Fluid Removal Only?

[Mizar]

 My Husband, has had Edema, in His Feet, for about Three Months. In the last Three Days, it has moved, into His Legs, to the Point, He can't Wear His Jeans. He
 is in Sweat Pants, right now. He said, that a Nurse at D, Today, suggested, He start coming in on Non-D Days, just for Fluid Removal, as they are already taking off as much as they can, during D. I'm not Familar with this and I Looked on the Web and didn't see anything about it. Does anyone else do this? How long does it take? He has not had a good Day, in Months and now, another Treatment? If anyone knows, what this Involves, please let Me know.

He can not Drive, so I take Him Everywhere. We already do, Dialysis, 3x a Week, A Coumidin Clinic, Twice last Week, His GP, A Heart Dr. , A Vascular Surgeon and a Pulmonary Specialist. I don't think, There is another Day in the Week, left, for more Treatments!
 
He told the Nurse, He would wait till after the Holiday, to make a Decision.

[greg10]

Hi Mizar,  I follow yours posts with interest, they are always informative as well as emotive and tells a very human story.

As you may know, thrice weekly in-clinic dialysis is often not the optimal and safe method for a dialysis patient.  There are other choices such as in-clinic nocturnal or home dialysis that may give you much better results.  I am assuming that the clinic doesn't think they could at the limited amount of time (3x4 hrs?) to be able to do a complete job of ultrafiltration (UF), that is the removal of excess fluid to try to get to the dry weight.  There is also a limitation as to how much UF you can do per hour, the consensus is that you should not be doing more than the weight of the patient (in kg) times 10 ml/hour.  For example, if your husband weights 80 kg, he should not go over 800 ml of fluid removal per hour.

Instead of more days of treatment, he should try to limit fluid intake and do longer duration of dialysis.  Do you think those choices are available to him?  In general, patients on longer duration of dialysis will have the time to slowly remove the excess fluid and do it in a safe manner.  Longer duration of dialysis also allow some solutes such as potassium and phosphorus, to be removed more completely.  The benefit is less food restriction and less phosphate binders.

[jbeany]

Most clinics have set limits on how much fluid they feel it is safe to remove during a single session.  (My old center used 5 K as a stopping point.) The reasoning behind it is that D takes fluid out of the bloodstream, not the tissues.  If there is a tremendous build-up of fluid in the tissues, it can't all move to the blood stream fast enough to all be taken off in a single session.  Some patients also have a personal limit - mine was about 2.5.  No matter how fluid overloaded I was, once I had pulled that much fluid off, I was going to crash.  (I learned that the hard way, and began regulating my fluid intake accordingly.) 

What the nurse is suggesting is that he come in for a couple of extra days during the week, so that they can pull the extra fluid off him.  Once he's back down to a normal dry weight, they will stop the extra sessions.  It's pretty standard practice for most D centers.  If he's had edema for months, it seems to me that they need to readjust his dry weight anyhow, to remove it and keep it off.

[rsudock]

mizar last week i had a new tech who didnt set my machine to take off any fluid. so i sat for 3 hours just getting my blood clean. the nurse had me come in the next day to do  UF . i sat for 2 hrs so they could get the extra fluid off. it went fine....now i realize i have to be more vigilant about the machine.

xo,
R

[Stoday]

If they are already taking off as much as they can, the only answer is to cut down on the amount of liquids consumed. Not easy, but it can be done as most of us here can testify.

[Bruno]

He told the Nurse, He would wait till after the Holiday, to make a Decision.

If he is accumulating fluid, putting it off will only worsen his situation.

[Rerun]

Get in there and get the extra fluid OFF.  It is hard on his heart to pump all that around.  Just take the next available slot.  It will only take a few hours and he will feel tons better...... maybe not right after, but in a few hours.

[FindingNeverland]

I've done it before, quite a few times actually because we were having a hard time reaching my new dry weight goal and I was accumulating too much fluid around my lungs. It only lasted two hours and believe me, I would rather do the extra treatment than have too much fluid on. I was hospitalized three times because of it. Each time they had to drain the fluid out and each time of course I also suffered the complications of the procedure, a partial lung collapse. Not something you want to go through. Now that I'm down to my new dry weight I don't have to go in for extra treatments.

[retrartpole]

It is crucial for you to take immediate action as it is not wise to have the excess water stored in his body as the liquid that needs to come out and to be removed contain a lot of unwanted substances and it would be bad for him it the matter is not taken seriously or prolonged. And I believe that the doctor you are attending to are well trained professional. If you do have any problem or doubts, I believe that they will be the best parties that could feed you with more information.

[rsudock]

mizar just wondering on an update on the hubs? Are things better? Did he go in for the UF treatment? Thinking of you...


xo,
R