Have I lost my mind? The situation is as follows. UF 2200. Pt pre wt 62.7 dry wt 60.5. Tech told pt he was 'not' using rinseback, set UF at 2200. Pt post wt 60.9. Hence 1.8 removed with .4 rinseback. Tech insists that there was no rinseback? HELLO. Told pt if UF set at 2.2 post wt would be 60.5 -- Please explain why tech(s) tell patients they will not use rinseback, does not make sense considering some return blood until line is clear, some until line is pinkish and some until line is light red. Am at FMC unit.

No rinseback.Hmmmmmm I hope the tech isn't using air to rinseback. Kind if dangerous.

Steven

Apparently, the tech meant that he would not add rinseback to the UF goal*. Therefore, the pt's post-tx weight was 0.4 kg more than his EDW, as would be expected.

During your orientation, were you told to add a certain amount to your UF goal for RB? What does your P&P state regarding RB? It should not be up to a tech's discretion (although it can be decided by a nurse) whether or not to add RB. You should ask your charge nurse for clarification.

HTH,

DeLana :)

* In my former clinic, when we dumped the prime, we added 0.4 kg to the UF goal to compensate for rinseback; later, when P&P was changed and we we gave the prime, we added 0.6 kg to the UF goal to compensate for RB and prime.

Sometimes we chose not to add RB to the goal, for instance, if the pt was very fluid overloaded, had a low BP, or was dehydrated (in which case we of course didn't take anything off).

Policy is for 600 but often patients are included when asked how much they want taken off. Taught to return blood (via saline return) until lines show pinkish color. My question would be, makes sense to me, that is no RB is added to the UF Goal but saline is given during blood return, then one would have to add RB amount ie 300. Maybe I am missing something here but that seems logical. When I discussed with tech he said 'no rinseback' and I tried to tell him that if the lines, upon blood return, were almost clear that patient received saline therefore left at higher the EDW...

It sounds like your tech is not communicating well; there is no way you can return blood without RB! S/he didn't add the RB amount to the UF goal, which is why the pt left over EDW. But the tech certainly gave NS during RB! (The old, long outdated and very dangerous air flush method is never used or taught nowadays).

Why would the tech not add RB? If s/he feels that the pt's EDW needs to be changed - which is, of course, frequently the case - s/he needs to communicate this to the (supervising) nurse who should, if s/he agrees, write an order to change EDW. I have seen that some techs believe they are nurses and never communicate this info - and other important info as well, which is poor practice

DeLana

My question was as yours. It seems that a few techs will take the UF Goal amount, to bring to dry weight, and tell the patient they will not add RB to the UF Goal. This FMC unit, does not practice this, but apparently the RNs are ok with this tech telling patients he is not adding RB. Seems like an elementry school child would understand there will always be some RB. Is there a standard FMC policy ie ours of 600 usually?

It's of course OK for techs to discuss a pt's weight, but not adding RB, or not taking off as much as the current EDW suggests, is just avoiding the real issue: the pt's EDW needs to be changed, and this needs to be communicated to the RN. This, however, is too often neglected. Then, Tech B won't know that Tech A didn't add RB, wonder why EDW wasn't reached (did the pt drink on the machine? Wrong pre-tx wt? Etc), add RB and pt cramps...

I never worked for FMC, the P&P I quoted was Gambro's; I currently work in inpatient dialysis for a non-profit hospital, but we have Fresenius machines. Our policy is never to add RB to the goal, although we usually give about 300 cc; we do dump the prime, but I'm still surprised that the pts often reach the wt goal we set (e.g., pre-wt 70 kg, goal 2000, post-wt 68 kg); obviously, it's not an exact science (in the hospital we're not too concerned about EDW, the MD often specifies the desired UF target).

DeLana

I discussed this with one of the float RNs who is excellent. She said what I thought that no matter what the goal, RB, or not, there is ALWAYS RB used to return blood. These 2008K machines we use NEVER calculate out such as what you stated with UF Goal 2000.. for example.

It may be that our dinosaur 2008H machines aren't calibrated right... LOL

DeLana