The high conductivity alarm went off about 6 different times during my tx. My sodium setting is 140 and the conductivity on the screen showed 14.2. Can someone explain what causes conductivty to be too high, and with the alarm going off so many times, did that compromise the tx or have anything to do with clotting I had in my chambers which I could see when the tx ended?

Conductivity is a measure of electrolytes in the dialysate solution (mainly sodium). The fact that your prescribe setting is 140 sodium (or 14.0 conductivity) should allow a 142 or 14.2 to be "within limits" and the equipment should not have alarmed. The standard variance is = - 5%. Usually we allow about a 0.5 variance. This is due to variations in the pump calibrations, strength of bicarb (if it is mixed at facility).
High conductivity can be caused by a number of things incorrectly mixed bicarb, wrong acid concentrate used, machine malfunction. It sounds like the staff should have checked to see what the limits were on the conductivity. When the limits are voliated it bypasses the flow to the dialyzer and sends the dialysate directly to the drain therefore protecting you from inproperly proportioned dialysate. These limits are adjustable to allow for different sodium settings and acid concentrates. As far as the clotting it sounds unrelated, the equipment going into bypass should not cause the blood pump to stop (unless accompanied by a tmp alarm). Some clotting in the venous drip chamber is not a worry and can be due to other factors (heparin dosage, reuse or non reuse, blood pump speed, access type, hemtacrit level). Hope this helps

I have had the high cond alarms on my machine two txs in a row. None of the other machines around me are doing it. The techs did check to see what the limits were. Do you mean that they are supposed to set my limits at put on according to my sodium rate? If they forgot to set the limits from the last person, then is that what caused the high cond alarm to keep going off? I heard them say that they were checking the limits. The alarm continued to go off. A tech said my bicarb was low or had settled. The bicarb was changed, but the alarm still went off. So then the tech said it was probably the acid. But everyone has the same acid pumped in. What does that leave then? You say the blood pump continues to run so does that mean the tx is not compromised? Thanks for the help!

I observed the machine again. The high cond. alarm continued to go off. I saw that the cond. on the screen was reaching 14.4. I asked the tech about the limits. He said they are 13.5-14.5.

I have this problem with my machines from time to time. I simply recalibrate the machines conductivity and this has resolved the issue for me.
If this continues, request to be placed on another machine. If it doesn't happen then at least the tech will know its that particular machine that has a problem. In rare instances conductivity cells in the machine need to be replaced.
I have Baxter Machines in this clinic and we clean the conductivity cells daily by using vinegar. This helps keep problems of this sort to a minimum. Different machines use different cleaners or methods.

Sorry for the delay Greg, I have a couple of questions first if the conductivity limits are your machine were to be set at 13.5 -14.5 (which is pretty standard) why is a 14.4 conductivity causing the alarm. What type of equipment are you dialyzing on. A couple of other thoughts first the excuse that the bicarb "settled" This is unacceptable if the bicarb "settled" it usually means that it was mixed improperly. When properly mixed bicarb can be kept for up to 24 hours. However most units will mix fresh bicarb daily or for each shift. As far as limits usually the bath (dialysate) is pretty standard if you run on a different acid concentrate (different potassium or sodium) than the person before you than the limits may need to be readjusted. If you run on a sodium variation program most of the equipment will automatcally adjust to "center" around the conductivity as it climbs during the variation program.
The fact that the blood pump continues to spin does NOT mean that the treatment is not being compromised. I only wrote that in regard to your clotting question. In fact when a piece of equipment is in bypass you are still have fluid removed but your ELECTROLYTES are not being balanced. I would definitely ask for another piece of equipment if this continued to be a problem. Also note the equipment number or serial number so you can tell if it is the same piece of equipment that you had previous problems with. Hope all this helps. Like I said sorry for the delayed response

Perhaps the PCT/Nurse is not operating the machine properly. None of the data jumps out as a purely technical issue. Many times clinic staff blame equipment, when they are not comfortable with their responsibilities as operators. Speak with the Director of Nursing or the Chief Technician, arrange to learn as much as YOU can absorb about the equipment so you are not misled by a caregiver whose knowledge base needs improving. ANYTIME the machine is in dialysate bypass due to an alarm condition, your treatment is compromised. ANYTIME the blood pump stops and alarm conditions are not reset promptly, your treatment is compromised. Unless your treatment time is adjusted to compensate for any time lost to excessive alarm conditions, you are NOT receiving your dialysis prescription.

[This message has been edited by Smiler (edited 06-01-2002).]

Thanks for all the replies and helpful instruction! I dialyze on a Fresenus 2008H. At my last tx, I had forgotten about the cond. problem and realized later that alarm didn't go off. So maybe the problem was with the setting or the mixing of the bicarb. One good thing about this machine, the tx goes better when the cond. runs higher. Some of the machines have cond. as low as 13.2 and I get terrible symptoms of vibration the last hour in my feet, legs and torso when the cond is low. Is it a machine calibration that allows the cond to run either higher or lower? I've read that the dialysate determines that. But then unless they use different brand dialysates would there be such a wide variance in cond readings?

The dialysate is made up of acid concentrate, sodium bicarbonate, and purified (usually ro) water. While the make up of the acid concentrate and bicarb determine the final conductivity, it is the pumps in the equipment that actually proportion these to the correct levels. If the pumps are out of calibration you could have a low or high conductivity, which would mean you would not be meeting the prescribed electrolytic mixture (sodium, potassium, dextrose,etc). High conductivity (or what appears to be high) could also be the use of sodium variation, a program which enables the user to increase the sodium so the person dialyzing is less syptomic (usually helps with cramping, hypotension). The electrolytes in the acid concentrate and bicarb are fixed, so after reviewing lab work the doctor, nursing staff may change the acid concentrate used. Usually this is done for potassium levels, spring time tomatos strawberries,etc. so people tend to have higher potassiums. So we lower the potassium in the dialysate to "draw" out the higher potassium in the blood. Again the machine and mixing of the bicarbonate do play a role in conductivity, if the proportioning of the equipment is off, the final conductivity will be off, if the bicarbonate is mixed improperly or sits too long the final conductivity may also be off.
Once again I will get on my soapbox and suggest that you keep a journal record things such as fluid gain, pre blood pressure, conductivity, temperature (both your's and the dialysates) and general feeling about how well the treatment went. If you run better at a high conductivity maybe sodium variation would be beneficial for you. Anything else we can help with let us know

Hey Coffee!
I can tell you I do pay careful attention to my stats and the machine appartus during tx. And I also obtain a copy of my flow sheet each tx looking to see if there is anything I didn't catch during tx. Most of the time, I dialyze on the same machine, but sometimes the machines are switched out or I am sent to another station to dialyze. It does appear that the lower the conductivity of a machine the worse the tx. For me 13.2 = very bad, 13.9 = better but last hour is symptomatic, 14.3 smoother sailing. I would like to try Sodium Modeling amd UF Profiling as I have heard these are options that can produce a better tx. Our machines have these features, but my doctor doesn't know the operation of the machine and the staff is not trained in them. So I can't proceed until I can figure out how to select the profiles that are correct for me. I understand the patterns of the profiles and which ones might be best for me, but I don't feel I can do this yet without more knowledge about it and support. It has taken me what seems like a long time to convince my RN that I have serious discomfort if the conductivity is too low. But she is working with me now by keeping me on a machine with high cond. except when it has to go for maintainence. Thanks again for the instruction, It seems like this info. is basic knowledge that my doctor and staff should know, but they don't seem to.

Hey Greg,
Glad the info helped. Also glad to hear you keep detailed records of your tx. By the little bit of info you provided maybe they should run you "hard" pull alot of weight early in the treatment (uf profiling) with sodium variation then "ease" off the last hour. The uf profiles show in percentages. So if you pull 110% the first two hours then slack off to 90% then 80%, or something similar it should help. The unfortunate thing with all these customized programs is that there is no definite "right" one for you, it just takes some playing around and fine tuning and information (which you provide). Good luck and post how you're doing I'd like to hear.

Hey Coffee,
Have continued to be on the same machine. The high cond. alarm still goes off, but has only gone off a few times a tx. Last tx, however, it went off a lot. I had a different tech and I found out how he got the alarm to quit.

I'm on a 2K with a sodium of 140. The limits are 13.5-14.5. The cond. would climb to 14.5 and 14.6 and thats when the alarm would go off. The tech changed the K setting on the machine to 3 and that caused the limits to go to 13.6-14.6. This is how he stopped the alarm.

I asked him if changing the setting to 3K interfered with the doctors prescription. He said no, because I was still getting 2K delivered.

I still feel decently well on this machine with the higher cond., no last hour crampiness, but is what this tech doing to stop the alarm wrong procedure that is compromising the tx, and will it cause me to get poor dialysis (Kt/v URR)?

I have thought about letting this go on and seeing the effect it has on my monthly labs. If I tell them to pull the machine, then I'll be back to a machine with lower cond. that gives me problems in that way which is even worse. Tks again for the help.

Update-
When I got my labs my kt/v went from 1.95 to 1.79. Another tech found that by changing the limits of 14.5 14.0 13.5 to 14.5 14.0 13.7, she was able to get the high cond. alarm to stop coming on or it comes on briefly towards the end of the tx. Is this a valid solution?

Since it was the low limit that was changed and not the high limit, it would not have any effect at all on whether or not the machine alarms for high conductivity.