In my previous unit, I was on the same machine each tx and experienced many consecutive txs without any problems. I set my own dry weight and goal and know how to get close to my dry weight.

In my current unit, I am put on a different machine each tx and have many more problems getting to the end of tx. minus fluid removal problems. It recently occured to me that maybe the reason for this is that the machines are calibrated differently thus affecting the estimate of my goal. Any comments or suggestions?

Renal dialysis facilities are obligated to follow stringent guidelines for machine calibration written by the machine manufacturers.
Fluid removal is checked by actually measuring the fluid removed and comparing that with what the machine says it took off.
Same as conductivity, the amounts are confirmed through a separate measuring meter.
All machines have mandatory equipment maintenance schedules, quarterly, semi annually, annually and as needed.
You will always have a very very small degree of variation between machines, and yes, sometimes machines will misperform, but a simple volumetric check while you run will comfirm the accuracy. We measure the effluent removed from the patient in a separate container and compare that with what the machine says you took off. You will know with in the first hour whether the machine is running correct and true or not.
With all these posts about all your problems, I am quite concerned that you and your renal facility are not cooperating very well together, they should be able to provide you with direct feed back instead of all of us trying to second guess what might or might not be occurring during your runs from your minimal and cryptic information
I would strongly encourage you to discuss this with your nephrology team, as you are part of the team that provides your treatment, you might find developing a better relationship with them more helpful than all of us put together.
ciao for now

Cruisetech,
The first part of your post was helpful to me. But the 2nd part of your post was insulting. Please Ccrrect me if I'm wrong, but I thought that RW tech board is an open board.

Lewis I am concerned that since you set your own dry wt and goal,and know how to get close to your dry wt ,you do not like the saline to be squeezed back, perhaps you should try home Dialysis. I am not trying to offend you but my Nephrologist does not allow his patients to dictate treatment procedures to him .The team concept Technicians,Nurses,Dietician,Social Worker,Nephrologist and the patient work together to provide the best treatment modality.P.S did you know that dry wt changes?

Hello Lewis,
My apologies if you feel slighted, I was only commenting on the many posts, on different boards, you have made, on the many different problems you are experiencing. I was simply trying to encourage you to use YOUR team of nephrology specialists as they have first hand experience on what is or isn't going on. We can only guess with the limited information you offer.
I applaud you for making an effort to learn more, and hope you will continue with you efforts.
To get a better opinion from the many specialists present on the various boards you post on, you may want to consider offering more specific information, for example have you considered that your weight issues may not be machine related, and may be related to the scale you use for weighing?I have a patient, that is anorexic, and would actually LIE to us as to what her dry weight is, we had pulled many machines for repairs before we finally clicked in that is wasn't them.

Old School,
I believe the patient is a full member of the tx team and has full rights to speak up when tx isn't being delivered correctly/is uncomfortable/unsafe etc. If you think it's dictating to the doctor for an aware, educated patient to bring his concerns to the doctor, or other members of the tx team, and expect solutions, then we have a very big difference of opinion. I do not think a patient should have to be run off to home hemo in order to get accurate, safe txs. Additionally, I have had 5 nephrologists thus far and every one of them has given me his ok to adjust my dry weight and set my own goal each tx. Do I know that dry weight changes each tx? I certainly do and adjust both dw and goal, accordingly. In many years of dialysis, I've had few doctors or staff who knew how to properly assess for dw/goal, so they were more than glad for me to handle the job.

Cruisetech,
My current team of nephrology specialists is the best team I have had thus far. Nevertheless, there are points even they admit they are not educated on. No one in dialysis knows it all- that's why we must work together as a team. Because I post on dialysis boards does not mean I do not go to my team or listen to their opinions. It is when they can not provide an answer that I look for answers elsewhere. And I always double check info that is given to me by my team, because they can be wrong at times.

Regarding giving more specific info when asking questions of board specialists/educated patients, you must try to remember that I am a patient who is in an ongoing learning mode. I try to make my posts as clear as I possibly can. If I am not clear enough, all one has to do is ask for clarification and I am happy to comply.

And I certainly do know that tx problems are not always due to the machine. My approach is to look at a tx problem and logically rule out what may be happening to cause the problem. Sometimes it has nothing to do with he machine, but sometimes it certainly is the machine.

Lewis,
Did you ever talk to the Machine Technician at your facility? If not, You can set an appointment with the help of the administrator(just in case he is hard to find) and then ask your Machine Tech all the question you have in mind.That way he can explain everything to you and unlike here we are only guessing what you really want to know and sometimes may give you answers that only offend you.

lpdc,
Rest assure, I asked to speak with the machine tech and we had a lengthy talk. He told me art. pressures should not exceed -240 due to hemolysis. His approach was to check the machine while I am on it. He said he would be at my next tx to see what the machine does while I am on it. That was 4 txs ago and he did not follow through.

Regarding guessing at what I want to know, I do not expect anyone here to solve tx problems for me. But I would like clear answers to technical questions without false assumptions that I haven't spoken with my staff. I am a fully funtioning adult who knows how to seek information on my dialysis tx and I know the right order to go in.

At present I am wanting to know how the art and ven pressures are calibrated. I recieved a reply on this on another board. I would like to know, also, why there is no alarm on the machines in my unit until the art. pressure maxes out. I asked the charge nurse and she did not give me a clear answer.

Dictating,,, , hm, well I don't see it as dictating, I see it as 'being part of the team; and who knows best how much to take off but the informed patient who is educated and continually tries to educate him/herself.

quote:

Originally posted by old school:
Lewis I am concerned that since you set your own dry wt and goal,and know how to get close to your dry wt ,you do not like the saline to be squeezed back, perhaps you should try home Dialysis. I am not trying to offend you but my Nephrologist does not allow his patients to dictate treatment procedures to him .The team concept Technicians,Nurses,Dietician,Social Worker,Nephrologist and the patient work together to provide the best treatment modality.P.S did you know that dry wt changes?

Lewis, I agree with everything you are doing, and, commend you for your efforts at becoming an informed patient in order to obtain quality delivery of ccare. I do the same for my family member. I get answers from a variety of sources; message boards, books, articles, staff, doctors. etc. I read all I can to learn more and more in order to educate my family member. Then, I can ask questions and 'question' what is being done.

Speaking of arterial pressures and alarms. I have a problem with the following: If I am wrong ok, but don't tech/snurses monitor and not just go by alarms?
The arterial pressure is slowly rising, NOW, shouldn't that be an 'alert' ;;;hey something is wrong'''' what is it? Let's try and find out before it hits -240? Now, am I wrong to say, if the tech/nurse sees this rising, shouldn't they intervene to see if the needle needs readjusting, is there a kink? just what is the one of six problems that it could be. Then, if they don't intervent and wait till the AP alarms at -240 just how does that affect the patient and exactly what is done? I am a bit confused. HELP>

Lewis,

Although it may be a slight possibility, I would rule out machine problems in your case. I don't know what equipment you use, but we'll use Fresenius H/K machines for example (one of most widely used models). The UF pump is allowed, by manufacturer, to deviate approximately .42% from expected value. We'll say, for example, a patient brings in 5 kilos of fluid weight. With a goal set for 5 kilos, provided the UF pump doesn't need to be shut off for any reason and said machine reaches that goal, that leaves a possibility for the machine to have removed anywhere from 4.979 and 5.021 kilos. Well, what if the machine was off you ask? Even if it was off 4% (which is a huge margin of error by the way and likely would not happen) the machine, set at 5 kilos, would remove between 5.2 and 4.8 kilos. Still pretty close. However, if you don't believe me, there is an easy way to prove/disprove my words. Verify it with the scale you weigh on (not a home scale, too inaccurate). However, be sure to remember any saline that was administered, any food or drink consumed during treatment or any thing else that can be a factor. Also, wouldn't other patients be experiencing similar problems? When was the last time your heparin dose was evaluated? There's a lot more factors to it than the machine, I'd explore more options before assuming one. Hope this helps you on your quest for bettering your knowledge and feel free to ask more questions if you'd like to know more.

One more thing... the arterial pressure also may have many causes. One guess I have to offer is that as fluid is removed throughout treatment, the blood becomes thicker making it harder to pass through your needles, thus increasing negative pressure. Just a guess....

[This message has been edited by GTSCSS (edited 08-10-2004).]

advocating,
Thank you for your support. As an advocating caregiver you know how important it is to search many sources for tx info.

GTSCSS,
If the UF pump is off 4% as you stated in your example, it can affect a patient greatly. Taking off just .2 more than what the goal was set for can throw a patient into a hypotensive episode. This is exactly my point. Sometimes the machine does suck out that extra .2 as verified by the scale. But other times, the patient is just dehydrated and the body will not release any more fluid.

Educated patients always add to the goal for any fluids taken in on tx to make sure their goal is correct. The reason other patients don't complain is because the majority of patients are uneducated on their tx. Such patients are either fluid overloaded per the goal staff have inaccurately set for them- thus they will not become hypotensive, but will go home fluid overloaded. Or they will cramp on tx., because the staff has taken too much off. Many has been the times I've seen patients wake up from a dead sleep in severe pain from cramping. So, the reason few patients complain of problems with the machine is because they aren't aware enough to know what's going on.

Regarding arterial pressures. I am referring to the starting art pressure being completely different on different machines--varying as much as 100 points.

looks like our ole buddy "patient" is back with a new name and IP address/ISP....read some of his old posts and compare to these...youll see that it is the same person just trying to find fault other than human (patient) reasons....no matter how unlikely/impossible

The 4% off is a highly unlikely event. The most I've ever seen the machine off is less than 1%. But lets just remember this. Humans are much more prone to errors than machines. It cannot be argued that machines, if maintained properly, are doing their job like they're supposed to. Machines don't get tired. Machines don't have other things on their mind. Machines are programmed to do their job and when they're not, their going to let you know. The odds of being harmed by a properly maintained machine being used by well trained staff are astronomical. Someone would really have to be trying or really not know what they're doing to hurt you. As far as your arterial pressure goes, I'd say the same for it. It's likely not a machine problem at all but a problem with your access. But what do I know? I can understand how people always want someone (or something) to blame when things to go the way their supposed to, but I think you're pointing in the wrong direction. Just my 2 cents. Good luck finding out what it is.

[This message has been edited by GTSCSS (edited 08-11-2004).]