[gone_mad]

I have been working as a "float" tech for a couple of month and at one of the clinics i was at they had some of there AVF bfr's up to 600. i have been working for many yrs and never seen it that fast. At home clinic the fastest we run a pt is 500. Does anyone know of P@P with FMC and bfr's and if there is a web site that explains how fast you can run a bfr!!

Thanks been driving myself crazy over this one!!

[traumaRUs]

At chronic outpt units, we often use 14 ga needles and a 600 bfr in an effort to achieve clearance as measured by kT/V. I have found this especially helpful with larger patients with a high body surface area (BSA).

[amidate]

I work at an FMC clinic and that blood flow does seem too high if you are using 15g needles. I have floated to several of our clinics and it depends on the medical director as to how fast the bfr can be run on any size of needles. We don't go over 550 with 14g needles but this is his preference. As long as you have a valid order and it doesnt harm the patient you should be ok. I would think with BFR that high you risk more recirculation, and possibly damaging the RBC's if run through too small a needle.

[PLTSGT]

I agree with the posters above. No smaller than 14g needles should be used for BFR of 600. Assuming his access can accomodate that rate, you still have to consider the patients weight and general condition. Again, it always comes down to company policy and/or physician's order.

[bluefabian]

Now I am confused and a little bit shocked. 600? 500?

You mean the Qb? The fastest that have done is 350 mls/minute. I dunno if that is slow to you because the places that I worked in, despite being the same branch... I have yet to see anybody breaking that 350 limit. Even that is too fast for me. And urea clearance seems to be adequate for that rate (or even slower), the again there are many factors that may contribute to that.

If you are talking about dialysate flow rate, then I know I'm in the zone.

[PLTSGT]

Yup, Qb.

Originally Posted by bluefabian

Now I am confused and a little bit shocked. 600? 500?

You mean the Qb? The fastest that have done is 350 mls/minute. I dunno if that is slow to you because the places that I worked in, despite being the same branch... I have yet to see anybody breaking that 350 limit. Even that is too fast for me. And urea clearance seems to be adequate for that rate (or even slower), the again there are many factors that may contribute to that.

If you are talking about dialysate flow rate, then I know I'm in the zone.

[Gooseberry]

In Southern CA acutes we use the following QB provided the access functions properly.
VasCath 300
PermaCath 350
Graft 350-400
Fistula 400-450

[dialysisguy]

i have a few pt's BFR over 450 in LA. one pt in particular has an MD order of 550!

[bluefabian]

How does such blood flow affects the heart and patient's tolerance? I occasionally had patients asking to slow down the rate after quite some time when they complaint of chest discomfort.

[Gooseberry]

The pump sucking the blood out creates negative pressure on the arterial side or the systemic circulation which reduces periferal resistance.
At the same time it overloads the venous side - end diastolic volume grows, making the heart work harder.
That's my reasoning.