Adequate Dialysis

[CBennett]

My question is What is adequate dialysis. I feel fine all the time. All my Blood work comes back perfect, I'm not on any special diet or fluid restriction except phosphorus. I am a very active 76 year old male. The problem is my Clinic says I'm not getting good clearance because my machine will not run on green but runs on yellow. They have the speed at 500 and using 14 button hole needles and it is not working. I don't care what the machine says I feel fine.  The clinic director said if I cant get the machine to run green medicare wont pay them for the treatment.

[Sydnee]

I'm sorry I can't help. Have they told you HOW YOU are supposed to make it run one green? If you are in center hemo don't they run the machine (unless you want to, some do here).

How young is your fistula? hubby had more yellows when his fistula was new. 

[CBennett]

I am doing in center dialysis, my fistula is 2 years old and I had a fistagram last week and no problem there.  I have been doing dialysis for 6 months.  I have one of only two techs that allways sticks my site and we work as a team to set up the mach.  I am ready to go back to small needles and slow speed to see if that helps. When I first started for several months I allways ran green.  I have no fluid removed so that's not part of the problem.

[cattlekid]

I'm sorry, but this sounds like complete garbage. First of all, Medicare only has guidelines for clearance, not requirements for payment. The clinic might get dinged for your clearance problems, but they will still get paid.

Second, it's not your problem about the clearance. The clinc has to figure out what will get your clearance up. Sorry to say that it will probably involve more time on the machine. Because you are running yellow, they will probably have to decrease the speed which will increase the time.

Is there a chance that you can switch clincs? Because if sounds to me like the people running your clinic are pure idiots.

[CBennett]

I forgot to say I'm running 4 hours now.

[Sydnee]

I agree sounds like a bunch of bull.
When Ed was on hemo he ran for 4 hours and 45 minutes to get good clearance but he is a bigger guy with muscle.
Are you a big guy or small man?
Ed and I don't think there is anything you've done wrong. Ed thinks many be the needles are not in the right position.

[amanda100wilson]

any chance of you do home hemo?  if you are in clinic and not getting adequate clearance, it is up to them to work it out, not place the responsibility on your shoulders.  I can't understand the guilt trip that they are trying to send you on.  it is their problem, not yours.  be your own advocate and tell THEM to sort it out.

[sullidog]

are they running you on the proper dializer?

[MightyMike]

14 gauge needles at 500 pump speed you should be great.  The only thing they can do is maybe use a larger dialyzer and see if that helps unless there is something else going on in your body.  Best wishes.

[noahvale]

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[nocturnaldialysis]

I wonder if any of you have looked at http://www.nocturnaldialysis.org ... and read the section entitled 'the good dialysis index' .. for a definition of and the parameters that define the minimums  that adequate dialysis should meet

[cattlekid]

I've seen this before and I've tried to use it to fight with my home hemo nurse when she has tried to monkey with my dialysis prescription in order to meet Kt/V.  I keep fighting with her about the fact that Kt/V is useless for those of us on short daily home hemo.  Goes in one ear and out the other because she is measured on Kt/V and they don't give a rat's behind about how I actually FEEL.

[PatDowns]

I've seen this before and I've tried to use it to fight with my home hemo nurse when she has tried to monkey with my dialysis prescription in order to meet Kt/V.  I keep fighting with her about the fact that Kt/V is useless for those of us on short daily home hemo.  Goes in one ear and out the other because she is measured on Kt/V and they don't give a rat's behind about how I actually FEEL.

Please discuss GDI and HDP with your nephrologist.  (S)he is the one who writes your dialysis prescription - not the dialysis facility. 

[cattlekid]

Unfortunately, unless the changes are major, my neph has given carte blanche to my nurse to make minor changes. I think it's because he is not the medical director of the clinic so he's not the one who is influenced by their performance.