Pump speeds for haemo- how fast can you go??

[haemogoblin]

I'm on a Gambro machine on a fistula.

How fast do you guys in the US and other parts of the world take your pump speed on the haemo machine?

I can get 425 out of my fistula but I think I could go faster!! Pump up the volume! 
Any Usain Bolts out there??

[jbeany]

I felt better at 450.  400 left me with a constant metallic taste, from inadequate cleaning.  The doc didn't want me to use anything higher than that - too much pressure on the access.

[RichardMEL]

I go at 300 now. I did get as high as 370, but I've been having these hot flushes that seem to be worse with the pump speed higher, so I've settled on 300. This means my clearance goes down (from 76%->72%) but that's still OK. I decided I'd rather a comfortable ride than a faster one at this point.

Traditionally in oz I understand we favour longer sessions at slower pump speeds to reduce strain on fistulas, and get a longer life out of them as opposed to shorter sessions at quicker speeds over 400. So I do 5 hours @ 300 (yes, it sucks!). I did about 2.5 or so years out of nearly 4 at an average of 350 though.

[cookie2008]

I use the nxstage and my pump speed is between 400 and 470 I like to run at 450.

[RichardMEL]

oh sorry I didn't notice this was for home hemo. my bad!!!

[sullidog]

My catheter runs at 400, but when I had a graft it ran at 450. My new graft we are slowley working up to that. Starting out with only 17 gage needles which I think you can only run at 250.
We have one person that runs 500 and her access is in her leg.
Troy

[sumodidit]

the highest I ran is 550, I had the highest pump speed in the clinic period, but I complained about chest pains so I asked to reduce it to 500 but I would like to increase to 525. I have the craziest setup tues: 4 hrs, thurs: 3.45 hrs, and sat 3 hrs...with 250 optiflux and 14 gauge needles. I actually want to goto a bigger needles. already got past the pain stage.....WOOT WOOT!!

[haemogoblin]

oh sorry I didn't notice this was for home hemo. my bad!!!

don't worry, we're not clicky about who can be in the home haemo club!  It's just a lot of clinic/hospital dialysis patients just shut their eyes and let the nurses worry about the machines- like my dad.  I asked him what pump speed he used to go at and he didnt have a clue.  he found it easier.

the reason i ask tho is because my clearance rate is in the 60s.  i do 3X4 hours a week on 425.  but my fistula is only a few months old.  will the clearance improve in time even if i dont up the speed?

[sumodidit]

my clearance was at the mid 50's running at 350, upgraded filter to bigger size 250, jump on 14 gauge needles and fought back on adding time, reduced time. labs and urr is alright now, there gonna have to make adjustments and your fistula has to mature to run at an optimized flow. dont worry youll get there!!

[KICKSTART]

You lot do some crazy speeds , we NEVER go over 300 in clinic !

[Zach]

With some toxins in your blood, it's the length of time per treatment that matters more than blood pump speed.
More hemodialysis = Longer, healthier life.

[haemogoblin]

With some toxins in your blood, it's the length of time per treatment that matters more than blood pump speed.
More hemodialysis = Longer, healthier life.

I was afraid you'd say that...

The longer I spend on that bloody machine the more i hate it.  Was trying to speed up the process of cleaning...

[jbeany]

Oh, no, sorry - don't shorten the time!  My clearances were good enough that they offered to let me drop down below 4 hours and I refused.  I upped pump speed because I still didn't feel good enough at the low speed at 4 hours, and they wouldn't give me more time.  (I was switching back to in-center from home D on NxStage, so I knew I could feel better than I did with the low speed.)

[sumodidit]

Well, each person is different and each doctor will take a guess on what they think is best. Honestly they wanted me to run a longer time, but I was going crazy sitting there for 4 hours....literally!! and they wanted to add more time and I was like no, even with my urr was around 50, i still felt ok, I mean I couldn't get up and run for a mile but I was good enough to go to school, work, and hang out, since my blood disease caused my kidneys to go out, I wasn't a typical patient, I pushed the envelope on everything and questioned everything, now I'm ok because I understand the process. but, like I said everyone is different. Honestly it is all risk, and you have to do what is best for you

[M3Riddler]

With some toxins in your blood, it's the length of time per treatment that matters more than blood pump speed.
More hemodialysis = Longer, healthier life.

Zack is absolutely correct,

Its not how fast you cycle your blood, but rather the time.  Even our in-center clinic do not run their in-center patients more than 350. I hate to read where people are at such high blood flows. This only puts stress on the fistula and damages the walls of your vein over time.
When you run at higher blood flows, you are not necessarily getting a better treatment. Many toxins in your blood take time to equilibrate back into the bloodstream from the tissues. This includes fluid. This is a mistake many centers do not focus on. They just want the patients in and out so they can put the next person on. Increasing the flow can also strain the heart.
I will not run above 300 bf. I urge everyone on hemo to research this and ask their nephrologists to lower your blood flow.....Your fistula will thank you...

///M3R

[mogee]

I go for 8 hours or more at a pump speed of 300.  I never go faster than that.  I used to use a Gambro.

[Trena]

I use NxStage and run 500 with my fistula. From the pictures of it, it's huge.

[del]

With some toxins in your blood, it's the length of time per treatment that matters more than blood pump speed.
More hemodialysis = Longer, healthier life.

I was afraid you'd say that...

The longer I spend on that bloody machine the more i hate it.  Was trying to speed up the process of cleaning...

It's true - longer time , lower pump speed does a much better job of removing the toxins. Hubby does nocturnal - 7 hrs 5 nights a week with a pump speed of 250.

[Bruno]

I agree with Zach and have replied so in another thread. Longer and slower is the way to go...7 hours with a pump speed of 250 for me.
But what I don't understand is if you are on nocturnal dialysis, why does the time matter? the whole point of nocturnal is surely that it offers plenty of time and gives you every day free.
That's as near as you'll get to having functioning kidneys.

[jstorm001]

Mine runs at 550 but I had it at 600 before but there's is no such doctor orders ever for 600 maximum should be 550 only

[Speedy1wrc]

Lower pump speed does not improve adequacy rather higher pump speed does. Increased time does too, but actually a higher pump speed does in fact increase Kt/V.

It does so firstly by total blood processed which does mean that shortening the time defeats the purpose. Using a low enough flow fraction will cause greater diffusion, but will also increase time. Time of course should be irrelevant. Increasing both the blood flow rate and dialysate rate decreases each of the membranes thickness and increases efficiency up to a point while maintaing the correct fraction. RUnning both higher pumps speeds increases K. If we also increase t clearance increases even more.

At a blood pump speed of 500ml/min  5x3hrs/wk I am at a URR 67 (goal=65) which is great. I am processing around 85L of blood against 30L of dialysate. My stdKdt/V is 2.3 (goal=2.0) which is also super. I am using a lactate based dialysate so it only applies to NxStage.

[KatieV]

I was doing 3 hour runs at 450 blood pump speed and processing 74 blood liters.  My new center says I can run up to 500.  Since I'm doing 8 hour runs, I usually go at 400.  I've found that 400 pump speed processing 60 liters of fluid takes that long.  If we get on a little late, I'll bump it up to 430 or so.  I usually process 185 blood liters now.

[Simon Dog]

the highest I ran is 550, I had the highest pump speed in the clinic period, but I complained about chest pains so I asked to reduce it to 500 but I would like to increase to 525. I have the craziest setup tues: 4 hrs, thurs: 3.45 hrs, and sat 3 hrs...with 250 optiflux and 14 gauge needles. I actually want to goto a bigger needles. already got past the pain stage.....WOOT WOOT!!

Which chain (Davita, Fresenius or other?).   My doc at Fresenius tells me that he can order the 160s and 180s, but that the easiest way for me to get a 200 would be to pull a job (federal prisoners at the Devans, MA prison all get 200s) as he cannot order a 200 without approval from the corporate pharmecetical and therapy committee due to the extra cost ... and the clinic doesn't even use 250s for anyone.

Still on a cath, running at 450 w/lines reversed - works best for me.  Great when I get a nurse at the clinic (they all listen to me); not so great with some of the techs (who are all way too smart to listed to a mere patient making a setting request).

[amanda100wilson]

I have the startings of pseudo-aneurism.  If I run at 450, it is more noticeable,  I have decided that I will,run at no more than 380 and do a three hour run (although I plan to do extended, when I will drop it to 250).  to run slower, it is necessary to run longer.  Doing it at speed and time that I do now, I get at acceptable Kt/v and feel fine.  Nonetheless, I am a firm believer, that extended/nocturnal is the way to go for those doing doing home hemo.

[lmunchkin]

I generally run John at FF 33-35%  BFR 350-370 (no more than 370)  BLP 68 - 73.   His last kt/v was 2.9.  He is short daily on NxStage.  Labs are great.  He is mindful of his intakes and does what he needs to do.

God Bless,
lmunchkin