Kay
Joined: 04 Mar 2003
Posts: 1
PostPosted: 04 Mar 2003 16:08 Post subject: TMP
Is TMP set by the tech or does it register in relation to other settings? My TMP is always 60-80. Is it different for everyone? Someone said it should not be a positive number or it causes backflitraion. What is that?
***************************************************
Nancy
Joined: 04 Mar 2003
Posts: 3
PostPosted: 04 Mar 2003 16:10 Post subject: Dumping the prime
The policy of some units is to dump the prime and the policy of other units is not to dump the prime. What is the reason for those who do dump the prime?
***************************************************
Ron
Joined: 04 Mar 2003
Posts: 2
PostPosted: 04 Mar 2003 16:12 Post subject: Putting the chair back
What are all the reasons the chair is put back?
***************************************************
Lynn
Joined: 01 Mar 2003
Posts: 6
PostPosted: 04 Mar 2003 16:19 Post subject: Sodium rate
Can you say more about how sodium rate is determined? When you say they want everyone to get to a base rate of 140 what do you mean? What I am asking is, patients are on many different sodium rates, so how does the doctor decide which rate the patient should be on? Does he look at labs or other factors in the tx?
***************************************************
Kent
Joined: 04 Mar 2003
Posts: 1
PostPosted: 04 Mar 2003 16:23 Post subject: Bypass
Which alarms cause the machine to go into bypass? What happens when the machine is in bypass? Are there alarms that don't cause the machine to go into bypass? What are they?
***************************************************
Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Mar 2003 15:41 Post subject: Kay
TMP = Trans Mem
ane Pressure<
><
>The TMP refers to the difference in the hydrostatic pressure which is the difference between blood and fluid. It is the pressure inside the artificial kidney as the blood releases the waste products through the fibers into the dialysate, that them washes them away. The TMP can vary due to 3 things.<
>1 the size of the dializer<
>2 the mem
ane area <
>3 the coefficient of that kidneys mem
ane.<
><
>The staff do not set the TMP. Normal value is -20-120. So your value is just fine.<
><
>Back filtration can happen when the TMP is a positive number. This means that the waste products are not removed from the blood, instead monacules from the dialysate move into the blood, not from the blood to the dialysate. This can be dangerous if there is bacteria in the dialysate.<
><
>Positive pressures or a very high and rising negative pressure can be an indication that your system is clotting off. This can happen very fast and is usually an indication that not enough heparin was given to keep your blood from clotting.
***************************************************
Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Mar 2003 15:46 Post subject: Nancy Reply with quote Edit/Delete this post Delete this post View IP address of poster
It used to be that everyone dumped the prime. That way the saline in the bloodlines was not added to your body. but many places now require that the prime be given as too many poorly trained and inatentive staff have hooked up the arterial line, forgot that the venous line wasn't hooked up, and walked away or were distracted so long that the patient bled out and died. <
><
>One reson to dump the prime is if you have a patient who is severely fluid overloaded and in CHF, you do not want to add to the amount of fluid that patient has to take off as they are usually pretty unstable cardiac wise and the heart is already under tremendous strain.
***************************************************
Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Mar 2003 15:53 Post subject: Ron
How far back do you mean? <
>If you mean why the chair is put back so that the patients feet are up, it is maily for comfort. It also helps the BP from not falling too fast.<
><
>Some patients like having the chairs way back, this helps keep their BP's up as their heads are down and they do not feel their BP's drop as fluid is taken off. I don't like to see this as many pateints then take a very long time to acclimate to sitting up and even longer for their BP's to be up enough and stable enough for them to walk out of the unit.<
><
>If a patients BP drops, the chair is put back so blood can get to the person's head, saline is given to add volume to the blood for adequate BP's. If blood flow is not adequate to the persons head, damage can result, even a stroke. <
>
***************************************************
Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Mar 2003 16:08 Post subject: Lynn
Sodium settings are usually a unit/ company policy. A base of 140 is within the normal perameters for sodium. If you look at your monthly labs, I think you will find that your sodium will be on the low side, at least it is for the majority of patients. <
>If patients come off at a higher sodium rate, say 145, they will be more thristy than a patient who came off at the base of 140. The patient who came off at 145 will also have more sodium in their blood stream than the one who came off at 140. <
>The person who came off at 140 has a bit more leaway in their diet then the person who came off at 145. The person who came off at 145 has a greater chance of drinking more fluids to quench their thirst, thereby gaining more fluid and having a harder time the next run getting it all off.<
><
>Some Dr's will write an order for a lower starting point for sodium modeling, say 145 or 148, but all the orders I have seen ask that the patient be
ought down to 140 by the time the sodium modeling is turned off.<
><
>Staff are usually given leaway in choosing a step or linear program for each individual patient, based on their fluid gains, ability to remove fluid, and their blood pressures during the run. <
>
***************************************************
Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Mar 2003 16:12 Post subject: Kent
The machine will go into bypass when ever the conductivity of the machine is too low or too high. when this happens, only fluid is removed during that time, not waste products.<
><
>Other alarms for which the machine does not go into bypass.<
>Arterial<
>Venous<
>Air<
>Clotted systems <
><
><
><
><
><
>
***************************************************
Sue
Joined: 04 Mar 2003
Posts: 1
PostPosted: 04 Mar 2003 19:08 Post subject: Heparin
Can heparin cause bleeding gums?
***************************************************
Lorrie
Joined: 04 Mar 2003
Posts: 3
PostPosted: 04 Mar 2003 19:14 Post subject: sodium
I am completely confused about sodium. I read the section on sodium. It says it can cause low bp, but it can also cause high bp??? Patients must limit sodium so fluid can be removed. Well, why then is saline or hypertonic given when bp drops? It sounds contradictory?
***************************************************
Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Mar 2003 16:20 Post subject: Sue
Yes, but the leading cause of bleeding gums is peridontal disease. If you have that, then the heparin can contribute to an increase in gum bleeding.
***************************************************
Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: 05 Mar 2003 16:28 Post subject: Lorrie
In dialysis patients, sodium causes high BP and fluid retention. <
>When a BP drops, it is usually because fluid is removed too fast, or if at the end of the run, too much fluid has been removed. Saline is given as a volume expander with the blood to help increase the BP to a safe level. <
>( above 100 systolic) The sodium in the saline is the same concentration as found in a normal persons blood. Hypertonic is a concentrated sodium solution and should not be given unless the patient is cramping severely as it will increase the sodium level a lot and increase the patient's thirst response.<
><
/>>Patient's should not leave the unit with a BP systolic below 100 esp. if they are driving. They could pass out at the wheel and hurt or even kill themselves and others. It has happened.
