We have a patient with possible first pass syndrome and we have no re-use. So far I've suggested double rinsing the dialyzer but the patient is still having issues. Any suggestions?

sorry, i'm no expert at dialysis but maybe this will help.
what is your prime volume?
maybe try a longer recirculation time, with a higher pump speed, and that prime is being dumped.
can you try another manufacturer?

good luck.

chieftex,

A couple things about first use syndrome...
1. It typically start within the first 15 minutes of dialysis and will subside before the end of the first hour.

2. It's possible for a patient to suffer from first use syndrome and it not occur every treatment.

As you probably already know, most cases of first use syndrome are caused by ETO. Even if your dialyzers are sterilized with e-beam, gamma, steam, etc., the bloodlines and other supplies are still done by ETO. If they are already rinsing with a full liter of NSS, a second one probably wouldn't do too much more. ETO is dialyzable, have them recirculate the primed system for at least 15 minutes at a high pump speed, UF is not neccessary but can't hurt other than using more NSS.

We have had patients that were apparently allergic to polysulfone, switching them to a cellulosic membrane did the trick. It has not been unheard of that some people can be sensitive to the polyurethane header material also, in which case you're pretty much stuck other than pre-medicating the patient.

Chuck