My first scary dialysis

[Bajanne]

I had my first scary dialysis session this Monday, two day ago.  After a weekend in Antigua where I must have consumed just a teeny bit too much fluid, I noticed that Monday morning (sleeping on a plane from 6.00  to 8.00 a.m.) my hands and feet were a bit swollen.  When I reached to dialysis ( I usually go for 11.00) my blood pressure was high - the bottom number was 104.  Well, I went on the machine and was off to sleep. I woke at about 2.00 p.m.  After a few minutes, I became extremely scared.  I thought I was about to die.  I was blacking out.  I called the nurse and when she looked at my blood pressure, the bottom number was 40.    She did what she had to do.  Then I became nauseous and vomitted.  She gave me a bit of juice.  Soon after that, my body settled down.  How scary!!!!!
Has anything like this ever happened to any of you?  I remember Epoman, I think, warning me about something like this when I was asking advice before I started dialysis.  I was thinking that I was getting away and would never experience it, but it caught me.
Is there anything you can do to avoid this?

[LifeOnHold]

Do they check your blood pressure every half hour? 

My pressure tends to drop in the last hour of treatment, which is why I try to slee the last hour-- for some reason if I'm sleeping, my pressure doesn't go very low. Do they allow you to eat or drink anything while on the machine?  You can try drinking some juice the last hour and see if that helps with the nausea.  Perhaps your dry weight isn't correct and they're trying to take off too much fluid.

I also had problems with my feet swelling on planes-- I used to visit my parents in Florida, and even on a 2-hour plane ride my feet would swell up so much I had to start wearing sandals on the plane.  (Not to mention how uncomfortable it was to be wearing tight pants... it's long dresses on planes for me from now on!)

[thegypsykid]

ask if the machines in the unit where you go can do UF profiling. it seems to help some. have them pull hard at the beggining and then taper off towards the end. it gives your body time to adjust by letting fluid move from your 3rd space back into your circulatory system and keep your BP a little more stable.

[LifeOnHold]

Yes, I've had good luck with profiling-- I can't remove anything at all in the last hour without cramping and crashing.  Profile 5 works well for me because it removes everything in the first 3 hours.  Thanks for bringing that up, gypsykid!   

[Jamie]

Bajanne2000,

 Not to worry as most of my dialysis treatments are pretty scary that's for me and the nurse thats hooking me up. I too have a blood pressure drop big time my last hour of my treatment. Of corse it is probably my own falut gain massive fluid gains. I need to work on just getting up to 4 kilo's per treatment then go from there.
  Epoman puts in his own needles well one thing for sure is he has alot more nerve than I. As for me I can't even watch when the needles go in but I'm getting much better with it.........Jamie-G


www.jamiegmagic.com

[mrhecht]

If you have not had this type of BP drop before, chances are that the extra fluid you put on caused the BP drop. My experience has been that your body becomes used to the normal amount of fluid that you gain between treatments and major deviations from that can cause the fluid shift to affect you more dramatically, i.e., nausea and BP drops. My suggestion is that if you know you have more than your normal amount of fluid on, don't try to pull it all in one treatment. An adjustment of as little as .2 (k) can make all the difference. I ALWAYS figure my own total fluid removal, no matter what they have as my "dry weight". Sodium intake can also affect how easy it is for your body to "give up" the fluid and for us female species, our monthly hormonal fluctuations also affect how tightly our body wants to hold onto fluid.

Also, I believe that BP taken every 15 minutes is safer than every 1/2 hour. If I am "BP challenged" during a treatment, I will ask for the BP monitor to take every 5 or 10 minutes. I also insist that the BP monitor be "turned" so that I can keep track of my own pressure and anticipate if I am about to "take a plunge". Pay attention to how your body feels at different BP, you will be able to anticpate by looking at your monitor and tracking it. I'm assuming that you were already reclining since you mention that you 'woke up', but on the off-chance that you WEREN'T, make sure that your chair is reclining during the last hour or so of your treatment when the chance of a BP drop is greatest.

One more thing, don't know if your unit allows eating, but statistically, most people's BP does drop after eating, when the blood vessels send more volume to the stomach area for digestion. Since part of our blood volume is already outside our body, this can cause a DRAMATIC drop in BP and often does, causing nausea & fainting.

[renal30yrs]

Before the days of bicarbs most patiens threw up all the time.  I remember the techs were often busier cleaning up the mess than any other task.

[angieskidney]

If you have not had this type of BP drop before, chances are that the extra fluid you put on caused the BP drop. My experience has been that your body becomes used to the normal amount of fluid that you gain between treatments and major deviations from that can cause the fluid shift to affect you more dramatically, i.e., nausea and BP drops. My suggestion is that if you know you have more than your normal amount of fluid on, don't try to pull it all in one treatment. An adjustment of as little as .2 (k) can make all the difference. I ALWAYS figure my own total fluid removal, no matter what they have as my "dry weight". Sodium intake can also affect how easy it is for your body to "give up" the fluid and for us female species, our monthly hormonal fluctuations also affect how tightly our body wants to hold onto fluid.

Also, I believe that BP taken every 15 minutes is safer than every 1/2 hour. If I am "BP challenged" during a treatment, I will ask for the BP monitor to take every 5 or 10 minutes. I also insist that the BP monitor be "turned" so that I can keep track of my own pressure and anticipate if I am about to "take a plunge". Pay attention to how your body feels at different BP, you will be able to anticpate by looking at your monitor and tracking it. I'm assuming that you were already reclining since you mention that you 'woke up', but on the off-chance that you WEREN'T, make sure that your chair is reclining during the last hour or so of your treatment when the chance of a BP drop is greatest.

One more thing, don't know if your unit allows eating, but statistically, most people's BP does drop after eating, when the blood vessels send more volume to the stomach area for digestion. Since part of our blood volume is already outside our body, this can cause a DRAMATIC drop in BP and often does, causing nausea & fainting.

Very good advice!!  (even if posted in very old threads lol) and very true! I now use profiling and the sodium ramp but I am thinking of taking that off and just using the profiling. What do you think?

Before the days of bicarbs most patiens threw up all the time. I remember the techs were often busier cleaning up the mess than any other task.

Wow is that why they use bicarbs now??

[mrhecht]

LOL with you long & hard about me not looking at thread dates!!! I'll get better! As for your question, I like the profiling with the sodium ramp (or modeling I've also heard it called). I think it's an individual thing. For years I didn't use the sodium ramp and ran on straight 138/140 sodium, then began to have severe bone paid in middle of treatment. The sodium ramp took care of that. If both are working for you, why do you want to remove the sodium ramp?

[angieskidney]

LOL with you long & hard about me not looking at thread dates!!! I'll get better! As for your question, I like the profiling with the sodium ramp (or modeling I've also heard it called). I think it's an individual thing. For years I didn't use the sodium ramp and ran on straight 138/140 sodium, then began to have severe bone pain in middle of treatment. The sodium ramp took care of that. If both are working for you, why do you want to remove the sodium ramp?

Because I thought that less salt in my body would be better. That maybe I wouldn't get so thirsty afterwards? Who knows .. I am still learning. They put me on the sodium ramp in the first place to stop my cramping at the end and the BP drop. But since then I have put on the profiling so I didnt know if both was necessary.

Speaking of dialysis ... my cab is late I am supposed to be AT dialysis right now 

[goofynina]

Very good advice!!  (even if posted in very old threads

 

LOL with you long & hard about me not looking at thread dates!!!

Isn't it great how good information doesnt go bad     

[renal30yrs]

They started toying around with the idea of bicarb around 1981.   I remember them (now defunkt National Medicalcare) using us as guinea pigs.  The results were so much better than the acid only group however.

[mrhecht]

Because I thought that less salt in my body would be better. That maybe I wouldn't get so thirsty afterwards? Who knows .. I am still learning. They put me on the sodium ramp in the first place to stop my cramping at the end and the BP drop. But since then I have put on the profiling so I didnt know if both was necessary.

Speaking of dialysis ... my cab is late I am supposed to be AT dialysis right now 

Regarding the sodium ramp; this may be "machine model" dependent, but there are a couple of types of sodium ramp/modeling. Linear, which is a gradual rise from normal 138/140 (13.8/14.0) to a high of 150 (15.0) back down to normal over the course of the treatment. Then there is Step which uses the same numbers; normal to high, but the increase/decrease happens in increments rather than on a gradual basis. I've not experienced increased thirst with the sodium modeling. It might be worth it to ask what your profile actually is; i.e., at what point in the treatment is your sodium level returning to normal? If your profile is the step increment, perhaps the return to normal is happening too late in the treatment. You could ask about a linear program if possible.

An option on the machines at our clinic, (which also use the UF profiling, pulling 'hard' at the beginning of the treatment) is a sodium "button" which can be held by the patient and increases the sodium level in the dialysate for a period of 7 minutes. We can use it up to 3 times during a treatment. Kinda cool......



EDITED:  Fixed quote tag - Goofynina/Admin.

[bluedove57]

My BP drops from the moment they start pulling fluid. I run low pressure to begin with. I start feeling bad when my pressure hits the 60's/30's. Normal BP for me is 88/45. I've litterly passed out before and thought it was the end for me. Luckly my nurses were attentive. It is scary and I know it won't be the last time. Now I know the symtoms of crashing as I call it and notify the staff before I crash. Knowing your own body and how it reacts is the best thing you can do for yourself. No one reacts the same but I know we all have had some scares.

[Bajanne]

Now I know the symtoms of crashing as I call it and notify the staff before I crash. Knowing your own body and how it reacts is the best thing you can do for yourself. No one reacts the same but I know we all have had some scares.

This is very true.  I am very aware of when my BP has become low and am able to alert the nurses.  I just get the feeling, and I say "check my BP, please" and almost invariably, it is low.  they are able to deal with it before I get to the horrible cramping.
BTW, stretching (something I just love to do) is almost a no-no for me.  My feet just love me to stretch them out so they can cramp!