Started dialysis in Jan'04. Once the 10 liters
of fluid in lungs were removed have had difficulty with no weight gain between treatments and most recently with a crashing
blood pressure and vomiting at the start of
treatment. This has been greatly relieved by
administering saline solutions at the start.
We started with 200cc's,then 300cc's and now
it requires 500cc's to halt the side effects.
Can anyone explain to me what is happening.

test

Jane,
I need a little more information to assess what could be happening to you.
-First- how much urine do you still put out? would you say more than a quart, or less in a day?
-You said you are not gaining weight between treatments- how is your appetite?
-Are you taking Blood Pressure Medications? Do you take them before your treatments?
-Are you loosing fluids any other way- i.e.: vomiting or diarrhea?
- Are you being monitored during your treatments on a Blood Volume Monitoring Machine?

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??

no need

If a pt comes in under or equal to edw I set them at minimum and I give flushes to send them out at what they came in at. I do it slowly over their treatment as if then I can regulate more closely in case of extra for hypotension, cramping or other side effects. I have a few that are very disciplined and dont need any fluid take off. Our nephrologist also encourages this and we have very little issue with dehydration. I dont know why some think just because they are on dialysis means you have to remove fluid. If they void well and monitor thier intake it may not be a removal issue. We dont use crit lines (for one our company is way to cheap heck we duck tape chairs and they wont replace those lol much less pay for crit lines). Corporate doesnt like it because saline has increased in price therefore guess they would prefer we dehydrate them Plus many of my elderly spend lots of time outside and in the florida heat they loose fluids there also.

Sounds like many of you need a CRASH COURSE in blood volume monitoring.HEMA METRICS has info that you can view and disseminate to your fellow Dialysis Clinicians who need help.PS The new conditions of coverage address this specific issue.This is the reason that continous training in Dialysis is important.Less LDO policy and Procedures and more HANDS ON TRAINING