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!

Try using The Crit-Line Monitor.This machine utilizes Blood Volume Monitoring to access dry weight.It really works---It is available from Hemametrics.

My doctor said our unit won't purchase a critine as they're not cost effective and he doesn't believe they're accurate.

quote:

Originally posted by Jack M.:
My doctor said our unit won't purchase a critine as they're not cost effective and he doesn't believe they're accurate.

Has he tried to use one?

I will ask him the next time he makes rounds. Can you tell me, with the Critline, just how close to the patient's dw can you get? And how much fluid should be pulled off, because when the fluid is pulled too close to the patient's dw (not under but too close), doesn't that reslut in low bp and uncomfortable symptoms? Would the object be to not get too close but not too far away?

Try going on line to WWW.hemametrics.com .This site will tell the whole story.Good Luck with your dry weights.

We gave crit-lines a long evealuation period.
The theory sounds good but unfortunately
everyone moves fluid from their extravascular compartments at different rates. When you factor in cardiovascular status, albumin levels and compliance issues
we found the answers were not always that clear. Also it really doesn't matter if the patient is at their dry weight if they are so symptomatic that they feel awful. In addition it is hard to justify the overpriced disposable that must be used each time since it is simply a 2 inch piece of die cast plastic.....

"Also it really doesn't matter if the patient is at their dry weight if they are so symptomatic that they feel awful."

If they are so symptomatic at their "dry weight" then perhaps that no longer is their dry weight? All the more reason for regular re-assessment of dry weight? That is the reason we are looking for a convenient and inexpensive yet accurate method of assessing patients' dry weight. What do you think? Thanks!

mrcsdc,

I find that the best way is the "old way", good old fashioned clinical skills.

Assess the patient for:
Blood Pressure
Jugular Vein Distension (JVD)
Edema
Acitis
Lung Sounds
How they feel

Modern Technology often does nothing more than muddy the water.

Chuck W.,
If you understand this subject I'd really appreciate it if you'd explain it in more depth. It would help me and many other patients.

Jack,

All of the items I mentioned are used to determine fluid status. Some of them can be used independently but most are used as an entire package.

Blood pressure: will typically but not always be elevated depending on the amount of fluid on.

JVD: The veins in your neck will protrude when you have excess fluid on. They are measure from your collar bone with you reclined at a 30 degree angle.

Edema: Once your vascular system is full, the fluid will move to the tissues. The main places it will accumulate is in your ankles, lower back and your face. Where the fluid is located is largely dependent on whether you sit, lay or stand the most.

Acitis: Is fluid in your peritoneal cavity. It typically accumulates here if your albumin level is very low and you already have a large amount of edema.

Lung sounds: Fluid can be heard as a gurgling or wheezing sound.

How the patient feels: Have you ever heard the saying "The operation was a success but the patient died"? It dosn't matter how much or how little fluid is taken off if the patient feels bad.

Products such as the "Crit-line" can only tell you the fluid status in the vascular system, not the rest of the body. Clinical observations that I mentioned will tell you the same thing and so much more!

I hope this helps.

[This message has been edited by Chuck W (edited 05-07-2002).]

Chuck W.,
Please keep teaching here. Let me tell you how I fit this criteria. I am totally compliant on fluid, but fluid is either hidden or something?? I will get some edema in fingers and face when fluid has accumulated. The RNs have never once heard fluid in my lungs. My albumin level is good, but I would say fluid settles in my stomache area. It is more difficult on a Mon. to get all the fluid off as more accumulates over the weekend although I don't go over my fluid limit. I never take off more than 2.8 on Mon.'s as although I need to take off as much as 3.4 as I am afraid of cramping. This goal includes .7 for rinseback and two drinks. Our unit will not dump the prime so I have to remove more fluid then I feel comfortable removing. By Wed. I get down closer to my dw. With all my txs, however, I feel uncomfortable symptoms when I get close to my dw. My feet get warm and I feel internal vibration starting at my feet and legs and working up into my torso. I shake like this internally all evening, but after a nite's rest it goes away completely. My doctor and staff have no clue as to what is happening. I feel like I am riding a wild bronco the last hour of dialysis and need a solution. I have found info. that this may be a conductivity problem. No one ever questions the ability of machines to balance conductivity, but I have info that not all machines are alike.

Chuck W.,
Please keep teaching here. Let me tell you how I fit this criteria. I am totally compliant on fluid, but fluid is either hidden or something?? I will get some edema in fingers and face when fluid has accumulated. The RNs have never once heard fluid in my lungs. My albumin level is good, but I would say fluid settles in my stomache area. It is more difficult on a Mon. to get all the fluid off as more accumulates over the weekend although I don't go over my fluid limit. I never take off more than 2.8 on Mon.'s as although I need to take off as much as 3.4 as I am afraid of cramping. This goal includes .7 for rinseback and two drinks. Our unit will not dump the prime so I have to remove more fluid then I feel comfortable removing. By Wed. I get down closer to my dw. With all my txs, however, I feel uncomfortable symptoms when I get close to my dw. My feet get warm and I feel internal vibration starting at my feet and legs and working up into my torso. I shake like this internally all evening, but after a nite's rest it goes away completely. My doctor and staff have no clue as to what is happening. I feel like I am riding a wild bronco the last hour of dialysis and need a solution. I have found info. that this may be a conductivity problem. No one ever questions the ability of machines to balance conductivity, but I have info that not all machines are alike.

Jack,

I would suggest running on sodium profiling if you don't already. In either case I would reccommend programming the profiling to stop 30 minutes before the end of your treatment, doing so will assure that you are not leaving "salty" and thirsty.

As far as your not dumping your prime goes, I am a believer in dumping it unless it is needed for weight and/or BP support. I do however fully understand the reasoning some facilities have about not dumping it.

What you have read about conductivity isn't completely true or false. To make dialysate "acid" concentrate and bicarbonate concentrate is injected into a flowing stream of purified water. This mixture then enters a mixing chamber where it is turbulated in order to mix the 3 components but since it is a constantly flowing stream, 100% mixing and distribution of the 3 parts is impossible so no matter what machine is used there will be fluctuations. The conductivity displays on the machines are all "buffered" so you may not see the fluctuation on the display, this is all dependent on the sampling of the conductivity cell and the refresh rate of the display. So basically what I am saying is that you could run the exact same solution through Machine "A" and the display will read a constant 14.0 but on Machine "B" it may fluctuate between 13.9-14.1 the difference between the two machines is the buffering of the display not the consistancy of the solution.
I hope that made sense.

We use the crit-lines with every patient, every day. We have found them to be a great tool to use in objective measurement of dry weight. The hematocrits don't always match the lab's hematocrits but they certainly give us a point of reference. With use of the crit-lines we have been able to decrease or discontinue many patient's blood pressure medications.
In regard to profiling, with the crit-line we have also been able to see that our diabetics offer refill in the first 2 hours faster than we are removing. We have changed our procedure for many of those (diabetic) patients and now pull the majority of their weight in the first two hours. This usually occurs without any discomfort and they "coast" the last two hours. Most of them feel pretty good when they get off. The first two hour pull has not held true for the non-diabetics. We have only had one patient that the crit-line should the patient had a lot of fluid left but we were unable to make it shift intravascularly. She seems to carry all the fluid in her abdomen. The crit-lines have been a great tool for us and an objective method to help in assessing patients. We still use all the skills for assessment.
We do not reuse either. Our mission is to provide the "Best care at the Best Price" and always try to do what is in the patient's interested. Sometimes that includes practices that are not reimburseable. It is a fine line to walk to provide Excellence in care but keep the financial picture in line so you don't go out of business and provide care to no one.