If ones arterial pressure climbs higher than -200 during the tx, what should the corrective course of action be? My arterial pressures seem to run close to -200 a little more or less, but then some readings go as high as the -220's or 230's. My RN feels the solution is to turn the blood pump speed down, but then I am not getting my full prescription. I have had my fistula checked out by vascular surgeons and they say my access is very good no problems. I run at 350.

Janette:

This is what I would do. First, I would check the blood tubing for kinks or crimps. If any are found, the problem should be immediately corrected.

If no problems were noted, I would then look at the access site. Does it appear to be infiltrated? Is there any pain? If not, then I would turn the blood pump down for approximately 10 to 15 minutes. Often times, your access site could simply be having a 'spasm'. No big problems with that... just like you may have a twitch in your eye lid, your access can 'twitch' also, causing your arterial pressure to change a bit. If things settled down after a few minutes, I would attempt to see if I could return your blood flow to a normal rate.

You are correct in that you won't be getting your full prescription with a decreased blood flow. However, it is even more important not to dialyze at an inappropriate arterial pressure. That could cause even greater harm.

Let me know if you have further questions or concerns,
Carol

Carol,
Is -200 set in stone as an arterial limit? Depending whos running the tx, other techs let the art pressure go as high as -250. I have also read where other renal RNs have stated that -200 is on the conservative side and they would set -250 as the limit. Every tx, most of my numbers will be at -200 or close to it, and then the other 2-3 numbers will be in the 2teens to 230. So is this suitable for me, or do I need to be concerned that I'm risking hemolysis? I will try your suggestions though and see how they affect the art. pressure.

I've also read that the needle placement could be too close to the vein wall affecting the pressures . I am trying a new thing where I ask the tech not to put the needles all the way in by a fraction as sometimes they seem to be up against the vein poking it and causing soreness during the tx. Previously, I had internal soreness quite often and this has solved that problem. Nevertheless, I'll still have a few higher art. pressures.

lower the blood pump speed to what speed?

Janette:

I can't tell you if the number is 'set in stone'. I can tell you it is the number that is most commonly used to describe maximum arterial pressure in the community.

I, too, have seen higher pressures and no damage done. However, that doesn't mean I would recommend it, or allow that to be the norm.

To get firm numbers for your pressures, you really need to check with your physician.

Pressure from placement against the side of a vessel can increase pressure. Be careful, however, when repositioning a needle so that it is not removed 'accidently' during the process.

Melonie:

I would simply try decreasing the blood pump speed in small gradients, 10 - 20 mls at a time until the pressure returns to baseline.

Carol