Maximum UF limit for hemo patients

  1. 0
    Hi all. Looking for research information and thoughts/comments on everyone's current practice.
    Do your units have a maximum level at which they will ultrafiltrate a patient? Does anyone know of any literature out there to back this discussion. We have a patient - younger, noncompliant with fluids,meds, diet etc etc. Anyway - he likes to have the staff in our unit set the UF rate at as high as 3000ml/hr for the first half of his 3:30 treatment. He has wicked cramps and is known to go hypotensive. We are not comfortable with this UF rate but have nothing to back us up when we want to refuse.
    Would welcome all thoughts and comments.
    Last edit by Northern nephron on Aug 17, '05 : Reason: typing error
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  4. 7 Comments so far...

  5. 0
    Our medical director has set a net maximum ultrafiltration of 2L/Hr. Perhaps, you could speak with your medical director and get a general written policy on this, or a specific UF prescription for this patient.

    Best wishes
  6. 0
    Quote from Northern nephron
    Hi all. Looking for research information and thoughts/comments on everyone's current practice.
    Do your units have a maximum level at which they will ultrafiltrate a patient? Does anyone know of any literature out there to back this discussion. We have a patient - younger, noncompliant with fluids,meds, diet etc etc. Anyway - he likes to have the staff in our unit set the UF rate at as high as 3000ml/hr for the first half of his 3:30 treatment. He has wicked cramps and is known to go hypotensive. We are not comfortable with this UF rate but have nothing to back us up when we want to refuse.
    Would welcome all thoughts and comments.

    Lots of things go into the mix, but the ultimate decision should be yours (and the doctor's). A bigtime crash can result in long term problems for the patient, and I'm sure in his lawsuit he will hold you responsible, as indeed you would be. Like I said, several things go into the mix. High Bun level with a high pump speed and high dialysate flow greatly contributes to hypotension and especially cramping. That's the reason you can pull so much in the UF only mode. Do you profile the sodium and the UF?. Tne bottom line (overused phrase, I know) is, you have the training, not the patient. The doctor will back you up, but YOU must run the show. Eventually as this guys heart enlarges and becomes weaker, he will become more fragile, so he might as well learn his lessons now. We had a guy like that. I had the unfortunate experience of dialysing him for the last time in ICU. He collapsed and died two days later at home at 43 years old. Your do no harm vow doesn't mean the patient will like what your are doing, or even like you for that matter.
    Steve
  7. 0
    Dialysis patients either comply with all the rules, or none of them, in my experience. I have had this kind of patient as well. It is ultimately the medical director's decision (in my case) for a maximum UFR. We have both SVS and profiling on our machines (Fresenius H and K). These are helpful, however, there is no way that we can follow a patient around and make them "obey" the rules "we" set for them. They still must live their lives, and, educate as we may, it doesn't matter to some patients. The younger ones have the "ten foot tall and bullet proof" syndrome, in other words, nothing can harm them. Sometimes, we as nurses, must simply allow them to live their lives and accept the consequences of their choices. It is different for our peds patients, but, even they have their own ideas.
    Back to your original question, we max out at 2000/hour. Profiling helps. Good luck finding an answer. Please talk with the CN or your medical director.
  8. 0
    Quote from wir5
    Dialysis patients either comply with all the rules, or none of them, in my experience. I have had this kind of patient as well. It is ultimately the medical director's decision (in my case) for a maximum UFR. We have both SVS and profiling on our machines (Fresenius H and K). These are helpful, however, there is no way that we can follow a patient around and make them "obey" the rules "we" set for them. They still must live their lives, and, educate as we may, it doesn't matter to some patients. The younger ones have the "ten foot tall and bullet proof" syndrome, in other words, nothing can harm them. Sometimes, we as nurses, must simply allow them to live their lives and accept the consequences of their choices. It is different for our peds patients, but, even they have their own ideas.
    Back to your original question, we max out at 2000/hour. Profiling helps. Good luck finding an answer. Please talk with the CN or your medical director.
    Our medical dir. lets us set the max UF rate... usually 2 max! Most can't tolerate more than 1.5/hr.

    You just get to know the patient and what they can and cannot tolerate. Good luck!
  9. 0
    I have seen patiens with 10-15 kilo's on, and no this is not compliant! And sometimes patients are not compliant with their meds also, or their diet, or their dialysis regimen, or their mouths for that matter, just no compliance ability.

    But please remember that these people too are patients and that we are there to serve them, and sometimes this tests every limit known to us...but in the end the one they are killing is themselves-slowly but surely. It is their crdiovascular system expanding, their tissue drowing, there lungs losing capacity due to excess fluids in them, their heart pumping more and more, harder and harder...and in time no more.

    I sometimes want ot just make them aware, or scream back, or just jsut....but remember you are the one in charge and if you feel it is unsafe you have the right to refuse...but do not refuse cause your angry, and don't let anger get you to do something you'll regret....take a breathe, ask for help, and remember your a good person and so are they....God created us all and he doesn't make junk!

    We used 3L/hr UF, as usually BP stays up with Ultrafiltration. Try starting them in Trendelnberg, maybe that will be enough. Try education of the physician so that trying different Sodium Programs along with UF programs to pull the weight off normally. Try using patient advocate groups to talk to the patient. Whatever, keep your coll! Good Luck!
  10. 0
    Our max is 2L/hr as well. Your patient needs some literature on how difficult his fluid gains are on his health. Go research nursing sites, dialysis sites and nursing research literature. CINAHL and other nursing research data bases have info you can print out. Go to your local college, ask for help to find this if you can't on your own. Or their nursing department.

    That patient needs education, education, education. I am currently doing a nursing research paper on compliance regarding Phosphorus and have found TONS of info on weight gains/non-compliance issues (this was on 9/29/05 I searched on-line) so I know the info is there!

    Encourage.. in positive manner... negativity doesn't work! Education doesn't always work.. but from what I have read, consistent education by TRUSTED NURSE OR PCT is imperative to compliance. Good luck... PM me if you need me to email you some sites.. :big:
  11. 0
    we also use the 2.0L/hr max. Sometimes slightly over if using UF profiling, than the rate drops after the first 30 minutes of tx.


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