The clinic my partner is in started a test trial with the CritLine this week. His current dry weight from the Dr's order is 62K. This is just a little too dry for him, so we bumped it up to 62.2K. He has NO problem challenging his dry weight...but he also knows when he is too dry and he increases his dry weight by small increments accordingly until he gets rid of the symptoms of being pruned.

Last night the staff used him for the CritLine trial. We gave them the go ahead and told them to do what they thought best for his treatment. We were looking forward to it! The CritLine indicated to the staff that Charlie needed to be challenged. His pre-weight was 65K, so by OUR calculations, he had 2.8K available for his UF goal, (plus 200cc for rinseback). They challenged him about 1 hour into his treatment by increasing his goal 1/2 Kilo. This gave him a new target dry weight of 61.7 Kilos. Sure enough, within an hour he started cramping, so they backed off by 300cc. They were now going for a target dry weight of 62K.

Interstingly...the CritLine in no way indicated that Charlie was about to crash.

With this new goal of 62K...he cramped BIG TIME about 15 minutes before the end of his treatment. UF removed at this point? He was right where he would have been if the dry weight goal of 62.2K had been left alone. Once again though...there was nothing on the CritLine that indicated to the staff that he had no more fluid to remove.

Maybe it was lack of experience with the CritLine. Who knows? Seems to me though that patient assessment AND feedback from the patient lets everyone know when dry is dry. Charlie ended up getting back extra saline to deal with the cramping and the low blood pressure, so his post weight was 62.4 and he lost the last 10 minutes of his treatment because they took him off early. The staff did a print out from the CritLine so when the representative comes back in, they can have him take a look at what happened. We haven't given up totally on the CritLine yet, but our enthusiasm for it sure has been dampened!

Don

I don't think enough can be said about nursing assesments. Medical technology is to be used as helpful tools. But we have the ability to assess the whole picture of a patient.

I have found the Crit-line to be a wonderful tool, but it does take some training to use it appropriately. I have found with many patients, but especially diabetic,pulling the majority of the weight in the first 2 hours and then "coast" the last 2, works very well. The patients refill better in the first 2 hours. I encourage getting the rep back in for some follow up sessions. Crashes will occur if you go over 20% (5% per hour).

The Crit-Line monitor works well in establishing and maintaining a dry weight. Get the rep back to ensure that the staff understands how to use the monitor correctly.. SUNNY give the monitor another chance...

Thanks for the info. They are waiting for the rep to come back in, but the rep is currently out with an injury. They're not using the CritLine until they get more training because they had several patients have problems while using the device...so they know they need better training.

Dear Sunny,
Please contact me. I work for HemaMetrics. The Crit-Line is a wonderful tool if used correctly. Please let me know where you are and I will make certain that someone gets back to the clinic to In-Service the staff.
Regards,
Nancy
email: nlepain@hemametrics.com

What do you do at your clinics when patients come in for hemodialysis with no extra weight on them. We have a pt that has been coming in three days a week for dialysis for the last few years. He is about 78 years old, 5'8", 165 lbs and for the last few weeks has been coming in with no extra weight on him at all! He is very disciplined with his diet. He eats and drinks exactly what his doctor says(not too much or too little fluid). He says he hasn't been doing anything different the last few weeks. He looks Great! I just don't understand it. The doctor has us lower his average weight so that it looks like he has gained fluid. I'm afraid we are going to completely dehydrate him if he keeps coming in three days a week like this. What do you think??