6% "take off" rule

Specialties Urology

Published

I work in a for-profit dialysis as an advanced practice RN. I am NOT employed by the unit, rather the MD's that staff it. I must preface this with the fact that I have only been in this position since July. I am very concerned about our fluid overloaded patients and the common practice to take off "as much as they want." I was always told no more than 6%of pre-dialysis weight. I have ordered PUF treatments for in between hemodialysis treatments to relieve pulmonary edema, but will not endorse more than 6% off. Who determines in your units how much is taken off?

Is it the patients? Do you need an order to take off more than 6%? How much say do your patients have? Thanks.

Specializes in Renal, Haemo and Peritoneal.

Our unit rule is 1kg per hour maximum and isolated UF (eg. 1000ml in 30 min) if they are really overloaded! 6% sounds about right though.

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Specializes in Nephrology, Cardiology, ER, ICU.

Thanks Farkinott - nice to know that is what is done internationally too.

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Specializes in Nephrology-Dialysis.
Our unit rule is 1kg per hour maximum and isolated UF (eg. 1000ml in 30 min) if they are really overloaded! 6% sounds about right though.

May I revive this old thread. I'm making a little search as I've come across a this "body weight percentage" as I was reviewing our protocols.

Same goes here. We follow a maximum UF rate of 1L per hour, and when sequential UF is necessary it would be for 1L for 30 mins.

However based on recent articles (with links found on another thread) we are considering shifting to the 13mL/Kg/hr guidleline.

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Specializes in Nephro-Dialysis / Intervention Radio.

+1 on the 13mL/kg/hour rule.

We have noticed a significant drop in intradialytic mortality rate when started following it.

Only 2 instances of a code in the past year in our chronic unit. Well it may be too premature too say, but having only 2 in a year as compared to what used to be an average of 5 is a good thing.

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In my unit we had guidelines, no more than 1L per hour, but this was not always followed. Those of us that knew the patients knew what they could handle taking off. Sometimes much less than the 1L per hour, occasionally a little bit more. Sequential allowed us to take more off. We also had people come in for extra treatments. If symptomatic we would decrease the goal. Our issue was the chronic noncompliance and a lot of patients who did not follow fluid guidelines at all and then knew they could come in for extra treatments whenever they felt like it. And guess who stays late to do it? Me. It was maddening to have patients come in with 2liter of Dr Pepper and drink the whole thing during treatment. The patient was diabetic and came in for extra treatments every week. I was not allowed to enforce the no drinking or eating policy in my facility because it decreased our customer service scores. So there the patients sit eating their KFC value meal and drinking more fluid than we could take off......and guess whose fault it is that they cant get to their dry weight, ours of course.

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