whatsnext
Joined: 28 Oct 2003
Posts: 1
Posted: Tue Oct 28, 2003 12:50 pm Post subject: we need standards
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They came up with a way to improve nearly everyone's KT/V last month. Now they turn the pump speed down to 50 and draw the post treatment labs direct from the return blood line. <
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>There needs to be standards and now standards on how the standards are determined.
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Fri Oct 31, 2003 12:59 am Post subject: standards
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all the information can be taken from the back of the machine and feed to a central computer. walmark does from thousands of stores for thousands of items. it would be child play to collect accurate data on dialysis.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Oct 31, 2003 5:54 am Post subject: LOL
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Well, it didn't work for me lol They did that for the first time in our unit this month and my urr and kt/v dropped. My urr had previously been in the mid to high seventies and dropped to 71%. They just did a redraw, but seem a tad confused because it was a normal tx. and in fact even had a higher pump speed throughout the tx... Perhaps needles were too close or something. Turning the speed down to draw shouldn't affect the outcome if the pump speed was normal through the rest of tx.. Lin.
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plugger
Joined: 11 Jan 2003
Posts: 235
Posted: Sat Nov 01, 2003 5:14 am Post subject: information
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Ridgerunner,<
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>What specific information can be loaded from a dialysis machine? I was talking to a staff member of my Congresswoman's office. I mentioned the fact that this was possible. She seemed very interested.
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Sat Nov 01, 2003 11:41 am Post subject: machine technology
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currently the information that is in the newer machines that comes from patient data include blood pressure, pump speed, basic dialysis prescription. i have seen computers attached to dialysis machines that the staff key in treatment information including notes from rn, and tech's and data warehoused. i was told years ago by my doctor that in the jetson age, the nephrologist will give the patient a disc and the staff will pop it into the dialysis machine and the machine will set itself and the machine will write down on to the disc any deviation from the prescription to be reviewed by the nephrologist. but have not seen this one yet.
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Sat Nov 01, 2003 11:57 am Post subject: DOQI
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From what I remember there is a standard way of drawing KT/V labs. The NKF has established DOQI guidelines for drawing so that there is consistency. Question is what line are they drawing the sample? Venous or arterial? If it is pulled from the venous line post treatment this is definetly wrong. Since urea is double pooled it will rebound after treatment. Drawing thirty minutes after treatment is a better overall indicator. Some of the newer machines will actually provide a flow sheet of the treatment. All of the machine parameters and BP are automatically logged in and printed at the end of treatment. Then the staff only has to sign the sheet. Sorry for the rambling post
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Sun Nov 02, 2003 3:10 am Post subject: Computer Information
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Plugger, Our computer sends to the center all the machine readings. Including Venous and Arterial Pressures. It also sends all alarms. I "think" whoever sets up the program can determine what they want and don't want.
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Sun Nov 02, 2003 4:04 am Post subject: machine data
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that would stop a lot the lying and cheating and the corps would not stand for that. it would save millions that are wasted on network and could be used for patient treatment but what would the poor people at network do about their high price vacations and over paid jobs.
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say what
Joined: 11 Mar 2003
Posts: 29
Posted: Sun Nov 02, 2003 8:25 am Post subject: No standard of formula
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The DOQI Guidelines were made by an unrestricted grant from Amigen. This is not to be confused with Standards. If you read the DOQI Guidelines they are disclaimed.<
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>No standard formula is used. Each clinic can use the URR or KT/V, and many math formulas to choose from. Also no standard on how to collect the formulas. Many of the companies own their own laboratories. <
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>Where I worked we drew it from the clean port with the blood pump still on to 100. <
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>Have you ever noticed that a patient with excellent lab values look uremic and no quality of life, but they have good numbers? The quality of life is the only qualifier and the industry knows it. <
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>What looks good on paper is not always the reality. This I agree ridgerunner, it seems like the networks are aware of this. They should work for Amigen maybe.
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Sun Nov 02, 2003 10:34 am Post subject: KT/V
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While the NKF are only guidelines, for the most part they are considered the level of care that most facilities strive for. As far a KT/V I am not a big fan of this either. Too many different factors involved. For this reason I prefer URR. There can be no manipulaiton of this as it is a simple formula. As long as the post sample is not diluted with blood coming out of the dialyzer it is probably a valid sample. A much better test is to wait 30 minutes post treatment so that you can get some indication of what is in the second pool. Otherwise all you are measuring is what came out of the blood, not the extravascular system where a good amount of Urea can be hidden.
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Sun Nov 02, 2003 11:56 am Post subject: none
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Good luck getting the patients to stay an extra 30 minutes just so you can get a lab draw
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Reality of care
Joined: 19 Aug 2003
Posts: 2
Posted: Sun Nov 02, 2003 11:05 pm Post subject: My clinic
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My clinic cannot decide what they are going to use from month to month. One month it is kt/v the next urr. The next month hct the month after that is hgb. They own their own clinic and at one time hinted around to manipulating the kt/v due to the fact that I have a little urine output. Come on folks get a clue, we need standards!
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Lin
Joined: 28 Oct 2002
Posts:
337
Posted: Mon Nov 03, 2003 1:31 am Post subject: Good labs!
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, I had excellent labs when I first started dialysis, but I felt like crap. Staff and my neph. just said ad nauseum "but you have good labs". As it turned out they were taking kilos of fluid off of me when it was real weight I was gaining. I was severely dehydrated and my labs weren't even correct! Things like dehydration can severely affect labs; gee I wonder how many pts even have correct labs. How well a person feels should be the ONLY thing that matters. The rest is just to make the unit look caring and good, and that is why so many pts. note that the pump speed is always turned up on lab day. Lin.
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EFFIEICENT DIALYSIS
Joined: 03 Nov 2003
Posts: 1
Posted: Mon Nov 03, 2003 9:00 am Post subject: Kt/V = SCAM
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As far as I'm concerned, Kt/V is not a true measure of an efficent tx. It is a ploy of doctors to make their results look good on paper. <
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>There are no standards safeguarding the measurement of Kt/V. With no one looking, the rules of measurment are easily
oken. <
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>Kt/V is not an accurate measure in the first place, because depending on how the tx is carried out (i.e eating on the tx or not, flushing the dialyzer or not, units and numerous other factors) the results are not standard from patient to patient and from unit to unit. <
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>I agree that it's not the paper results, but how well the dialysis consumer feels that measures the efficiency of the tx. What is the patient's hct and hgb? If the patient must rely on EPO it shows the tx is not efficient. <
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>Kt/V is the industry's poor excuse for not providing efficient txs. It's a smoke screen!
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I dont
Joined: 03 Nov 2003
Posts: 1
Posted: Mon Nov 03, 2003 11:34 am Post subject: understand
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I've never heard that an efficient tx. would keep a person from needing EPO. Would you explain how this works? I've been on dialysis for 8 months and yo-yo back and forth between needing it and being off it. Thanks.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Nov 03, 2003 11:56 am Post subject: EPO
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A pt. may need extra epo if blood is lost when not all is returned to the pt. at end of tx. but the biggest need for epo is
ought about by the body's innability to produce it. I was on epo over a year prior to starting dialysis and that certainly was not because I didn't have an efficient tx..! I think the poster made a typo or doesn't understand how blood cells are made. Lin.
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Mon Nov 03, 2003 2:52 pm Post subject: Pick one
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You cannot argue for standards and against measurement. Forget KT/V for a moment and use URR. Anyway, the KT/V formula starts with URR anyway. This is a valid measurement that has scientific evidence that supports it. What would you use if not URR? What measures do you think should be included in these standards? I suggest that you all get a copy of the NKF guidelines and read them. Amgen grant or not, they were developed by individuals in the field. The best that this industry has to offer. There is no way that grant money could influence these guidelines. They are valid and I would suggest that these be the starting point for the standards that are discussed here but never really identified. AAMI also has guidelines for hemodialysis and these are routinely accepted and used as standards by each state's department of health.
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plugger
Joined: 11 Jan 2003
Posts: 235
Posted: Wed Nov 05, 2003 6:13 am Post subject: machine info download
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Thanks for the replies on the machine info. I think I'll send my Congresswoman's health person what I've got and list of people to talk to. I'm still a little confused as to what would be a good formula for reimbursment. URR + whatever else and time maybe? Of course if the reimbursment for time didn't decrease after a certain amount, it might hurt treatments such as slow nocturnal. Medicare could go
oke paying for it. Anyway I'm just thinking out loud here.
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Flaw
Joined: 05 Nov 2003
Posts: 1
Posted: Wed Nov 05, 2003 7:28 am Post subject: using URR
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using URR is very flawed....because it dosnt account for weight loss during the run...the pre sample is diluted because of fluid and the post sample is concentrated because of the fluid loss...its even worse when you gain a lot of fluid weight and have to remove it...its not accurate at all
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Opinion
Joined: 17 Jan 2003
Posts: 13
Posted: Wed Nov 05, 2003 9:18 am Post subject: Lab values
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It amazes me that a KP6 or kidney profile (sma6) is not used. It is a standard test that tells the kidney function.<
>Many other values are indicated in that test. It is one that is anD"> indicator for renal function. Your other electrolytes are equated also. It is about more than K and Cr, it is about calcium which is also VERY important and an all over electrolyte test on kidney. <
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Thu Nov 06, 2003 10:20 am Post subject: lab tests
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it is very plain that the person who wrote about the adaquate lab tests is a well trained person . give us more information. will it cost more than urea clearance. what about using creatinine as a standard.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Thu Nov 06, 2003 12:48 pm Post subject: Opinion
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are you saying the sma6 should be done pre and post? With the urr and kt/v supposedly they show how the toxins are reduced between the beginning and end of tx.. Lin.
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Lab tests
Joined: 10 Nov 2003
Posts: 1
Posted: Mon Nov 10, 2003 3:35 pm Post subject: sma
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They are routine test that tell the whole electrolyte picture. It has cr in the test,as with all important electrolytes. It would be cheaper.
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Wed Nov 12, 2003 2:25 pm Post subject: Labs
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The electrolyte test mentioned does check for renal function with Creatinine. However, in ESRD you are dealing with patients that do not have renal function. Therefore,
another test is needed to determine adequate treatments. The dilution mentioned in the previosly post is not accurate. True, there is dilution in the first sample and concentration in the second. And there are other problems with secondary pooling of urea. But if not this test what would you suggest be used? As far as I can see this is the current gold standard. Until something better comes along we are stuck with this.
