High Blood Pressure and High Venous Pressures

[willieandwinnie]

Hi Everyone,
I'm just about at my wits-end. Len (my husband) had he's abdominal wound closed in December and developed breathing problems again. He wouldn't eat much hospital food (imagine that) and he losses weight rather quickly (I always seem to find it). His labs were horrible and they had to give him potassium, he really should of had a blood transfusion but he was right on the border. Our clinic had us come right before Christmas to give Len iron through an IV, he got it again at January's, February and March's clinic. His blood pressures have been uncontrollable since mid December, they actually go up during dialysis. I needed to get his methydopa (500mg) refilled and the mail order service send a information sheet, that I really read this time. It clearly says 2 times you should NOT take with iv iron or iron supplements (which Len also takes), it gives no reason! Anyone have an idea of why?

Also, we have been having trouble with Len's Venus pressures, I don't get much of a flash when I stick him and then I have to keep turning the pump speed down. I have had him to Washington Hospital Center 3 times in the past 3 weeks, 2 venograms with antipastic, one sonogram, two more venograms and 1 dobbler. They say there is nothing wrong. I just don't get it.

Len takes a boat load of medication, he weighs himself a hundred times a day, he watches his intake and can tell you within a quarter a pound of his weight. We pissed out clinic off big time by choosing Sunday, Tuesday and Thursday as our dialysis days. We are only a cash register to them and they make it very obvious with their comments. I don't trust them or the doctors, we have been told out right that we read too much. That just pisses me off so bad.

We have contacted NxStage about their machine so we could at least travel some. I don't know if anything will become of this because of Fresenious, but you never know. I'd love to hear from everyone that uses NxStage about their experience.

Sorry this is so long winded. Blood pressure readings and graph problems have me about ready to go over the hill.

WillieandWinnie

[fireguy]

Last time I had problems with blood flows , had a fistulagram two weeks before that was good. Went to needle one Friday night and no flash,thought we had missed,happens sometimes.. Tried again Sat Morning,still no blood, so we went in to hospital and had it checked out. They found some clotting, with a combination of clot busters and a tool call a rotor router,similar to a dentist drill, they cleaned my graph out and has been working great since. blood flows on Baxter 1550 has been 350-400 with good pressures. We are very lucky here to have an excellent dialysis  unit with a great relationship with interventional medicine unit.

[willieandwinnie]

Hi fireguy
We use the Fresenius 2008H and we had been running pump speeds of 450. Now we are down to 400 with good Venus and arterial pressures. It's just makes you crazy when things aren't what they use to be. We love the vascular surgeon, he said we might just have to change the pump speed. Also, since Len's blood pressure readings have been all over the map, we are going to up Len's dry weight by .2 and see what happens. That is one of the nice things about doing this at home, we can change some things and see if it improves other things. Do you get iron? Our clinic is for profit and they let you know this. Pretty sad I'd say. They won't let me give him iron during treatments because they wouldn't be reimbursed for it, like they are when they give it iv on clinic days. Patient comfort and well being not their top priority.

[fireguy]

Our Health care here all covered by Gov. Profit not an issue. Also very lucky to have an excellent dialysis home unit with great support only an hour away or by phone 24 / 7. Yes I get iron as required ,depending on numbers. The unit sends it us and we take care of administering it during dialysis at home.

[Rerun]

WandW,

When you say "high" blood pressure, what is it?  Mine is 165/110 and that is "resting."  I'm trying all kinds of drugs to get it down.

I think 400 blood pump speed is pretty good.  With catheters you only get 300. 

Anyway, my question is what is his blood pressure.

[willieandwinnie]

Hi Rerun
We did dialysis this afternoon and Len's pressure sitting before dialysis was 138/81 and after 3 hours and 15 minutes of dialysis he's sitting pressure was 178/89. The go up the whole treatment and I'm confused as why? I told him that maybe he has gained back some of the weight he lost in November and December. There is just so much to learn and keep track of, sometimes it hurts my head.

[Rerun]

I'm no doctor, but I wouldn't freakout over a BP of 178/89.  There are various opinions of what "high" blood pressure is.  Even the charts keep changing as to when you need to start high BP medications. I think "now" anything over 120/80 you need to look into getting medication.

His sitting at the beginning is GREAT (138/81)!  I've been told that the bottom number is important to watch.  So, 89 is still pretty good considering what he is going through.

But, you have been watching it rise, so it is good to catch it now. 

I'd call my Pharmacy and have them look up the interaction with iron and methydopa.  Let us know what you find out. 

Hang in there!!! 

[Epoman]

Hi Everyone,
I'm just about at my wits-end. Len (my husband) had he's abdominal wound closed in December and developed breathing problems again. He wouldn't eat much hospital food (imagine that) and he losses weight rather quickly (I always seem to find it). His labs were horrible and they had to give him potassium, he really should of had a blood transfusion but he was right on the border. Our clinic had us come right before Christmas to give Len iron through an IV, he got it again at January's, February and March's clinic. His blood pressures have been uncontrollable since mid December, they actually go up during dialysis. I needed to get his methydopa (500mg) refilled and the mail order service send a information sheet, that I really read this time. It clearly says 2 times you should NOT take with iv iron or iron supplements (which Len also takes), it gives no reason! Anyone have an idea of why?

Also, we have been having trouble with Len's Venus pressures, I don't get much of a flash when I stick him and then I have to keep turning the pump speed down. I have had him to Washington Hospital Center 3 times in the past 3 weeks, 2 venograms with antipastic, one sonogram, two more venograms and 1 dobbler. They say there is nothing wrong. I just don't get it.

Len takes a boat load of medication, he weighs himself a hundred times a day, he watches his intake and can tell you within a quarter a pound of his weight. We pissed out clinic off big time by choosing Sunday, Tuesday and Thursday as our dialysis days. We are only a cash register to them and they make it very obvious with their comments. I don't trust them or the doctors, we have been told out right that we read too much. That just pisses me off so bad.

We have contacted NxStage about their machine so we could at least travel some. I don't know if anything will become of this because of Fresenious, but you never know. I'd love to hear from everyone that uses NxStage about their experience.

Sorry this is so long winded. Blood pressure readings and graph problems have me about ready to go over the hill.

WillieandWinnie

Just so you know I have a fisutla and I have not got "Flashback" for YEARS, and my fistula is one of the best at my center. My fistula has been tested and they say it's in perfect working order. I NEVER get "flashback", my fistula is almost 13 years old.

- Epoman

[Black]

Hi Everyone,
...We are only a cash register to them and they make it very obvious with their comments. I don't trust them or the doctors, we have been told out right that we read too much. That just pisses me off so bad. ...

  I would have been livid -- what an insult?!?  We checked out 3 local clinics and were disappointed, grossed out, and angry, so I can understand.  Damn money hungry, petty idiots would prefer we be ignorant so they can abuse and neglect us w/o us knowing it.   

Is there another center where you can go?  My husband is set up to train on a NxStage when he starts dialysis (currently at 15% function).  The center is about 100 miles away and inconvenient for the few weeks of training but after that the once a month trip will not be too bad.  Have you checked out something like that for ya'll?

[kevno]

Hi Willie and Winnie,

Pump speed 400 not bad, considering I can only get a max pump speed of 250, today 235 with a Venus Pressure 190 going back into a line. Never had much of a flash back even when my fistula was a good one. I suppose I should not complain to much seeing how it is 26 years old. Plus now I try to get the Nurses to use the lines now and not the fistula. BP hard to say, it's different with how old you are, your weight and sex. BP on the machine today at 120/70 off at 110/75, but I was 0.4 under my target weight.

How often have the Doctors changed his target weight? What I can not understand if he as gained weight and his target weight not changed. Then usually the BP is low, because you are dry. The machine is trying to take off fluid, which is not there to take off, so the BP lowers.

[Panda_9]

Pump speed of 450?!?! Holy sh*t  That would cause high pressures for sure. How many hours of dialysis is he doing? If you dont get any flashback, still try opening the cap to prime with blood....if no blood, withdraw with an empty syringe....if no blood then recannulate. If your really having trouble you need to let someone know.

[hyperlite]

450 isn't that ridiculous. I usually run at 450 with arterial pressure around -200 and venous around 180...I have pushed it up to 500 before (-220/200) but i got dizzy watching the pump spin 

[willieandwinnie]

Hi Everyone,
I just wanted to update you on my husbands progress. At clinic in April, they stopped Len's EPO completely. He was getting between 10,000 and 15,000 units because his numbers were horrible after November's surgery. After we stopped the EPO, he's arterial and venous pressures started to go back were they were in December. We have been running pump speeds at 440 and 450 again. DFR is 700. When we went to clinic in May they started EPO again, but this time at 2,000 units. We don't draw labs again until the middle of June, so I'll be curious to see numbers.

Thanks to everyone who replied to me. It is nice to hear from other patients about how they deal with the same problems.

WillieandWinnie

[Panda_9]

At a pump speed of 450 I would imagine it would be hard to keep the pressures down. My venous goes too high if I run at more than 250! I cant beleive they run people at such a high speed, its just stupid.

[hyperlite]

How is running at 450 stupid? as long as the arterial pressure and venous pressure are around -200 and 200 respectively, theres no harm, and the faster pump speed means more blood processed which means cleaner blood...I say if you can get 450, go for it!

[Gus]

For a very well matured fistula you can run a high blood pump speed. I run mine at 420........it all depends how you feel. If you can handle higher pump speeds without feeling sick or no problems with pressures then go for it.

[Panda_9]

That is just how it works over here. Pressures of 200 is too high, and 450 pump speed is crazy. You see in your country the idea of dialysis is hard and fast, which isn't good for your heart. The US have a higher death rate than us, so you do the math.

[hyperlite]

That is just how it works over here. Pressures of 200 is too high, and 450 pump speed is crazy. You see in your country the idea of dialysis is hard and fast, which isn't good for your heart. The US have a higher death rate than us, so you do the math.

Actually I'm in Canada, not the US...and the death rate for patients on dialysis in Canada is actually lower than in Australia (15.3 % vs. 15.8%)...In Canada the idea of dialysis is not hard and fast. It's getting the most out of the little time you have. So by having a higher pump speed, you are allowing a much higher amount of blood to be processed and cleaned...I dont see how you can think that pressures of 200 are too high? The average person on dialysis using a central line, will only get a pump speed of about 300, and their pressures will be around 200...The part of being on dialysis that hurts the heart the most, is the increased blood volume that needs to be pumped by the heart. This causes the heart to enlarge, which is quite dangerous.

[Panda_9]

Thats just how we have been trained, and it is my general understanding that the fast pump short treatments arent good for your heart. I ran at 250 pump speed both times I had permacathe with no trouble. 

[hyperlite]

Yeah but aren't you the one who complained about how 3 sessions a week for 4 hours, was not nearly enough dialysis for you? At 250 pump speed, I'm getting almost double the amount of dialysis as you with 450...

[Panda_9]

I get adequate dialysis, and Im happy running at 225, Im only young, Id like to live a bit longer yet. How many hours per week do you do?

[hyperlite]

I go for 12 hours a week....(3 x 4hrs), my average kt/v is 1.90

[Panda_9]

I do 35-40 hours a week. Kt/v on 5hrs a week 250 pump speed was 1.7. Not sure what it is now, I would assume its improved.

[Len]

I am on home Hemo  I run 8 hours per night    my question to Hyper is , I run a 200 pump speed  and that is 200 ml per min   now if 200 is taken out   and 200 is put back in,  the way I see it  the heart doesnt work any harder no matter what the pump speed is  as  its taken out of the arm and put right back in ,  no more blood is being pushed through the heart ??  what did I miss ?

[hyperlite]

I am on home Hemo  I run 8 hours per night    my question to Hyper is , I run a 200 pump speed  and that is 200 ml per min   now if 200 is taken out   and 200 is put back in,  the way I see it  the heart doesnt work any harder no matter what the pump speed is  as  its taken out of the arm and put right back in ,  no more blood is being pushed through the heart ??  what did I miss ?

I think you were referring to where I said:

Actually I'm in Canada, not the US...and the death rate for patients on dialysis in Canada is actually lower than in Australia (15.3 % vs. 15.8%)...In Canada the idea of dialysis is not hard and fast. It's getting the most out of the little time you have. So by having a higher pump speed, you are allowing a much higher amount of blood to be processed and cleaned...I dont see how you can think that pressures of 200 are too high? The average person on dialysis using a central line, will only get a pump speed of about 300, and their pressures will be around 200...The part of being on dialysis that hurts the heart the most, is the increased blood volume that needs to be pumped by the heart. This causes the heart to enlarge, which is quite dangerous.

I wasn't talking about during dialysis...I was talking about in between dialysis sessions. When a dialysis patient drinks something, it isn't filtered out of the blood and excreted like in a normal person. So the blood volume increases. So if you have a goal of lets say 3000, then that means that your heart is pumping an extra 3 L of fluid around...thats what causes your heart to enlarge.

is that what you were referring to?