Pump speed

[BigSky]

What do you folks mean when you say your fistula "Blows"?

I use a pump speed of 425
15 gauge (blue) needle for the arterial (fistula), pressure -250-260 (I stick this one myself)
16 gauge (green) needle for the venous, pressure 260

I guess my pressure numbers are high compared to most of you folks.     

Maybe it's because my hematocrit is 41% ... and of course my preference for a smaller needle in my venous site.

Am I suffering from Deja Vu? I thought I just answered to this post? I don't know if the term is correct but I call it "fistula blow" when they stick me and then I get a goose egg and they have to put ice on it and infiltrate another spot.  It has been happening an awful lot I am afraid this is just something I will have to get used to and accept as part of my treatment 3x/wk 

Have you tried a smaller gauge needle?  Maybe try a 16 gauge.

[angieskidney]

Have you tried a smaller gauge needle?  Maybe try a 16 gauge.

It would have to be 17 as my unit does not carry the 16 and won't order it just  for me.

Today I asked the nurse I had to stick me in the usual arterial spot but to do farther up my arm for the venous. It seemed to work (today at least)! I just came back from dialysis.

[Panda_9]

Zach, why dont you use a 15g on your venous? Ive used 15g almost all along. 260 is very high, I would be going for the 15g, unless there is some reason why you cant.

[Zach]

It's just my own craziness.  I want to be different   

Actually, part of the reason is my crit is kinda high ... right now about 43.1.  And I don't even take EPO.  (that's for another thread)   

In the mean time, when I exercise the arm (dumbell curls) the number goes down a little.

[Panda_9]

What does hematocrit have to do with what needle you use?

[Zach]

What does hematocrit have to do with what needle you use?

Just that the higher your hematocrit, the thicker the blood gets as you remove fluids, the higher the resistance through the needles.

[Panda_9]

So wouldnt you need a bigger needle with a higher HCTto get lower pressures? I cant say we use HCT to determine needle size here. Usually we start on a smaller needle then work up to a 15g, which seems to be what most people are on. I had to move up to a 14g because of clotting, and then started on aspirin so I could go back to using 15g.

[Zach]

So wouldnt you need a bigger needle with a higher HCTto get lower pressures? I cant say we use HCT to determine needle size here. Usually we start on a smaller needle then work up to a 15g, which seems to be what most people are on. I had to move up to a 14g because of clotting, and then started on aspirin so I could go back to using 15g.

Like I said, just call me crazy.   

[Panda_9]

Zach, dont be silly, go to 15g!!! They really arent a big deal. I dont even think of them as needles anymore. I think of them more like straws lol

[Zach]

I hear the crowd in the background: Go 15g ... Go 15g ... Go 15g!!!     

[Epoman]

I hear the crowd in the background: Go 15g ... Go 15g ... Go 15g!!!     

Zach, you do what ever works for YOU, man you have my respect when I first read you bio, 24 years in-center (No transplant) AND you work FULL-time AND you are a very well informed patient. So just keep doing what you do. 

[kevno]

15g sounds big to me when one of the three decide to have a go at my fistula (which they do about every 3 months) they use a green 17g needle because the needle is so small, the pump speed is still only 250. With Venus pressure about 130.

[Panda_9]

Well yes 15g are big, but if it helps the pressure well why not change. Theres not that much difference in size. Once your used to it its a breeze. I hate pressure problems!

[angieskidney]

She is right! I use the 15ga and I went straight to them from 17ga since my unit does not have the 16ga! It is not so bad.

[Panda_9]

I would rather use a bigger needle then screw up my fistula

[Terry Hixon]

If my post show up with just a character and nothing more, blame it on the cat jumping into my lap. I have seen blood pump speeds upwards of 500 with accompanying dialysate flow rates of 800ml/min with high flux dialysis.

[Naive27]

i run at 525 most of the time my transonic said it works at 1990 and i use 15 gauge needles and 14 on test day and i go 2 1/2 hours 3 x 's a week

[Panda_9]

Naive27 do you have any renal function left?

[angieskidney]

i run at 525 most of the time my transonic said it works at 1990 and i use 15 gauge needles and 14 on test day and i go 2 1/2 hours 3 x 's a week

14? Damn that is huge! I didn't know they do go that big!

What is the difference between a800 and just plain 800 for dialysate flow rate? I am now at 400 pump speed with 3 days no blow outs (ever since the 2nd fistulogram last Monday and now they no longer have to run me back the old way !!)

[BigSky]

i run at 525 most of the time my transonic said it works at 1990 and i use 15 gauge needles and 14 on test day and i go 2 1/2 hours 3 x 's a week

I am wondering why 14's on test day?  Wouldn't that actually give a false blood lab workup because it would enable more blood to be processed over what you normally run at? Or is it the same?

[Zach]

I am wondering why 14's on test day?  Wouldn't that actually give a false blood lab workup because it would enable more blood to be processed over what you normally run at? Or is it the same?

Sounds kind if fishy to me.     

[Panda_9]

i run at 525 most of the time my transonic said it works at 1990 and i use 15 gauge needles and 14 on test day and i go 2 1/2 hours 3 x 's a week

I am wondering why 14's on test day?  Wouldn't that actually give a false blood lab workup because it would enable more blood to be processed over what you normally run at? Or is it the same?

The guage of the cannula doesnt determine the amount of blood processed as far as Im aware.

[angieskidney]

i run at 525 most of the time my transonic said it works at 1990 and i use 15 gauge needles and 14 on test day and i go 2 1/2 hours 3 x 's a week

I am wondering why 14's on test day?  Wouldn't that actually give a false blood lab workup because it would enable more blood to be processed over what you normally run at? Or is it the same?

The guage of the cannula doesnt determine the amount of blood processed as far as Im aware.

All I know is that when they were using the 17gauge on me they couldn't run me as fast as they now do with the 15gauge.

[Panda_9]

You do have a very good point there Angie! Im not sure thats what was meant in the previous post, which is why I questioned it.

[AlasdairUK]

Hi,

I run a pump speed of 400 for 4 hours 3 X a week. I use 14 gauge needles. This does not change the blood flow, but it reduces the pressure. My pressure is about 140 for both art (-)  and ven (+).

I do not want to run a faster pump speed as this puts more strain on the heart.

Cheers
Alasdair.