Quote from nurseREA
I know that if a person is crashing or cramping etc that it is acceptable to turn the uf off until the patient is stabilized then turn it back on. My question is can you leave the uf off for an extended amount of time without having any harmful effects or decreasing clearance? A lot of nurses that have many years experience say not to but there are doctors now that say it is ok. Can anyone explain the different reasonings for this?
It is a manufacturers recommendation. If you use the Fresenius K machines, the manufacturer recommends no less then300ml/hr. If UF is off or too low, supposedly you won't get great clearance. If you use the Phoenix machines, the minimum rate is 100ml/hr per manufacturer. I have asked this question many, many times. And this is always the answer. Doctors and nurses have either told me it didn't matter or it truly did. But if you want best results from dialysis, I'd go with what the people who made the machine recommend. It has to do with convection and pressure going in and out of the dialyzer (I think lol.. So they say). They say if you aren't pulling off some fluid, then the particles have nothing to travel with out of the blood stream. It makes sense, but it's usually not a nursing policy, more of a recommendation for best clearance. Replace with saline if you must, go with your policy. Personally, I never turn the UF off unless the patient is in tears cramping. You should always set the machine to at least remove prime.
Just explain that to docs and they have always agreed. "I see here you wrote for no UF, but the manufacturer recommends a minimum UFR of 300ml/hr to achieve optimal clearance and best treatment, is that ok? I will replace with saline, flush 100ml every 30 minutes. " if they say no , ok--The patient will still get HD, but it won't be as effective. Clearance also goes down if you reverse the lines, low bfr, low Dfr, or clotting in the dialyzer.