Hhmm... some questions

[texasstyle]

As some of you may know, my husband does dialysis 2x a week. Today I found out from him he is on the highest settings the machine will go without going onto a third day.. (his words lol) I'm assuming one of these settings is the flow rate. I wanted to know what would this other "setting" be? I'm thinking here that 3 times a week with lower settings would be more gentle on the body and he would not be so wiped for most days. I saw his lab report today. KTV normal but phosphors a little high but improving since last month. I get so confused with most of this yet but learning.Any input helpful. Thanks









EDITED:Moved to general discussion- kitkatz-Moderator

[RichardMEL]

I've been told that higher pump speeds (>400-450+) can be not so good in terms of the access and it has been suggested by some (hemodoc may have more on this) that it could lead to failure of fistulas over time. Down here we have a rule nobody goes over 350 (I sit on 350 most of the time because I feel the need... the need for speed) though most patients go at 300. Hence we do 4 and 5 hour sessions at the lower pump speeds rather than 3-3.5 at the higher speeds common in the US. The idea is indeed that gentler pump speeds are better for the access (and so is more dialysis).

I'm happy to be corrected on this though.

[YLGuy]

It is good that his kt/v is good.  Dialysis only removes a small amount of phosphorous.  Phosphorous is more controlled by diet and making sure he takes his binders. 

[willowtreewren]

the other setting may be ultrafiltration or the amount of fluid being drawn off.

The high flow rate isn't going to help his access any. 

Thinking of you.

Aleta

[texasstyle]

Thanks guys. Makes sense to me about the really high flow rate possibly damaging the fistula. When I put my finger on his thrill, I can imagine from feeling how high the pressure must be that's going through that area alone. It's freaky to touch! lol

[Malibu]

Is your husband in-center?  Or home?  The machines in-center are different than the home machines.

We here at home (hemo, NxStage, US, Houston, TX) use a flow rate of 450.

[YLGuy]

I am in center and my blood flow rate is 400.  The dialysate flow rate is 600.  They use 15 gauge needles(actually bunts as I have buttonholes).

[nursewratchet]

Some docs, and clinics use a blood flow rate as high as 600.  That is scary to me, we go only as high as 500, but that is pretty normal, and dialysate flow of 800.  That is also normal.  There is a "rule" or thought by some that the dialysiate flow rate should  be twice the blood flow rate, although, dialysate is maxed at 800.  SO, the idea that 400 blood flow fits that model.  Max needle size is 14 guage.  Most are 15, and smaller if trying to use a new fistula.  The dialyzer can be larger, there are many sizes, depending on the brand. 

NONE OF THESE THINGS WILL REPLACE TIME ON THE MACHINE!!!!! Despite what ever settings they are using, they won't add more time, which is what he needs... This is a situation where time is better, and size won't help him. 

[texasstyle]

I so agree with you Nursewrachet. More time. It's apparent but I can not force him. I am trying to learn all I  can because this effects me too. Also, if I have some ammo (education) I can come at him both barrels. He did metion he believes he uses a 13 gauge but not positive. I've been having some really good days the last week where I feel good about myself. Yeah for me! lol.

[nursewratchet]

He can't use a 13 guage needle.  Too big, and the access would blow.  14 is the largest.  Unless some doc does that, but I can't imagine that.  It is against any protocols and policy I've ever heard of.  I could be wrong though.  SHOCK!!!!!