clearance, URR, Kt/v

silverfoxxy · May 14, 2006

First thing is to redraw. Could have been drawn improperly. If the blood pump wasn't set low enough, the blood wasn't drawn from the arterial port or the machine wasn't in bypass that could skew the results.
ESRD is the only chronic illness totally funded by Medicare. They aren't gonna let us draw it every time. Yes, the machine gives you a value. It's a very biased value. What the machine gives you is a value that is the ultimate all things considered. The patient is an individual.
The results also are dependent on fluid gains, dietary indescretions (sp) etc. Does your unit put up posters all over the place saying "Monday, is lab day BE GOOD". Also, labs have to be spaced out because the big 2 FMC and Davita have so many patients now their labs can't handle all of the draws on one day.
Many units were doing labs exclusively on Monday's/Tuesday's. Supposedly the worst day. So it would be more representative of the patients true clearance and Kt/V. Some units noticed that their labs su**ed. And that's not good for CQI and the unit. So they changed them to Wed/Thurs. And yes those days might return "better" labs. But that's the nature of the business.
If Kt/V continues to be low:
Larger dialyzer, different type of dialyzer, dietary consueling, and increased time. One or all of them.
Also, has the patient had a life situation that's changed his behaviour. Death in the family, divorce etc. Causes them to gain fluid weight, eat improperly etc. Just like all of sudden a high blood sugar. They went to a birthday party. Or something like that.
One thing to remember also, is these patients can't afford blood draws all the time with their H/H's.

Nephro: You sound like you are certainly seasoned and your education is appreciated. All patients have draws done on Monday and returned on Tuesday except for the afternoon shift which the post labs come back on Wednesday. Thank you again

NephroBSN, BSN, RN · May 14, 2006

Nephro: You sound like you are certainly seasoned and your education is appreciated. All patients have draws done on Monday and returned on Tuesday except for the afternoon shift which the post labs come back on Wednesday. Thank you again

Let's see I started doing hemo in 1987. And NO we didn't use wash tubs then.. LOLL

Then I left to get my RN and came back in 1997. Almost 10 years this time. I've worked in 11 states in the last 4 years as a traveler. For the big 2, several in house chronic units, and several of the smaller independents.

I believe I've seen most all of it. But probably not. :lol2:

diabo, RN · May 14, 2006

Urea reduction ratio, (URR) as well as Kt/V can both be poor indicators as to how healthy the patient really is, as was mentioned in the recent conference in San Francisco. If a very noncompliant patient comes in on lab day with a sky high BUN, the difference between the pre and post bun will be great, so the percentage will be high. Conversely, if a complient patient has a low pre BUN, the percentage will be lower. Which patient is actually healthier, the compliant one or the non compliant?

Overweight patients in many cases do better dispite their lower Kt/V. This is not only because they eat more, but also because fat cells act much diferently than muscle cells. The Kt/V equation would be more accurate if the ideal body weight were used unstead of the actual body weight. We certainly don't want to disregard all the results, but the overall well being and nutritian must be at the top of the list in determining how the patient is actually doing.

Steve

diabo, RN · May 14, 2006

sorry, I did mean lower. I corrected it, thanks.

Steve

urrRN · May 18, 2006

The URR and KT/V are actually specific to that day (when the blood is drawn) but should be a pretty good indicator of the adequacy of the pt's. dialysis. It's not supposed to be an indicator of their overall health. We do our draws on Mon. and Tues. We used to draw on Wed and Thurs, but the pre BUN is higher after 2 days without dialysis, so we get better KT/V's. We're forced to play the numbers game. The KT/V you get on the 2008K is actually a sodium measurement done without incorporating the pt. ht, wt, age, sex, tx. time, KOA of dialyzer, etc. The best thing we've found to use it for is figure out if the dialyzer or line is clotting. If the venous and/or arterial pressures start going up and the KT/V goes down, you probably need to flush the kidney.