dialysate prescription

[student60]

Do all dialysis units have routine orders for changing the dialysate prescription?

What determines a change in K+. For example, at what level (K+) is the dialysate changed from 2 to 3, or 3 to 2. Thanks, like to hear what other units are doing and if there are community standards Tx.

[babs_rn]

Routine orders? No. Not with the K+. Your medical director might have developed a protocol but I haven't heard of it being a standard. In the osteodystrophy management the BMMs have been given more leeway in some areas in addressing the CA bath but not the K.

Generally our docs will make changes based on the patients' K levels but if they're really high they need to run in the hospital anyhow. K, as we all know, directly affects the conductivity of the heart and a drastic change in that during a single treatment needs to be very closely monitored.

As for smaller changes, it's simply not something I've heard of but then things change in healthcare (and particularly in dialysis) every day. Might be something to watch for.

[KAT1994]

At our unit we have standing orders: K+6=1k w/a stat re-check the next tx, MD, and dietician are notified. We only move up or down one bath; for example, k+ of 3 goes to 5.4 they are only moved to a 3k instead of a 2k bath. I would probably re-check k+ in a week or two. Our dieticians work with the pts very closely and for the most part they don't fluctuate that much. We check labs at least once a month.

[jnette, ASN, EMT-I]

At our unit we have standing orders: K+6=1k w/a stat re-check the next tx, MD, and dietician are notified. We only move up or down one bath; for example, k+ of 3 goes to 5.4 they are only moved to a 3k instead of a 2k bath. I would probably re-check k+ in a week or two. Our dieticians work with the pts very closely and for the most part they don't fluctuate that much. We check labs at least once a month.

We too, have standing orders for the dialysate baths.. for both acid and bicarb.

They are as follows:

K+ levels 3.5 or

K+ levels 3.6-6.4 ... 2k bath

K+ levels 6.5 or > ... 1k bath

Bicarb settings on machines go by sliding scale, according to the monthly lab draws.

Any new patient is started on a standard setting of 35.

Thereafter, anyone having

Anyone

Results of 22-25 (target) is maintained at their current setting.

[nosonew, BSN, RN]

At our unit we had a 2K or 1K bath.. nothing else. If below a 5.0 K we did a 2 bath...if over 5K we did a 1 bath. All we could do. Also, I titrated versus patient telling me what he or she was eating.. summers, lots of 1.0, winters, 2.0 due to veggie consumption.