Rinseback Setting

[PrimeTimer]

I may be asking 2 questions here that actually concern 2 different topics but here goes...

Can anyone explain in laymen terms the impact of increasing/decreasing the Rinseback Factor setting on the cycler? My husband uses the NxStage System "S" cycler and for that cycler, the Rinseback Factor is Parameter/System Setting #13. According to the manual, the default volume setting is 1.45 multiplier. His neph has him use 1.48, which means when we do rinseback we see "283" on the top screen of the cycler. He has used 283 ever since he's been doing home-hemo (over 2.50 years). Am wondering if the Rinseback Factor plays any role in why his BP suddenly increases when we take his "standing pressure" after treatment. This doesn't always happen but he does go through periods of it. His BP always goes back to normal a short while later but like I said, sometimes it shoots up right after treatment. Thought I've read about this before here on the site but can't find it now (old thread?).

I want him to bring this up with his neph but in the meantime, was curious if others experience this BP increase upon standing after treatment and what, if any, System Setting 13 has to do with it.

As an fyi, here's what the manual says: 
   
                  Parameter #13 Rinseback Factor
 
                   Rinseback Volume= (blood side Dialyzer volume + blood cartridge volume) times rinseback factor

[Xplantdad]

My daughter does as well. From what I have found out it's called Intradialytic Hypertension See here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830363/

Potential Pathophysiologic Mechanisms of Intradialytic Hypertension

    Volume overload
    Sympathetic over-activity
    Activation of the renin-angiotensin aldosterone system
    Endothelial cell dysfunction
    Dialysis-specific factors
       

• net sodium gain

       

• high ionized calcium

       

• hypokalemia

    Medications
       

• Erythropoietin stimulating agents

       

• Removal of antihypertensive medications

    Vascular stiffness





Holly's rinseback is set at 288 ...which is supposed to be the "volume" of fluid in the cycler and the liines to rinse back all of the blood back into the body safely. I always add an extra .3 to what we need to take off to get close to her dry weight


I am interested to hear what other people have to say and have experienced...as well! 

[PrimeTimer]

Thank you, Bruce! I think I am also going to start a separate thread under General Discussion concerning BP rising after treatment. I will try to include the link you shared. When we do rinseback I want to make sure we are rinsing back all the blood we possibly can but wonder if we are perhaps rinsing back too much fluid with it. Makes me think I am just giving him one big saline bolus.   

[Vt Big Rig]

When I was in Indiana rinse back was 288. Now in VT they have it set at 258. I have noticed any difference.

[Simon Dog]

You can change the rinseback in the NxStage setup parameters.  It's indirect, since you set a multiplier applied to the filter+tubing charging volume.  I believe the standard filter/tubing set is 190ml, and the default multiplier is 1.45, leading to 275.5 (not sure why it comes out 277)

There are other interesting settings worth a look.

- Turn off Warning #5 when UF complete
- Dim display light after a period of no alarms (they brighten when there is an alarm)
- Default UF rate and amount.  Since I was told never to run UF < 0.3, I set that as my default so I don't start from zero.  Similarly, I have the UF amount defaulting to 1.00 for a shorter adjustment to the actuual
- Mas # of times you are allowed to rinseback->disconnect->reconnect.   

[PrimeTimer]

You can change the rinseback in the NxStage setup parameters.  It's indirect, since you set a multiplier applied to the filter+tubing charging volume.  I believe the standard filter/tubing set is 190ml, and the default multiplier is 1.45, leading to 275.5 (not sure why it comes out 277)

There are other interesting settings worth a look.

- Turn off Warning #5 when UF complete
- Dim display light after a period of no alarms (they brighten when there is an alarm)
- Default UF rate and amount.  Since I was told never to run UF < 0.3, I set that as my default so I don't start from zero.  Similarly, I have the UF amount defaulting to 1.00 for a shorter adjustment to the actuual
- Mas # of times you are allowed to rinseback->disconnect->reconnect.

Thanks, Simon Dog. I am going to change the setting and give that a try or stop rinseback early and see what happens over the course of a few days. FYI: Even if I stop rinseback early I can still get his final numbers from the cycler (done it before when I saw clotting at top of dialyzer). I also think we need to challenge his dry weight again. I want him to bring all this up with the neph but we shall see. Thanks for providing the info on other settings. That #5 gets on my nerves but also serves as an alert that we are getting near the end of treatment so had better wash up and put my mask and gloves on and tell hubby to turn down the TV so I can hear myself think. Especially on nites when he's watching cage fighting. Things get loud around here whenever he watches politics or cage fighting. The TV gets louder and so does he. Hmm...might be why his BP goes up.