If the acid/ bicarb is improperly mixed or its not the recommended type for the machine what are the effects on the patient? Shouldn't this be strictly checked?

Kimberly:

Yes, it should be carefully checked.

Theoretically, if your machine has been properly maintained and does not have any abnormalities with it, it will not allow for inappropriate acid / bicarbonate to be used simply because the conductivity would be incorrect. Now, this would be for serious errors (for example, reversing the acid and bicarb hook ups); what needs to be remembered is that the conductivity could be in a normal range, but the dialysate is still not what is prescribed for you.

The best example that I can give here is that of potassium. There are probably three or four widely used potassium concentrates. It is important for clinical staff to verify all components of the dialysate prior to placing a patient on hemodialysis to ensure that the prescription is correct.

Take care,
Carol

Could you please explain this again. I didn't quite understand everything you said. Also, how could I as a patient verify all the components? And what determines the correct range for the conductivity? What is the meter they use for? Does it have to do with the conductivity?

kimberly:

What really needs to happen is that dialysate should be checked for conductivity each treatment and when any part of the dialysate may be changed (for example, if you are using jugs that 'run dry' during treament).

As a patient, ask to see the results of the conductivity check. It should be between 13.5 and 14.5 on the average. This will vary a bit from manufacturer to manufacturer, and on the type of dialysate you are using. The above range is where you will see results the majority of the time.

Ask and find out what your electrolyte prescription is. What is the potassium (the K), sodium, and glucose ordered to be at? Ask the nurse or technician to see if that is the acid being used on your treatment. If you are using a bottle or jug, ask to see the label.

The hand held meter you are referring to probably does measure conductivity and maybe pH of the dialysate. Conductivity is actually a measure of the electrolyte ions in the dialysate.

Hope this helps!
Carol

Carol,
I asked the RN about what level the bicarb should be at. She said 13 something and it can vary in either direction 6 points with 12.9 being the lowest acceptable reading. I have been noticng what it measures on the machine and my run sheet and usually it says about 13.1-13.2. I have also found measures of as low as 12.7 on old run sheets. Might these readings be too low?

What is the purpose of the meter as far as how it compares to the machine's reading? Is it a double check or is the meter more accurate than the machine?

If conductivity is measured at the beginning of the tx to let's say 13, does that mean it will remain at 13 the whole tx unless there is a problem of some kind? Or should there be a different reading at tx's end? Other than the jug running low or running out, are there any other things that can occur to affect the reading? Our dialysate (everyone on a 2) is usually pumped in from a tank in the water room unless there is a breakdown at which time they use jugs.

What happens within ones body if the conductivity is too low for the person? What happens within the body if the patient gets the wrong acid concentration?

Can you furthur explain electrolyte ions?

Thanks very much, Carol.

What actually is bicarb?

Bicarbonate is the buffer solution that is used in making up the dialysate.

12.9 seems a bit low to me regarding your conductivity. I would gather in this case that your machine may be receiving too much dilution. HOWEVER, I don't claim to be an expert in all fields, and I suppose it is possible that there is a dialysate out there that equates to a conductivity of 12.9. I would ask for reclarification, if possible. My concern is that with a condictivity of 12.9, you would expect to see a sodium composition of around 129 in the dialysate. Sodium levels below 13.5 have been shown to cause increased cases of hypotension and cramping.

According to Daugirdas in the Handbook of Dialysis, third edition (2000), the sodium level in dialysate is generally between 135 - 145. Conductivity of that solution would then be between 13.5 and 14.5.

I would expect to see some variation in the reading of the conductivity throughout treatment simply because nothing is 'perfectly' set at - for example - 14. A little variation would be normal, and to be expected. Also, if the machine is equipped with sodium modeling, you would expect to see and increase in the conductivity and resultant decrease near the end of treatment as the dialysate returns to baseline.

The meter used is simply as a second check of the machine, to make sure that all is well, and that the machine is functioning properly.

Blood that is exposed to dialysate that is too low in conductivity can result in the person having servere variations in their serum (blood) sodium, making them have cramps, or have problems with blood pressure control. It can also result eventually in crenation of the red blood cells (this is where the red blood cells actually 'shrink' on themselves and can't function properly). Blood that is exposed to dialysate that is too high, will have red blood cells that can rupture (this is refered to as hemolysis). Both situations are not good for the patient.

Electrolytes are substances in the blood that carry electricity that help your body do what needs to be done (for example, this electricity in your body is actually what makes your heart beat and your other muscles move). Alterations in these electrolytes can cause body disturbances (for example, if potassium levels - an electrolyte - are too low, your muscles and heart will not be able to function correctly).

Common electrolytes include potassium, magnesium, and sodium.

Carol