Clearance

[Bajanne]

I am presently doing 4 hours per session.   I would really like it shortened.  The nurses tell me that depends on my clearance.  Please explain the term "clearance"  for me.  I thought it mean getting rid of all of my fluid, but it seems to be more than that.
How can I hasten my 'clearance'?
(I was just looking over the messages and noticed that I always seem to be asking questions.  Thanks for your continued helpfulness)

[O in]

clearance
is the rate of removal of toxins from your body

check your blood test results for urea pre dialysis (range 20-25) and post dialysis and the difference will be the clearance
check your blood test results for creatine (range up to 0.
check your blood test results for your URR% (ideal range 75%+)
check your blood test results for KT/V (ideal range 1.2+)

if you shorten you session time you will reduce clearance levels and wont feel the best
and if you shorten you session times it will mean that you have to increase the fluid takeoff rate which will likely increase cramping
if you are using an F8 dialysiser then you can assist clearance using an F10

myself i am using F10 session time is FIVE hours clearance is URR 76% and KT/V is 1.7%
hope this helps

[Rerun]

Oh my God!  I can barely handle 3 hours!  Just shoot me!   

[O in]

Oh my God! I can barely handle 3 hours! Just shoot me!

dont cry rerun

remember the longer the session the better the clearance and the better you will feel at the end of it
as well the longer the session the less impact fluid removal will have on your body

and the treatment is one whole lot more gentle

[Bajanne]

Thanks, O in.  My nephrologist was trying to explain  the same thing to me today.  I think I am understanding it a bit better.  Still want a shorter session, though (but not at the expense of my well-being)

[Epoman]

Thanks, O in.  My nephrologist was trying to explain  the same thing to me today.  I think I am understanding it a bit better.  Still want a shorter session, though (but not at the expense of my well-being)

"O in" explained it well. However remember it is your body they can't make you stay on the machine any longer than you wish.

[Bajanne]

Oh, yes, they can.
When I asked the supervisor to cut short my session the day I was taking a plane home for the holidays, she refused and said I would have needed the consent of the nephrologist.  However the nurse who was actually dealing with me told me that I can sign a form releasing myself, which I did and got of an hour earlier.  Another lady who also was to take a plane asked the supervisor for the form and she didn't give her (the supervisor was her attendant nurse) and the lady was there crying.  The thing is, she was only asking for ½ hour and I got to get a whole hour off.

[LifeOnHold]

In the States, that form is called an AMA-- Against Medical Advice.

The 'catch' at my unit is, sometimes the nurse will get you to sign it, but then screw around with other patients so long that by the time they come over to you and disconnect you, it's almost the time when you would normally be coming off the machine, anyway. 

It's interesting that when nurses decide to take people off early because they have too many patients coming off at the same time, you NEVER have to sign that paper-- you only have to sign it when it's YOUR idea to end treatment early. 

[Epoman]

Oh, yes, they can.
When I asked the supervisor to cut short my session the day I was taking a plane home for the holidays, she refused and said I would have needed the consent of the nephrologist.  However the nurse who was actually dealing with me told me that I can sign a form releasing myself, which I did and got of an hour earlier.  Another lady who also was to take a plane asked the supervisor for the form and she didn't give her (the supervisor was her attendant nurse) and the lady was there crying.  The thing is, she was only asking for ½ hour and I got to get a whole hour off.

You need to demand to be taken off early I don't care if it's in the states or mother Russia it's your body, your decision. Next you want off early you tell them take me off now or they will face a lawsuit for detaining you against your will. I now they are just trying to help you but regardless of where you are in the world it is still your body and no one can make you be on dialysis.   

If they ever tried that on I would cut and clamp my lines and manually return my blood and take myself off. The cut and clamp procedure should be learned by everyone in cases of emergencies, ask your center about it. I know in the states it's mandatory for patients to learn. It only takes a few minutes to learn.

[kitkatz]

If they don't take me off when I say so, I will bitch, bitch bitch.  They know I will file a complaint with the head management amd I don't give crap what happens.   The techs and nurses usually don't give me any BS.  I am a fighter.

Katherine

[Panda_9]

Just remember, by coming off early you are only doing yourself more harm than good. I think you should be thinking youselves lucky that you are still alive from having only 3-4 hour treatments. 4 hours just isnt enough for me.

[RichnStacy]

I asked to be taken off early one day.. I don't recall why I was asking, it was right after I started dialysis and the nurse told me I couldn't be taken off.  I said, not a problem and started removing the tape from holding the needles in place.  She came over to my chair and asked me what I thought I was doing and I told her, matter of fact, that I was leaving and she could either assist me in removing the needles, but if not, I didn't have a problem removing them myself.  Needless to say, she was more than helpful in having me sign the AMA form and then removing the needles.

As Epoman said, it is your body and they can not force you to do something against your will.  It is against the law, plain and simple.

[fireguy]

if you really want to do shorter sessions, you will have to them more often to get the same clearance. If you do not clear well enough ,you will not feel good and it will eventually effect other organs.Dailysis does more than remove fluid, it balances the chemicals in your body. Fluid retention is not an issue for me, never have any to remove because of ostomy. Put must lower creantin and urea every couple of days to feel good. can stretch it out to four days ,but not much more before I start feeling tired and cranky. Just check your pre and post blood work to get an idea of how well you clear. It will give you an idea of wether you can reduce the time, my guess is no.

[RichnStacy]

Bajanne2000 wrote:

I am presently doing 4 hours per session.   I would really like it shortened.  The nurses tell me that depends on my clearance.  Please explain the term "clearance"  for me.  I thought it mean getting rid of all of my fluid, but it seems to be more than that.

I feel your pain!  I was exactly the same way because, when I started in-center, they had me going for four (4) hours and I absolutely hated it, and I wanted my time shortened, but they kept telling me I would not meet my clearance; however, I have a Tech there, whose husband is a home dialysis patient, and she whispered to me one day that my dialyzer was a 180 and to tell the Doctor the next time he made rounds that I wanted a dialyzer 200.  I made the request and was able to scale back my time to three (3) hours and 15 minutes and my labs are great and I meet my clearance.  Maybe someone with a lot more knowledge can jump in here and tell you more about it.  I am just going on what the Tech told me, so I don't know all of the ins and outs of it and whether this would work for everybody.

[Panda_9]

Depends how they define "great labs". You see with renal patients, alot of things are going to be abnormal, which for us, is considered normal levels. You are lucky to be able to get away with such little dialysis, and I would be surprised if you said you felt great too. Your labs might be "great", but could they be even better with more dialysis? Its only going to affect you in the long run. If I were you I would learn a bit more about long term dialysis, and what some of the important blood levels mean.
I would be interested to see your results!

[RichnStacy]

amber79 wrote:

Depends how they define "great labs". You see with renal patients, alot of things are going to be abnormal, which for us, is considered normal levels

I think in reference to "great labs" they basically mean that they are within range, neither too high or too low.

You are lucky to be able to get away with such little dialysis, and I would be surprised if you said you felt great too.

Well to be honest, they only cut it back to that amount of time because I complained and wanted out of there.  I plan on increasing my time on tx when I get home because I am sure I could feel a lot better than what I do.

I would be interested to see your results!

They drew blood today for labs so when they come in next week I will get a copy and post the results. Maybe you would be willing to explains some of the ones I don't understand??? (on knees begging:))

[Epoman]

amber79 wrote:

Depends how they define "great labs". You see with renal patients, alot of things are going to be abnormal, which for us, is considered normal levels

I think in reference to "great labs" they basically mean that they are within range, neither too high or too low.

You are lucky to be able to get away with such little dialysis, and I would be surprised if you said you felt great too.

Well to be honest, they only cut it back to that amount of time because I complained and wanted out of there.  I plan on increasing my time on tx when I get home because I am sure I could feel a lot better than what I do.

I would be interested to see your results!

They drew blood today for labs so when they come in next week I will get a copy and post the results. Maybe you would be willing to explains some of the ones I don't understand??? (on knees begging:))

This is a good idea for a thread, for the FAQ section, when you get your labs post them and we can explain what they mean.

- Epoman

[Panda_9]

RichnStacy, please do post your labs, I would be fascinated to see them!! I find it hard to believe that your labs would be within range on such little dialysis. If they are well thats great. I would be happy to post my nocturnal labs if anyone is interested. I could also post my shitty labs as well, for the comparason, just to see the difference between 20hrs a week and 30-40hrs a week.

[kitkatz]

The other day I asked to shorten my dialysis session because they put me on fifteen minutes late.  I needed to go see my husband who is in the hospital.  The lobby doors lock up at eight o'clock  and I need to be there before eight.  Othewise it is a pain the the butt to get in there.  The tech says:  Will you sign the paper?"  Meaning the AMA paper.  I told her "I will sign any damn thing you want me to sign as long as it gets me of this machine at seven o'clock!".  She brought me the paper but no pen so it sat there for an hour.  Then I signed it and wrote a comment on the bottom that I was put on late.  She did not like that at all. Oh well.

Katherine

[Rerun]

That happened to me too.  They put me on late and they wanted me to sign a paper.  I told her that SHE needed to sign a paper from me admitting fault.  I made her put on a statement at the bottom too.   

[Epoman]

The other day I asked to shorten my dialysis session because they pout me on fifteen minutes late.  I needed to go see mu husband who is in thehospital.  The lobby doors lock up at eight O'Clock  and I need to be there before eight.  Othere it is a pain the the butt to get in there.  The tech says:  Will you sign the paper?"  Meaning the AMA paper.  I told her "I will sign any damn thing you want me to sign as long as it gets of this machine at seven O'Clock!".  She brought me the paper but no pen so it sat there for an hour.  Then I signed it and wrote a comment on thebottom that I was put on late.  She did not like that at all. Oh well.

Katherine

  http://ihatedialysis.com/forum/index.php?topic=411.0

[kitkatz]

Ooops beat me with a wet noodle. I apologize and will modify it.  I spell checked the damned thing too before posting it!  Twice!  Can you believe it!  Well now I better read the damned things better. The spellcheck is not catching my dumber mistakes.  Mea Culpa!   I modified the post, correcting the errors.


Katherine

[Epoman]

Ooops beat me with a wet noodle I apologize and will modify it.

Thank you, you are one of the top 5 posters on the site, I need you to help me set the example. 

- Epoman

[kitkatz]

I know. I know.  I was tired last night, but have no excuse.  I will watch it from now on.  Thanks for the gentle reminder.

Katherine

[John S.]

Thanks, O in.  My nephrologist was trying to explain  the same thing to me today.  I think I am understanding it a bit better.  Still want a shorter session, though (but not at the expense of my well-being)

"O in" explained it well. However remember it is your body they can't make you stay on the machine any longer than you wish.

Jeez, EPOMAN, are brains must have been fused at one time. 99% of dialysis patients are very scared to do something that the doc does not recommend. My run time is "supposed" to be 3 1/2 hours. If I want to run 3 hrs 15 min., that is what i do. If i want to run 3 hours 11 minutes, that is what i do. Some days i run 3 hours 39 minutes, again, my choice. I also skip one day a month as personal time. I then work out twice as hard, sweat twice as hard, watch my fluid intake twice as hard.

This is what "I" want to do. Not what they think I should do because it has proven to work for other people. I'm me, and i know what works for me. 12+ years gives me that right.

john