what is the best and safest way to remove large fluid gains for diabetic pt. who cannot do extra txs and 5.8 is usually all
we can take off in 4.5 hrs. Run her even? Start her off high at 8.0 goal then turn her uf off when bp drops. we have no uf profiling with cobe. She ends with headaches if goal set too high and bp is around 104/58 and always has to sit awhile. help!!!!

First: Some investigation is in order.... what is going on with this patient and the continually high fluid gains? Is it a non compliance problem? Are her blood sugars so out of whack that she is continuously thirsty and needs to see her MD for further follow up? Does she simply not know the rationale behind limitting fluid intake?

However, to remove this fluid, I would try to create a UF profiling system. Try to remove the largest portion (ie 75%) of the fluid the first half of the treatment, and then remove the last quarter the last half of the treatment. This is going to take some heavy nursing and technical intervention. DON'T ATTEMPT THIS IF YOU DON'T HAVE THE STAFF TO OVERSEE THE PROCESS. What could happen then is that you perform the entire treatment at the higher rate of fluid removal, and the patient is severely compromised. Also, you shouldn't attempt this if you don't have a procedure for it within the company you work for, or without first notifying your immediate supervisor and the MD.

You also might want to try sodium modeling. I have had very good success with sodium modeling and removal of fluids. I would recommend using a 10% linear approach and seeing if that helped any.

BEFORE you attempt any of these variations in treatment, you must first have a written order from the MD since you are modifying the dialysis prescription somewhat.

Does anyone else have any suggestions?

Let us know how things work out for you.

Carol