Sodium Profiling

  1. Hi, have a question for all you renal nurses re: your sodium profile use. We have the Fresenius K machines and they have programed Na profiles in the machine. The favored one in our unit is the linear starting at a Na level of 150 and dropping to 135 over the course of the treatment. The question arises - do we need to stop the Na profile with 1/2 hour remaining or is the gradual decline in Na level to 135 sufficient. Also, does anyone have any other profiles or suggestions to assist us with unfortunately high fluid gains interdialytically. We do not have alot of spare time and can't allow patients extra treatment time to remove fluid and have resorted to the Na pull to assist with this removal. What are your thoughts/suggestions.
    Thanks,
    K
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  2. 17 Comments

  3. by   ageless
    we use linear.. set from 145 declining to 135. No need to shut it off, it reaches baseline at the end of the scheduled time. Always check the patients blood sodium level before using and remember it causes extreme thirst so it could be the cause of noncompliance.

    Has mannitol or albumin been tried?
  4. by   Northern nephron
    We tend to use albumin in extreme hypotensive cases but not for routine fluid removal. What are your average fluid gains? Does a start of 145 seem enough? How do you find your post Na levels with this type of profile....I have not noticed a problem with ours but we have some nurses who are concerned.
  5. by   ageless
    We use 145 because of concern over post Na levels and the cardiac associated problems.
  6. by   Northern nephron
    Thanks again. May I ask where you nurse and do you use the Fresenius K? I am from Manitoba and we have had these machines just over one year. We are still experiencing growing pains.
  7. by   ageless
    fresinius H...I do predominately acute care.... remove anywhere from 0 to 7-8 kilos a treatment. In acute we can also use several different drips to help support B/P.
  8. by   Northern nephron
    Thanks for all of your responses. I appreciate the input.
  9. by   TELEpathicRN
    Hi, I am an acute HD RN and we use FH's. If you use the step NA+
    its is set at 150 and stays 150 until 30 mins before termination of tx( you have to set it to cut off), if you use the linear, it starts at 150 and slowly goes down to baseling by the end of the tx. Our docs always use 150 as a starting point. I dont think I would have much luch increasing BP with NA of 145. Some of our new docs use a step profile of 148 for the entire tx, mostly used in severely hypotensive pts (ICU pts, ARF, etc...).
  10. by   Northern nephron
    Thanks for the input. This is how we have been using the linear profile at present and personally do not feel that we have a problem however, others do. Our doc is also of the opinion that we need the 150 Na level but I just wanted others feedback as to the stop time before our next unit meeting. Have you ever noticed problems with your post Na levels without turning off the linear profile 1/2 hour before the end of treatment? The previous responder didn't seem to have trouble. I really appreciate the feedback.
  11. by   TELEpathicRN
    Nope, the step is the only one that is supposed to be turned off 30 mins before tx ends. It stays at the same level and then just stops 30 mins prior to taking the pt off, enough time for the pts Na to level back out. The linear is a slow and steady decrease in the NA level from 150 back down to 135, so there is no reason to have problem with post NA levels being high. With the linear profile, it returns to normal before the pt gets off the machine.
  12. by   jnette
    Yep ! Here, too. I work for a Fresenius company. Our doc has on use the 150 on all but one pt., he gets a 155.. he's a BIG fella !

    We use mostly linear, and a few step. We don't decrease at the end, either, and most run the full tx. A few half-hour shut-offs, but as stated, those are the "steps". We also program in the UF Profiling on several of our patients... the one with BP problems. We use mannitol for hypotention.. usually does the trick. And hpertonic saline for cramping.

    I love reading how others do theirs, etc. Can always learn something ! Not that we would be able to change our docs minds, however.. but it's still worth noting !
  13. by   Allaroundnurse
    We have H's and K's, we use 146 to 148 linear on most patients. If they are diabetic our doc's like step. If we use 150 for more then 2 treatments our doc's like to know because they may need to adjust B/P rx. We do not use Na profiling until the SBP is <170 and then you have to remember to set your Na profiling time to your RTD. Remember that some patients do get inc. thirst with Na profiling.

    We also use UF profiling with the Na modeling. I have found that my Low B/P patients who have problems at the end of treatment respond better to a Profile #1, most run well with a UF profile #2. I have had a few crampers that did real well with #3. Just don't set 5,6,7 8 even though it is on the machine.
  14. by   ValWai
    We used to use UF profiling together with Na profiling. We start off with 145 and gradually down to 140. Patients seem to tolerate this quite well but we find patients will become overloaded easily after Na profile. And more patients got admitted for the same problem. So we stop Na profiling and continue to use UF profile during treatment. And we observed a decrease in no. of overload and admission.

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