Advice: Profile or Not? - Page 2

Good points, especially in regard to patient safety...no matter what the patient does (or does not do) on their end, the onus is still on us to make appropriate patient-specific treatment decisions.

I'm also a big proponent of nocturnal at-home dialysis. I am not a "fan" of big corporate dialysis chains, but I give companies like DaVita credit for researching and developing these options, no matter what their financial agenda/motive is behind it.

And if you ever find the magic bullet for convincing patients who abuse fluids to stop it, please let me know. Over the years I've tried very hard to educate high fluid gainers as to what will happen in about a year's time if they continue.

I'm not sure I've ever witnessed a chronic fluid abuser who doesn't one day walk into the unit no longer able to achieve a blood pressure above 90 Systolic. That's when the drain-circling begins.

Very frustrating. But let's face it, many of patients that end up on dialysis are there because they were not good, "life managers" to begin with. Rare is the patient with a lifelong history of poor self-management that suddenly sees the light once they're dialysis dependant.

My printer is busticated, so I'm looking forward to printing out the full study you posted at work tomorrow. Thanks for the link.

Sad truth is only 33% of patients will live to 5 years

Absolutely correct Madwife. The latest stats I've seen also show that the older the pt is when they start dialysis, the less likely it is that they will reach the 5 year mark.

I have been seeing more and more pts starting HD when they are 80+ and they usually have poor outcomes.

I congratulate you on being an advocate for your patient. The behavior of your charge nurse is something I have seen alot -- a lack of respect for the patient, a lack of understanding of the diaysis treatment... This is the problem with incenter care -- taking off large quantities of fluid over a short period of time --- It is obvious, from your statement, that there might be other patients having other problems and if the charge nurse can not give advice, supervision and teaching / education of other RNs perhaps you need to do something more to protect your patients. Perhaps you can ask for an inservice on various aspects of care.. especially considering we don't know all the medical problems/illnesses this patient has which might make a big difference.. the dialysis treatment is not cookie cutter and each patient is an individual with individual needs...

traumaRUs

could you post the link to the literature about the profiles.

"latest literature proves that when you use a profile, you are stressing the heart too much".

thanks!

I posted the original citation March 30th:Nature Publishing Group : science journals, jobs, and information this helps.

Many facilities use sodium profiliing, however, recently I have read a few articles where they are advising not to use such -- and they are finding more problems. from recall, related to cardiac --if TraumaRU, or someone can approve, I will look back and post the article --- It is tough removing so much fluid in such a short time -- some units will have the patient come in for an extra treatment, which the physician can order and with supporting rationale, Medicare will cover --

Why don't you try for a smaller UF goal per tx, say 3500-3800, and have the patient come in for extra treatments?

Nowadays, the UF formula our practice uses (as do many others) is no more than 13ml/kg/hour of fluid removal. There have been several articles about sudden cardiac death while on dialysis. If you have ever had this happen (and I have), it is a scary bad deal and you don't get a second chance.

Extra treatments sound good in theory, but dialysis units have to have space and that is not always the case.

I agree with fluid restriction education and Na restriction in diet. It's really hard pulling that much fluid in a certain amount of time. Maybe an extra treatment in between his regular treatment schedule so that you're not pulling too much fluid per treatment. Personally, I like UF profiling esp for those who have poor refill.