Clinical Manager has concerns about our H machines not finishing treatments on time. She mentioned that when the treatment reaches the RTD time, some machines still are not finished because of the UF goal is not reached yet, so they still have to continue treatment for a few more minutes (which makes a big difference for her apparantly). I'm not too familiar with this.....any ideas or explanations are appreciated. thanks!! i hope i explained correctly!!
thanks!!

The nurses are probably turning the UF off during Tx. When the Pt's BP starts to drop, they turn the UF off to let the Pt recover. Once stable, they will turn the UF back on. Of course, once you turn the UF off, you're not taking anything off the Pt. So you will lose the time needed to take all the Pt's fluid off. The only way I can think of to get all of it off after pausing the UF, is to change the UF rate. I would never recommend this becuase if you had to turn the UF off in the first place, the Pt was non-compliant. You shouldn't drain the Pt faster, because the BP will drop even lower, and could "code". Hope this helps explain.

I believe the RTD starts counting down when the machine senses blood and the UF goal time starts counting down when the UF button is pushed on. If for any reason the UF button is turned off there would be a time discrepency as well as if the button isn't turned on until the patient has been on Treatment a few minutes. I know at our facility we go by the RTD time when taking patients off unless they ask to go their full UF time or we forget to turn them on at the beginning of their treatment (Operator error). If you work in a facility that has both H and K machines the uf gets overlooked on H machines sometimes because the K machines uf turns on when you confirm the tx has been initiated. I hope this has answered at least part of your question.

I think I miss spoke when I wrote the RTD starts counting down when the machine senses blood. The UF has to be turned on and the machine has to sense blood before the RTD starts counting down. And our patients run a longer Treatment if we forget to turn them on and they are usually not happy about that. I got some info mixed up inside my head. Sorry about that.

I do agree with San Augustine nuses or techs are probably turning the machines off due to bp problems or other problems like cramping or vomitting. These should be charted to account for the loss in UF time though.

Another thing that can cause this is conductivity or temp alarms. When the machine goes into bypass because of these alarms the treatment time will continue but the UF will stop. Tell the techs not to let the bicarb run dry, that will get em'!

Thanks for the explanations!!
so the RTD does not stop when the UF is turned off then???

Actually, RTD (think of it as "run time dialysate")is the time that there has been dialysate flow going to the dialyzer. Any condition that causes bypass, ie temp, condo, blood leak, post olc test, shunt door open, blood not sensed or optical detector door open- will cause this timer to stop, but the uf timer(and uf pump) will continue to run during most dialysate alarms.
Unless you are the prescribing md, both timers should reach 0 before tx is complete in order to comply with prescription.

WOW!! Now i'm really confused....

Every time that the machine is performing a on line PHT test the UF pump stops and the UF time will stop as well.
This test is performed several times during the dialysis treatment. This is the main reason why you will see that the RTD is completed before the UF time.

That's true, if you have on-line PHT enabled. Another common reason for uf pump to stop, is the operator turned it off (pt cramping or hypotension incident), then forgets to adjust goal and turn back on. This is not a good thing because you may not meet minimum tmp requirement of dialyzer Mfr., and could possibly get reverse tmp.