DialysisEthics2_Forum
Educational => Questions (2003-2006) => Topic started by: admin on August 30, 2009, 02:40:42 PM
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patient
Joined: 29 Oct 2002
Posts: 137
PostPosted: Sat Jan 10, 2004 7:12 pm Post subject: SM
In testing out SM linear 145 with a base of 140, I have found that
inging the sodium back to the base 30 min from the end of the tx does not work for me. This causes the sodium to be depleted from my body with the conductivity dropping to 13.6-13.8 on my machine in the last 30 min. This is on my machine that has a starting cond. of 13.7 -13.8 (before setting SM linear 145).<
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>So, I am not clear on the purpose for setting the sodium to come back to base 30 min before the end of tx. It definitely doesn't work with me. How could such a setting be a standard unit protocol when it obviously doesn't work in my case? And I know other patients who have tried it and it doesn't work for them either. They experience the same thing I do - a depletion of sodium and immediate hurtful symptoms (headache, pressure on heart, chest, stomach, muscle soreness, achiness in bones, mental fog, nausea etc). <
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>When the cond. of my machine falls below 14.0, I have found that if I reset the SM, the cond will rise to about 14.2 again and I will feel fine until more time elapses (about 2 hrs) and the cond drops to 14.0 again. At that point, I have to reset again. Some txs I have to reset one time, and other txs I have to reset 2 times to stay above 14.0 the entire tx. That is the key for me - I am not comfortable below 14.0.<
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>My nurse says why not set my sodium base for 142. That way the cond will not drop below 14.0 and it will not be necessary to reset the SM.<
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>Do you feel that this is an accurate statement? By resetting the SM with a base of 140, I do not experience thirst. If I change the base to 142 could that cause thirst? <
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>Also, what happens if the SM linear is set at higher than my setting of 145? I understand it can be set as high as 150. <
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>Shouldn't there be a way to properly assess a patient to decide what SM program he should run at? I would like to know where I can find this info.
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KIm
Joined: 17 Dec 2003
Posts: 4
PostPosted: Mon Jan 12, 2004 10:42 am Post subject: iron and epo
Mu current labs are: hct-36.3, hgb-12.1, ferritin-580, iron sat- 26, iron- 48. When is it time for iron? I get 2900 epo 3x a week. I have not had any iron since my last iron infusion. Why is iron given in an infusion rather then steadiy less at a time?
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KIm
Joined: 17 Dec 2003
Posts: 4
PostPosted: Mon Jan 12, 2004 10:43 am Post subject: Iron and liver
I've heard it bad if too much iron gets to the liver. How can this be prevented?
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Paul
Joined: 06 Jul 2003
Posts: 4
PostPosted: Mon Jan 12, 2004 10:46 am Post subject: Calcium
What should calcium be for us on dialysis? I read somewhere that the high 10's are best. Is this so?
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Mary
Joined: 24 Oct 2003
Posts: 2
PostPosted: Mon Jan 12, 2004 10:52 am Post subject: CO2
When CO2 decreases too much some patients are out on sodium bicarbonate tablets, but I've read where others say the doctor raised the bicarb on the machine or changed the acid K #. My doctor said he wanted me to use bicarbonate tablets as these other ways had side effects. Any info on this?
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heather
Joined: 13 Jan 2004
Posts: 1
PostPosted: Tue Jan 13, 2004 6:09 am Post subject: bicarb
How low should bicarb go in the jug before it is changed? Also, should tx begin with a full jug of bicarb or is it ok if txs are started with what's left of the bicarb from the previous patient? It seems it would be better if every patient started out with a full jug. <
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>Is it alright for bicarb to poured from another patients jug into my jug?
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KIm
Joined: 17 Dec 2003
Posts: 4
PostPosted: Tue Jan 13, 2004 7:03 am Post subject: Iron
My doctor rounded and I asked him if my numbers indicated that I needed iron. He said because my ferritin was over 500, it was not time yet. <
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>Then I got a copy of my labs and the RN anemia manager had notated that I should get iron once every 2 weeks as my hgb was 12.1.<
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>I also asked my doctor why my ferritin had gotten up to over 1500 prior to now coming down to 580. He said it was because I have had iron loads in the past. <
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>So, I asked my doctor if he meant that if I am given an iron load does that mean they can not control how high my ferritin will go? At that point he didn't give me a clear answer.<
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>This has me very concerned as the doctor had just said that too much iron raises the ferritin and can damage the liver and other organs. <
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>When giving iron loads how is it determined how much iron to give so that ferritin is not raised too high with resultant damge to liver, etc? How would I know if I had liver damage as my ferritin has been high for months.
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Lorrie
Joined: 04 Mar 2003
Posts: 3
PostPosted: Tue Jan 13, 2004 11:12 am Post subject: Bun
My pre bun usually runs 60 average. This month it was 81. What does that mean?
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Lorrie
Joined: 04 Mar 2003
Posts: 3
PostPosted: Tue Jan 13, 2004 11:17 am Post subject: bun
Also my post bun was higher at 25. My kt/v also went from 1.74 to 1.36. Could this be a lab error? I was given a different single use dialyzer this month. I hope it's not of lesser quality.
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hd patient
Joined: 22 Nov 2003
Posts: 4
PostPosted: Wed Jan 14, 2004 5:28 am Post subject: THANKS!
Hi FRN!, <
>Just stopping in to say thanks for all you do and to tell you I'm doing 100% better due to my improved dialysis knowledge! Knowledge really is power and it feels so great to be in control of my txs instead of the txs controlling me. <
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>Thanks again and have a great day!<
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>hd patient
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leadsag
Joined: 31 Oct 2002
Posts: 263
PostPosted: Thu Jan 15, 2004 7:00 am Post subject: Re: Educational Questions, Part 49.
YEsterday we were informed that from now on they will be doing "dry sticks". <
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>In the past they had a syringe of saline attached to the needle that they squirted into the trash can before cannulating. THey claim it will give us higher/better labs since the saline was diluting the samples.<
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>Uhmmmm how does the saline dilute the sample when you squirted it into the trash?<
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>I suspect it is the cost savings achieved by eliminating the 2 syringes that were used in the previous method.<
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>Do you see any thing we should watch for with the new dry stick procedure?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 9:11 am Post subject: Patient
Go ahead and try setting your sodium base to 142 and see how it works for you. It won't hurt to try it and you won't know if it will work for you unless you do it once. You could also try, providing that the unit will allow you to do so, set your sodium to start out at 150 and then slowly fall throughout your run. <
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>Depending on your units policy, you can also set the sodium to drop to base only 15 min before your off time. The majority of the units I have worked in will only let you drop it to base 30 min before your off, but a few will let you do it at 15. <
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>You will need to play with the sodium and see what program works best for you. This is the only way to find out. What works for one patient doesn't always work for another.<
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>If none of this works, then please talk to your Dr and discuss what does work for you. You may need a Dr order to do something that works for you that the units policy will not allow.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 9:22 am Post subject: Kim
Iron studies
need to be done monthly as each patient uses their iron at their own pace, some faster than others and others much slower. this needs to be monitored closely as EPO needs adequate iron stores in the blood to work it's best.<
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>You have adequate iron stores for now. When those numbers drop and your EPO needs to be increased, then the staff need to look at your Ferritin and iron levels. You should only be given IV iron when you need it. <
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>Too much iron and you could become iron toxic and yes, it could affect your liver. Weekly doses of IV iorn are<
>only given to those who "eat it up" and can not keep enough of it in their bodies for the EPO to work it's best. The rest of you need it only when you have inadequate stores in you body.<
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>When Ferritin is down to 300 and Iron is in the mid to low 20's, then a series of IV iorn should be considered.<
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>Iron is given in an infusion as it has been proven that patients like yourself get the best benefit from it. Oral iorn is not absorbed well enough to provide the adequate iorn the EPO needs to do it's job. And some patient have trouble with oral iron as it can cause stomach upset. <
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Founding RN
Joined: 21 Jan 2004
Posts: 1
PostPosted: Wed Jan 21, 2004 9:38 am Post subject: Paul
Calcium should be 8-11. 9-10 is prefered. If the calcium level is too low or gets too high, it can, like potassium, cause the heart to stop.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 9:42 am Post subject: Mary
Bicarb tablets are safer and can be something you actually need, like TUMS, that can add calcium to your diet if you are low on that. <
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>It is harder to keep changing pre set settings on the dialysis machines, then remembering to re set them after you use it. Also most companies are going to standard solutions and will not alter them as it adds that extra expense of having to test each altered solution to make sure it is safe to use.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 9:44 am Post subject: Heather
Bicarb is good for 24 hours from the time it was mixed. Yes, it is much nicer if every patient can start out with a full jug, but combining left overs from other jugs is o.k. also, as long as they are not over 24 hours old.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 9:55 am Post subject: Kim
A series of IV Iron will dramatically increase the Iron, Ferriting and coresponding lab values. What is needed here is a close monitoring of these lab values.<
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>The anemia management RN is wrong in saying you need IV iron every 2 weeks. That would only increase your values and they need to come down. This would only be right if you were not to recieve a series of iron infusions again. But again, close monitoring is needed here. <
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>When a full series is given, no, the final lab value can not be controled. But it is important to let the ferriting and Iron levels drop down to the lower values as this shows how fast the body is using the iron.<
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>If each time you are given a full series of Iv iron and your lab values go way up, then you and your Dr. need to consider only half a series when you need it.<
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>I wouln't worry too much about liver damage as long as the iron and ferritin levels are allowed to come down to the levels I mentioned in my previous reply to you. Damage come about with sustained high levels that never come down.<
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>If there is liver damage it would show up in various liver labs like SGOT. For more specific info, please consult with your Dr.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 9:59 am Post subject: Lorrie
It is possible that the kidney you were given does not have a co efficient equal to the previous one. You need to check with your Dr. on this. It would appear that you are not getting the amount of dialysis that you need. This may require you to spend more time on the machine if they will not give you a kidney that is equal to the previous one. There are lots of different choices out there and one should be able to find a non-reuse that is as good if not better than the reused ones.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 10:00 am Post subject: HD Patient
Thank you!
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Wed Jan 21, 2004 10:05 am Post subject: leadsag
I would agree with you that it is a cost saving thing. But most places do dry sticks anyway and there are no problems. As to diluting the samples, that is only if they didn't draw the saline out before drawing blood. <
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>Actually, I find doing dry sticks much better in gauging when I am in the access and how well the needle is threading. I only use wet sticks on a patient who clots their needles before I can get them taped up and connected to the machine. Then I use heparin in the needle tips only.