i am aware that some units will connect the arterial and the venous needle at the same time at the start of dialysis. this essentially gives the patient ~200cc of extra fluid, however,i feel, it provides an extra bit of safety. not only are the potential risks for infection reduced but the patient is at no risk of loosing blood.
does any one have any information on this practice? i would like my unit to start using this practice. any info would help

[This message has been edited by donna2003 (edited 08-13-2003).]

Donna,

I am a cheif tech at a clinic in Oklahoma and we do this procedure too. We use the guide line as follows. If the patient gains less then 3kg the patient is given the 200cc of saline if he/she has gained 3kg or more it is done the "old" way. If the patient is given the saline it is figured into their goal and taken off during tx.

Example patient gains 2.9kg their goal would be 2900 + 200 (in dialysate lines @ start of Tx)+ 200(rinse back)= 3300.

As for the risk of infection I agree but we do have some that will gain >10kg in between Txs. What do you do for those type of patients? An extra 200cc of saline that they do not need!! Right? As for loosing blood, it has been my experience that a patient will not lose any to no blood at all if done correctly. I mean come on we are only human and I know I have let the line get a little red before who hasn't? It is a good practice unusal to get use to but a good one. If you need anything further email me.

Matt

Donna,

We, too practiced the policy of giving prime to patients who needed the fluid and also to our catheter patients. We felt there was less risk of infection. However, the CMS Inspector that came to our unit disagreed. She said AAMI standards dictate that no patient on reuse should receive the prime solution. They feel over time even very low levels of germicide could do the patient more harm. I live in Michigan. I'm not sure if this is the same where you are. My guess is you better check it out before your unit gets a visit from CMS.

Dizzy,

The CMS inspector was trying to make you comply to their own personal opinion on the matter. There is no AAMI standard or regulation regarding this. Many of the inspectors have worked in dialysis and try to get you to comply with what was policy where they worked at. These things are usually mentioned in the exit interview but when you receive the actual survey there is no citation because there is not a regulation to back them up.

Donna,

The practice of "dumping the prime" is from the old days before there were high UFR dialyzers like we have today and that extra fluid was a pretty big deal.

With the dialyzers and volumetric machines that we have today, the extra fluid is of little concern. However, there are still pro's and con's associated with both methods, some real and some exagerated. It is up to the individual unit/company to decide which way they want to do things.

Chuck

[This message has been edited by Chuck W (edited 08-28-2003).]

The CMS response about giving the prime on reuse dialyzers is actually stated in dialyzer package insert. It is doing a "saline refreshment" by which you replace the recirculated saline with fresh saline. This practice has been going on for years.

Dumping the prime or in other words "Bleeding the patient on" is NEVER a good practice.
The patient could bleed out.
With the sophisticated UF control machines we have now the practice of bleeding the patient on is outdated and dangerous!

I agree that dumping the prime sounds like a bad idea because that's about 200-300 cc's of cardiovascular volume (average) that the patient will be 'losing' from the corporeal circuit at the start of treatment. I'd want to stick with giving them the prime.

Most dialyzer package inserts & many Dialysis Machine manufacturers recommend that the prime is refreshed. In Oregon, where I work, the CMS surveyors expect ur to follow manufacturer rec's. It makes good sense from a best practice standpoint, and a risk management one.

"WASTING PRIME" or "bleeding on" is against comapnay policy at Fresenius Clinics and Fresenius Acute Units in North America!