Author Topic: Questions Part 43 (part a)  (Read 1377 times)

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Questions Part 43 (part a)
« on: August 30, 2009, 09:32:32 AM »
Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 10 Feb 2003 19:15    Post subject: Educational Questions, Part 43.    

To our Readers and Posters,<
>The best defense in any fight against a disease is education. <
>This column of questions and answers is an attempt in that direction. Anyone is welcome to ask questions. <
><
> What I want to reiterate again is that my answers to your questions DO NOT and SHOULD NEVER take the place of your Dr.'s advice. I am not a Dr. and my answers are based on my many years of experience in the dialysis field. What works for one patient may not work for another. EVERY Patient needs to schedule and attend regular visits with your Dr. in their office.<
><
>This column is for dialysis and dialysis related questions. Please be aware that clinics and companies, machines, policies and procedures vary from place to place. <
><
>I hope that we can help in furthering your dialysis education.
>Thank you!<
>Founding RN <
><
>P.S. I work full time so I may not be able to answer your questions right away. But I will get to them ASAP! <
>

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plugger



Joined: 11 Jan 2003
Posts: 244

  
PostPosted: 26 Feb 2003 10:33    Post subject: daily dialysis and lab values    Reply with quote Edit/Delete this post Delete this post View IP address of poster
I was wondering if two people had the same lab values (one on 3X a week and the other on daily dialysis). Would the person on daily dialysis be healthier since they didn't have the buildup of fluid as much?

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 26 Feb 2003 14:46    Post subject: Plugger    

The answer depends on how long the daily dialysis is. If you are talking very short daily dialysis, the labs may be about the same as the 3x's a week routine. The benefit would be that fluid would not build up in the body and it would almost eliminate left ventricular hypertrophy of the heart.<
><
>If you are talking about slow nocturnal, yes, that person would be better off. Comorbid conditions would affect how well a pateint does, but if there are no significant comorbids, then you have only to look at the Lynchburg results, Marty's dad, and ridgerunner for those kind of positive results.

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Jill



Joined: 26 Feb 2003
Posts: 3

  
PostPosted: 26 Feb 2003 15:55    Post subject: Testing for URR and Kt/v    

What is the correct timing and day of the week to test for URR and Kt/v? I understand units try to rig the results. How do they do this?

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 27 Feb 2003 00:48    Post subject: Jill    

Usually URR and KT/V are done with your monthly labs. There are no set rules as to what is the best time/ day to draw the blood. <
> Questions have been raised about how accurate the lab results are when the blood samples are sent across country instead of being processed in a local lab. I personally have seen a difference in lab results when sent to a local lab and the company owned lab. The kinds of tests done can be done in any lab. To get the KT/V, the numbers are put into the computer and then computed there for the KT/V result. From what I have been told, the formula is complicated and this is the easiest was to get the results. My search online found that there are 2 different formulas for KT/V. That leads to another question, which formula is the most accurate? The companies try to say that their labs are specialized in ESRD labs. I think the jury is still out on this question. There is really nothing complicated about the basic monthly labs drawn. Any full service lab should be able to give accurate results. Only the KT/V results could be a problem.

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Lynn



Joined: 01 Mar 2003
Posts: 6

  
PostPosted: 01 Mar 2003 13:18    Post subject: Sodium    

How is a patient's sodium rate determined? You mentioned running patients at 145-150. I run at 140 and any higher than that and I get serious thirst.

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Ken



Joined: 01 Mar 2003
Posts: 1

  
PostPosted: 01 Mar 2003 13:27    Post subject: rigging lab results    

I heard that running labs after a weekend will give an artifically higher result for the URR and Kt/v. I asked at my unit what day labs are done and sure enough its the first Monday of the month. Someone else said that her tech kicked her blood pump up to 500 on lab day. She asked why and the tech said to get the best lab result.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 01 Mar 2003 21:55    Post subject: Lynn    

Sodium settings are set by unit/ company policy. It is generally recognized that a base line of 140 is where all patients should be by the end of their runs. <
>As to determining who needs sodium modeling, where the starting point is, ( 145-150) that is usually based on unit/ company policy and the patient's individual ability to remove fluid, their BP and how much fluid they normally gain between runs. It is more or less a trying of several sodium options that are available on the machine to find out which one works best for each patient. You are a rare one if you do not need any sodium modeling at all. Keeping your machine at the normal base setting of 140 is just fine!

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 01 Mar 2003 22:09    Post subject: Ken    

By drawing your monthly labs on the first day after a weekend, yes, your labs will be off. It is because you have that extra day to gain fluids and waste products. And there has always been the question of how accurate the labs results are after being flown across country to be processed in the company labs. The reason they draw these the first day of the week is so that they can be flown across country and hopefully processed in the same week. Also if there is a mistake in drawing or a missed draw, it can be done in the same week.<
> As to kicking the blood pump speed up to 500 one day a month, if there is not a Dr. order to do so, then this is a violation of your Treatment perscription. It also contributes to the developement of heart problems and will give you a false lab report of your results. What you need to know is how well you are being dialized on a daily/weekely basis. <
> The theory is that the faster the pump rate, the better cleaning you get, but if you do only 500 once a month, that is not giving you a true picture of how well or how bad you are doing. This should be looked into and if there is no order to bump up the pump speed to 500, then this needs to be reported to the unit manager, your Dr. and if no response, then report it to your state. The tech is not your Dr. and Dr's orders must be followed. The tech doing this should be written up and reprimanded. <
> This would be considered a major violation if the state came in and caught this with no clear Dr's order. They would also question why it is done only 1 day a month, on lab day. <
> It is after all your health and life!

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Lynn



Joined: 01 Mar 2003
Posts: 6

  
PostPosted: 02 Mar 2003 04:00    Post subject: Sodium Modeling    

I have always run at a straight 140, but I probably do need sodium modeling as my bps do drop into the 90s by the end of tx and it feels somewhat uncomfortable. But I'm scared to try it as the techs don't know anything about it and think its just for big fluid gainers. I don't want them to just set a model and hope for pot luck. Could it make me cramp?

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Marcie



Joined: 02 Mar 2003
Posts: 1

  
PostPosted: 02 Mar 2003 04:22    Post subject: The Perfect TX    

Once in awhile I have the perfect tx. I feel great all tx long and when I get off I feel like I could go shopping. There's a big difference in the way I feel, because usually I just hobble home. I have asked the doctors what is different about these txs. They don't have a clue and just say I must of lucked out. Can you think of any possible reasons

 for these unusally good txs? Obviously something has to be in balance in a way that it usually is not. I don't think its something in me thats changed..it has to be something in the tx.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 02 Mar 2003 04:45    Post subject: Lynn    

My best suggestion to you is to learn about your machine. Ask the techs to show you how they program your machine. Then develop a checklist that as soon as they have you on, go over with them and have them recheck the settings. Have the machine turned so that you both can see and verify the settings.<
><
>My other suggestion is that if you want to try sodium modeling, try a 145 linear. That means that at the beginning of your run, the sodium would start out at 145, then slowly descend down to the 140 base. Make sure that it is turned off the last 30 min. of your run so that you do not experience increased thirst. So if your run is 3.5 hours, the sodium program should only be on for 3 of those hours.<
><
>Sodium modeling should not make you cramp. It is used to help prevent cramping when a lot of fluid needs to be removed.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 02 Mar 2003 04:56    Post subject: Marcie    

There is not a set answer to your question as there are many possibilities. My advice to you is the same I just gave to Lynn, learn how your machine is set, what the settings are and then make up a checklist and go over it as soon as you are on, etc. Doing this will help you discover if there are any differences in your treatments. <
><
>Some common things to look at are fluid gains, premenstral, menstral, sodium intake, diet changes, ? weight gain, and even stress in your life. Keep a log and listen to your body, it will tell you and help you have better treatments.

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Post subject: I Crown You


Joined: 02 Mar 2003
Posts: 1

  
PostPosted: 02 Mar 2003 05:22    Post subject: Queen For The Day!    
FRN,<
>Every so often I just have to stop in and tell you how much I appreciate you. If everyone who worked in dialysis was half as dedicated and caring as you, there would be no more problems in Dialysisland. You have saved my life many times and contributed a great deal to making me a confident patient. I always pass it on. Love and God Bless!

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 02 Mar 2003 16:11    Post subject: I Crown You    
Thank you!

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Bill



Joined: 15 Feb 2003
Posts: 7

  
PostPosted: 04 Mar 2003 16:27    Post subject: Labs    

What is the lab thats taken post tx for? Isn't there supposed to be a waiting time of 5 minutes before they collect it so it will be accurate? At my unit they don't wait the 5 minutes.

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Bill



Joined: 15 Feb 2003
Posts: 7

  
PostPosted: 04 Mar 2003 16:30    Post subject: Labs    Reply with quote Edit/Delete this post Delete this post View IP address of poster
Also, I've heard the day of the week labs are done is important, because it makes a difference in the results. Companies will do it on a day of the week that give better results.
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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 05 Mar 2003 16:15    Post subject: Bill    

It is the post BUN. It is compared with the pre run BUN to see who well you are being dialized.<
><
>In my expereince working in many different units, I have found that there are almost as many ways to draw a post BUN as there are units! Which is the correct way? Who knows as there is not a set standard out there to make eveyone do it the same way.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

  
PostPosted: 05 Mar 2003 16:18    Post subject: Bill    

The day of the week labs are drawn does matter. If it is drawn on a Mon. or Tues the lab results will reflect the extra day you had to eat and drink fluids. If done the second run of the week, it would reflect more accurately how well your dialysis is working for you.
« Last Edit: August 30, 2009, 12:06:51 PM by Administrator »
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