Crashed ???

[talon999]

Well I think Friday night was my first "crash". I am fairly new at this, I've been doing it for just over a month. So far I have been on 17 and 16 gauge needles.  Well, Friday they threw in 15 ga needles (because they were there). Up to this point my flow rate has been 250 for most of the time. Friday they ran me much higher at 350-400 for the entire time. I started cramping after about 3 hours and at the end I could not stand for any length of time. I had to sit down again and the nurse gave me some boullion to get my blood preassure back up. Finally I felt alright to walk out and drive home. No big deal. Is the the "crash" that I have read about on here?


Mark

[Rerun]

Yes, welcome to Hemo Dialysis. **CRASH** I suggest you up your dryweight about a kilo and see how you feel.  Especially if you are urinating, your dry weight is hard to target.  Keep us up dated on how your runs go. 

                                       

[flip]

When you start cramping have them turn the UF off and give you some saline.

[talon999]

Thanks Rerun,
My dry weight is estimated to be 60 kilo's. I left the hospital at 60.1 on Friday. I do not believe that I have ever been down to 60.0. Yes I am still peeing (yahoo !!)
I will mention this tonight. I know that the determination of my "dry" weight seemed to be a bit arbritary at the time. Some of my techs seem to be worried about
my problems and others are not so concerned. Human nature I guess.

Mark

[jbeany]

If you've only been on a month, then, yes, they are still guessing at your dry weight.  The truth is, that's all it ever is - a guess.  What they won't tell you is that you can start setting your own dry wt, and tell them how much fluid to take off, depending on how much you ate, what clothes you are wearing, etc.  It's your body - take charge and don't let them boss you around!

[flip]

You're absolutely right, jbeany. When I weigh in they ask me how much I want to take off. I'm gaining back some of my old weight loss so I'm gradually increasing my dry weight. You're the boss, Talon. If you start cramping and they won't do anything, just sign out and leave.

[talon999]

Thanks Guys,

Heh Heh, I am not sure that I am at the point where I would just check out.

Mark

[twirl]

say something at the first sign of cramping
I cramp in my legs and now in my chest
they used to be nice about cramping
now they act like we are imposing on them
they used to have us push against their leg with our leg that cramped
now, they could not care less
they just say not to have some much fluid even if they is a very little gain
cure al--- answer

[flip]

when I check out early, I always write down the reason on the AMA form before I sign it.

[talon999]

I do not sign any forms. I am curious to see what tonight will be like. It seemed like many people were concerned when I crashed. Time will tell....

[G-Ma]

yes, what everyone said...through trials I have found out I can't take off more than 3.8 k and this includes the saline they push back so the min even a toe starts cramping I know the tech has not listened to me..everyones body is different and we need to learn to listen to our body. Check and double check what they do.  I am learning this.

[IUNurse]

Yep, definately a crash.  But as you can tell the crash was more related to your fluid than what size needle and what your blood pump speed was.

[flip]

Another thing that might help....I always hook "striaght up" so I get saline as soon as the blood starts flowing. It will reduce the possibility of cramping.

[G-Ma]

 

[Rerun]

say something at the first sign of cramping
I cramp in my legs and now in my chest
they used to be nice about cramping
now they act like we are imposing on them
they used to have us push against their leg with our leg that cramped
now, they could not care less
they just say not to have some much fluid even if they is a very little gain
cure al--- answer

Twirl have your son come in and start knocking some heads together! 

[talon999]

Well, last nights run went much better. I had a tech that I have spent alot of time with. He put me back on 16 ga. needles and ran a consistant 350 flow rate. No cramps and no crash. I still left at 60.1 kilo's. I cannot seem to get that last tenth.

IUNurse, wouldn't larger needles and a faster flow rate increase the fluid that was removed? This is all a bit new to me.


Mark

[thegrammalady]

don't worry about the .1 and don't let anyone else tell you it's important. you left at 60.1 and if you come back in at 63 you know exactly how much you've gained (i always wear the same thing to dialysis (yes i wash it in between) that way they can't attribute heavier clothes to fluid gain) i always take off what i have gained plus .6 (rinseback) works for me. if a cramp starts have them turn the uf off for a bit, possibly the rest of the treatment. i don't let them add saline, but that's up to you and how you feel. i figure if they don't add it, i can drink it. remember you are in charge, most techs (dietitians and social workers)  have a one size fits all attitude and that just doesn't work.

[flip]

The fluid removal is set on the machine and it will adjust the flow rate accordingly. Using larger needles and a higher flow rate can speed up the process and reduce the time. Lower flow rates are easier on the body and you leave feeling much better. The down side is that your URR might suffer.

[jbeany]

Don't let them stick you in that "even numbers" trap.  If you weigh 60.1, then that's what you weigh.  My doc does the same thing - dry wts are always set at something ending in .0 or .5.  As if it isn't bad enough that they expect us to weigh exactly the same thing every day, we have to have it come out in an even number as well?  Just cause they can't do math in their heads? That's just idiotic.  I weigh what I weigh, and I set my dry wt and fluid goals according to what I want - not whatever rounded number the doc wants to put on my chart.

[talon999]

Don't let them stick you in that "even numbers" trap.  If you weigh 60.1, then that's what you weigh.  My doc does the same thing - dry wts are always set at something ending in .0 or .5.  As if it isn't bad enough that they expect us to weigh exactly the same thing every day, we have to have it come out in an even number as well?  Just cause they can't do math in their heads? That's just idiotic.  I weigh what I weigh, and I set my dry wt and fluid goals according to what I want - not whatever rounded number the doc wants to put on my chart.

Yeah jbeany , I never could figure how I was supposed to weigh exactly the same every day. I doubt that anyone could do that. I do not worry too much about my weight going in or leaving. I am too new to know what is really important and what is "fluff". I am more concerned when I come in at a larger than normal weight.


Mark

[IUNurse]

I am thinking hard about this Mark:  if you have larger needles and a faster flow rate it is easier to pull of the fluid, but the speed at which the fluid is pulled of is set on the machine (by setting the time you run and the amount to take off in that time).  Pulling fluid off too fast and pulling too much fluid is what causes cramping.  I don't know though, I could be missing something.  But I really do think if you concentrate on your dry weight- that is what will help.  If your fistula didn't infiltrate with the 15 G needles, then that is a good sign that your fistula might be ready for the bigger needles.  Our clinics eventually move to 14 G needles (for the arterial only I thnk).  Anyway, good luck to you!

[flip]

My center won't use anything larger than 15 or allow a flow rate greater than 500. Different strokes for different folks. I use a 15 @ 500 with a 210 dialyzer and I always feel good when I leave. They let me decide how much fluid to take off.

[IUNurse]

As you may not have read I am a PD nurse now, but if I remember right, my hemo patients that were more involved seemed to do better than those who weren't involved at all!  Blood pump speed is also no more than 500.  I think the 14 G needles helped with arterial pressures.

[flip]

It does but it also leaves a bigger hole. I clot quickly but some of our patients take forever with a 15 or 16. I'm not sure I would use a 14 if it were available. I hope to eventually do NxStage and it will run 600. I may try a 14 then with a buttonhole.

[IUNurse]

I don't know enough about NextStage, I need to read.  I was told (by competitors) that NextStage ran really slow.  I have not seen a dialysis machine run 600.  Interesting.  Our patients on 14 G needles did not bleed any longer than they had on 15 G needles.  Certain patients are more prone to bleeding than others.  I remember I held a patients sites for 6 HOURS once to stop her bleeding!  She was prone to bleeding issues.  And when it happens there really isn't much you can do but hold the sites and pray!