puffyness, jugular venous pressure, and lungs.

[BigSky]

Have them use a crit line if they have it.  A crit line measures oxygen content continously and hematocrit hundreds of times a minute.  When the body is full of extra fluid the blood is diluted and the hematocrit level is lower.  As fluid comes off the machine can tell if the fluid is coming off too fast by how the hematocrit rises during fluid removal.  If not enough fluid is being removed the hematocrit will not change all that much.  It plots it out and there are markers to show where fluid removal should be at a given moment.  If those markers are hit too soo it means too much fluid is being removed too fast and if they are not reached it means not enough fluid is being removed.  This helps because during dialysis the nurse can see what is going on and adjust the fluid removal rate up or down depending on what the crit line is saying.

[sandman]

Can someone explain to me what a "crit line" is and what device or machine is used to messure this?

[Panda_9]

BigSky, what you have described sounds the same as a BVM.

[BigSky]

Can someone explain to me what a "crit line" is and what device or machine is used to messure this?

A crit line is machine that measures oxygen and hematocrit of the blood while on dialysis.

They hook a a little plastic thingy (medical term there )  in between the top of the dialyzer and the tubing.  A spring clap device is put onto the little plastic thingy and measures the oxygen and hematocrit and it translates the data to the crit line machine which displays the data on a graph.

Must pretty much be the same thing Amber 79.


Better than I can explain it, here is a link to the site. 

http://crit-line.com/Default.jsp