I am looking for input and opinions from those who are well experienced with the 2008K machine.

TMP - if a patient usually runs 40-50, give or take, then at the end of one treatment (last hour) runs "0" then "+10" what does this signify?
To my training (new to dialysis)I am told that it could mean clotting in dialyzer, related to patient's hgb being higher, not a problem, a problem as dialysate can pass through to patient, 'don't worry'. The TMP correlated to AP/VP as both were lower than usual 150/120 give or take, versus 190/210 w/ TMP 50. I know the TMP relates to the AP/VP but am concerned as this was not addressed by staff. HELP

The TMP is the transmembrane pressure, and is a reflection of the positive pressures within the dialyzer and the (usually) negative pressure on the dialysate side of the fiber. The TMP reading will change based on the UF rate that the machine is running. If your patient always requires the same amount of fluid removed every treatment, then a change in TMP may indeed be significant. When the TMP is different than usual, it most often means there is a problem for the machine in reading the pressures, and the usual culprit is a flooded transducer protector, which by being flooded, prevents the machine from accurately reading the venous pressure. Clotting in the dialyzer often causes a higher than normal TMP, as the machine senses that less fluid is being removed than is programmed (because so many fibers are clotted off), so it cranks up the negative dialysate pressure to get back on track, thus driving up the total TMP. The arterial pressure in our unit is measured pre-pump, and thus does not play a part in the TMP.
Another concern with unusually low APs and VPs is that the blood pump rollers may not be completely occluding the tubing as they go round. This would result in a blood flow rate lower than what the pump says it is delivering, and that would result in lower arterial (less negative, that is) and venous pressures (less positive). Recirculation in the vascular access may cause less neg pressure on the arterial side because of the venous blood taking a U-turn to go right back in through the arterial side. Also, a flooded transducer protector on the arterial monitor line could also cause artificial and inaccurate readings.
I know I have been wordy, sorry! There are just so many variables in dialysis, and you are quite right to NOT take things lightly. I think you are going to be great at this line of work! Good luck!

Although my dialysis experience is principally on the technical side of things [save for what clinical knowlege I've received from my briliant nurse wife ], I do think it's worth mentioning that needle placement can also have an effect upon TMP. I've seen a TMP issue remedied by adjustment of the venous needle on more than a couple occasions.
Nuff said