During hemodialysis one method of improving blood pressure is reducing the temperature of the dialysate to 35-36 degrees c. What about warming dialysate for patient comfort? I am aware of literature that describes the risks of hemolysis with increased temps but none state at what temperature this would occur. Many patients complain of being cold and the typical response is more blankets. Would increasing dialysate temperature help?
onyx77 404 Posts Dec 16, 2007 I don't have a complete answer for you, as I am a new grad. But, I had part of my clinical in the dialysis center (28 hrs) this last semester and the first time that I heard anyone talk about changing the temp on the dialysate was on my last day there. It seemed that a client complained of being cold and the temp was increased and about 30 minutes later the same client c/o being too warm and the dialysate temp was lowered. So, I guess it can be done, but that is the extent of my knowledge on the subject. Hopefully someone else will have a straight answer for us!
Chisca, RN 745 Posts Specializes in Dialysis. Has 39 years experience. Dec 16, 2007 So now I see there is a renal sub forum. If a moderator wants to move this thread there I would appreciate it. Thanks for your reply onyx77.
LiverpoolJane 309 Posts Specializes in Dialysis, Nephrology & Cosmetic Surgery. Has 21 years experience. Dec 16, 2007 The policy at the unit I work on is that the machines' temp is defaulted to 36.5c I have been asked by patients to increase it and I really don't like doing so - I am more inclined to reduce if anything to try and reduce the risk of hypovolaemia etc. If I have increased at all it is only to 37.0c - but that is not evidenced based, I just feel that you wouldn't want to increase the machine temp higher than normal body temp!?I have several articles on dialysate temp - I could try and locate them and if you wanted copies I could scan them and e-mail them to you?
Tweety, BSN, RN 32,973 Posts Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 31 years experience. Dec 16, 2007 So now I see there is a renal sub forum. If a moderator wants to move this thread there I would appreciate it. Thanks for your reply onyx77.Done.
Chisca, RN 745 Posts Specializes in Dialysis. Has 39 years experience. Dec 16, 2007 The policy at the unit I work on is that the machines' temp is defaulted to 36.5c I have been asked by patients to increase it and I really don't like doing so - I am more inclined to reduce if anything to try and reduce the risk of hypovolaemia etc. If I have increased at all it is only to 37.0c - but that is not evidenced based, I just feel that you wouldn't want to increase the machine temp higher than normal body temp!?I have several articles on dialysate temp - I could try and locate them and if you wanted copies I could scan them and e-mail them to you?Good points. Why does the machine (Fresenius) allow a range from 35 to 39 degrees? In what scenario would you want to set it higher than body temp? All the articles I have seen on temp refer to lower temps to prevent hypotension, I would appreciate any evidence based info you might have.
jnette, ASN, EMT-I 4,388 Posts Specializes in Hemodialysis, Home Health. Has 10 years experience. Dec 16, 2007 Here you go.. you might find this answers some of your questions.:)http://uninet.edu/cin2001/html/conf/schneditz/schneditz.htmlhttp://www.kidney.org/professionals/KDOQI/guidelines_cvd/intradialytic.htm
Chisca, RN 745 Posts Specializes in Dialysis. Has 39 years experience. Dec 17, 2007 The second article refers to "standard dialysate-temperature (37-38°C)38 degrees would definitely be above most patients body temp. Core body temps are not routinely measurable unless a bladder temp or PA catheter is available. The focus remains on cold dialysate temps to deal with hypotension. By it's very nature an extra-corporeal blood circuit is going to cool the body.
anurseadvocate 216 Posts Sep 17, 2009 In going back over posts found this one. First I was informed that the 2008K machine temp is automatically set by the machine.. NOT TRUE.. staff set the temperature.Staff often increase the temp when patients complain of being cold.Why not just adjust the room temperature. One RN told a patient 'the reason we keep the room temperature cold is to prevent bacteria from growing'... LUDICRIOUS................where did this statement come from as I have heard MANY staff state this............
Lacie, BSN, RN 1,037 Posts Specializes in jack of all trades. Sep 17, 2009 I have seen staff do this and completely disagree! In my state it is considered an MD order and should be treated as such. We always adjusted the clinic temp an not the machine temp. Our MD had a standing order that the RN may adjust the temp if needed for pts we knew had difficulty with hypotension, etc but never "just because the patient was cold". As far as infection control - that's ridiculous. The first thought being the temp should be pt comfort not staff comfort.
km5v6r, EdD, RN 149 Posts Specializes in Acute Dialysis. Has 25 years experience. Sep 18, 2009 I agree in an ideal world the room temp would be high enough that the pt is comfortable without additional blankets etc. Unfortunately I have to work in the room with the pt. I have to wear a full paper lab coat with long sleeves, gloves, and mask when on the floor. Standing at the center nurse's station requires PPE. Even with short sleeved scrubs underneath I am sweating in the middle of winter. Add a hot summer day to and I am dripping. Dripping onto a patient while changing a dressing, placing a tricky needle, or giving care is an infection risk. One of the larger male techs at the outpt unit always has large sweat stains on his back and chest during the shift. He will try wearing just a thin t-shirt but still obviously over heats. If the room temp was increased so that the pt with blood in the circiut is comfortable without additional blankets means the staff is sweltering. I'm sorry but I will happily give them additional blankets, adjust their personal quilts etc. Just keep the room cool enough so that I don't pass out.
GeauxNursing 800 Posts Specializes in Dialysis. Sep 18, 2009 The policy at the unit I work on is that the machines' temp is defaulted to 36.5c I have been asked by patients to increase it and I really don't like doing so - I am more inclined to reduce if anything to try and reduce the risk of hypovolaemia etc. If I have increased at all it is only to 37.0c - but that is not evidenced based, I just feel that you wouldn't want to increase the machine temp higher than normal body temp!?I have several articles on dialysate temp - I could try and locate them and if you wanted copies I could scan them and e-mail them to you?Our standard temp is 36.0. Doctor's order is needed to change it. One clinic I work at has individual track light above each station. If the pt requests it, the "sun lamp" is turned on.Our machines go into bypass when machine temp hits 37.0 or 34.9.
