Apart from regular chest X-ray, bp monitoring, and caliper measurements etc 1) is there a more convenient way to assess the dry weight of patients each month?

2) Has anyone used the Bioanalogic body composition device to assess dry weight (It can give % water, fat, and lean mass)? It is supposed to be quite reliable and accurate compared to hydrostatic method.

3) anyone has a chance to use the Fresenius Hydra ECF/ICF device to assess dry weight?

Thanks!

I just noticed the above post. I hope someone out there in Dialysis Land can answer it. I've had two doctors now who will not use Critlines. They say they are not accurate and not worth the investment. I am very interested in methods of assessing dry weight. In the units I've been in, dw is poorly assesed if at all. And, of course, that means serious problems for patients.

The most reliable way to assess dry weight is also the easiest to do with the added benefit of it not costing anything at all.

A thorough physical assessment should be done both prior to and immediately after dialysis.

The assessment should include:
1. Lung sounds
2. Heart sounds
3. Edema
4. JVD
5. Blood Pressure
6. Heart rate and rhythm
7. How the patient feels

The physical assessment won't tell you "how much" fluid there is (though some doctors can take a pretty good educated guess), but it will tell you if the weight should be adjusted for the next treatment.

Remember that just because a piece of technology is available (at whatever cost), dosn't mean that it should replace good old fashioned clinical skills. If your healthcare team lack these skills, you would be safer to find another team.

There are indeed many methods of determining dry weight, and nothing can
replace the through clinical assessment of such. However, that being said,
it is important to note that even when using any or all of the current
methods of assessing dry weight, the leading cause of death in hemodialysis
patients is still cardiovascular disease. Additionally, a vast majority of
hemodialysis patients are prescribed (multiple) anti-hypertensive
medications. Also, transplant surgeons and transplanted patients report
that upon transplant of a kidney, patients lose weight, in many cases
substantial amounts- even those who were at what was thought to be at an
accurate dry weight. What does all this mean? We at Hema Metrics, the
makers of the Crit-Line, believe that fluid overload is at epidemic
proportions among hemodialysis patients, and that their cardiac disease(s)
and conditions are a direct result of long-term, undetected fluid overload.
Crit-Line is a valuable tool in identifying fluid overload and then safely
and effectively treating fluid overload by providing a "window into the
intravascular space". Crit-Line takes the guesswork out of dry weight
assessment, and does so with proven, repeatable improvements in outcomes. We
would cordially invite you to try Crit-Line for yourself and also speak to
current Crit-Line users who can speak first-hand of its benefits. (www.hemametrics.com)

I've been in two units now and both doctors said Critlines were inaccurate and not worth the investment. Is this just a smoke screen then?
As a patient, I continually have this sense that I have not reached my dry weight. My newest doctor got me off of blood pressure medications recently for which I'm very pleased. But he thinks I have the perfect text book case of desending pressures and have removed all the fluid each tx. I start tx with a bp of about 120-140, go down to what I estimate (as best I can) to be my dry weight, but I still sense there is more fluid to go. The problem is, I can't go any furthur, because my blood pressures drop into the 90's and my body won't release any more fluid. Is sodium modeling and Uf profiling usually used in conjunction with the Critline to extract the remaining fluid yet provide a comfortable treatment? I may have text book pressures, but my txs are very uncomfortable as is and I have low bp and weakness ruining my evenings. Also, I've heard of patients who wound up in the hospital where it was discovered that they were carrying a lot of extra fluid they didnt know was there. Like me, they went to what they thought was their dry weight each tx, but all the fluid wasn't being removed.

The Crit-Line is a CQI tool that allows the clinicians to safely and consistently dialyze their patients to their accurate dry weights. The Crit-Line provides a "window" into the intravascular compartment of the body by monitoring a patient's blood volume in real time during dialysis. When using the Crit-Line, the clinician can accurately determine how well a patient's plasma refilling rate(the ability to move water from one compartment to the other) is keeping up with the ultrafiltration rate of the machine. Having this information in real time enables pro-active intervention based on the amount of fluid the patient's body is able to shift into the intravascular space during any given dialysis treatment. The graph that the Crit-Line displays is really an ultrafiltration profile custom designed for each individual patient. Therefore we do not recommend machine (dialysis)UF profiling while using the Crit-Line. The Crit-Line allows increased accuracy and control of the fluid removal process during dialysis. Na profiling may be used but remember the higher the sodium the faster the fluid removal diring the beginning of dialysis.
I hope this helps to answer your questions. Best regards.

Thanks, but you lost me on that last part. The Critline determines what the UF rate should be so as to remove the correct amount of fluid, but what interventions must take place, if like in my case, low bps occur at the end of tx?

We know that by the time a patient's blood pressure drops, they are already in trouble. By monitoring the Crit-Line display (in graphic form) a trained clinician can make an appropriate intervention before the patient becomes symptomatic. Sometimes it is as simple as putting the patient's dialysis chair back.

Thank you for replying. It seems like from what you are saying, the Critline will show when the point is arriving that the body can not release anymore fluid without an intervention. Are you knowledgeable as to what, specifically, those interventions are that work in conjunction with the Critline's monitoring, or is that beyond the scope of what you do?

The inrerventions are the same as those that would be made without use of the Crit-Line; ie: Trendelenberg position, reduce UF, saline bolus,etc. The great thing about the Crit-Line is that it allows the clinician to be pro-active; the intervention happens before you (the patient)has a morid event!

I am not referring to morbid events. I'm asking if there are techniques that can get the fluid off that is resistant? Anotherwards, I may get down to .3 above my dw and my bps are now into the 90's. I know there's more fluid on, but its resistant that day. What I'm asking is, are there techniques for removing the correct amount of fluid the most efficient way that should be used in conjuction with the Critline? Does the Critline show when fluid is resistant so techniques can be used to draw the fluid out, and if so, what are the specific techniques?

The Crit-Line does not show fluid resistance. It shows plasma refilling. As long as plasma refilling is taking place, more fluid can be removed. You may need to have your chair tipped back so that your head is down. The best way to determine if their is more fluid to be removed is to put the UF rate to minimum, the last ten minutes of the treatment. If refill takes place, there is more fluid to take off. If their is no refill present, you are as dry as you are going to get for that particular treatment.
Hope this explains your question

quote:

Originally posted by Linda A:

I agree with Chuck. I feel there is no better way to determine true dry wgt than a GOOD nursing assessment. EDW is an ongoing frequent assessment, predialysis, intradialytic, and post dialysis.The October 2002 issue of Nephrology Nursing Journal has a great acticlewith CEUs pertaining to this topic.

Patient,

First off all let me start out by saying I work on the technical side of the dialysis world and only have a general understanding of the clinic side of things and am not familiar with all of the tools and methods used by clinical staff. However, it sounds to me that by trying to get off that 'little extra' bit of your dry weight is causing you to bottom out in the blood pressure department. Have you suggested or has your doctor suggested perhaps lengthening your treatment time a little? It sounds to me like maybe it's just too much fluid and too little time. Don't get me wrong, I'm not calling you non-compliant by any means. Just maybe adding a little more to your treatment time would give your body time to adjust and get that extra fluid? Sodium and UF profiling are great but isn't it still taking off the SAME fluid in the SAME amount of time? I'm just throwing out suggestions to try and help. Hope it works. Good luck!

[This message has been edited by GTSCSS (edited 04-24-2003).]