Do you use 2 Bags of NS or 1?

[Nurseinthemaking]

I am interested in knowing if there are other places that are doing what we just switched to.

We were originally priming our machines with a full bag of NS, and then hanging the second for the dialysis and take off, we generally used almost 2/3 to 3/4 of the 2nd bag. We were told that we need to back it down to one bag, prime it with half a bag then take off with the other half.

Are there risks to this. I vaguely remember reading something in the past about 1st use syndrome, is this where this could come into play and if so what are the S&S of this? SOB, and is it flank pain or chest pain, they are diaphoretic to aren't they?

Are there other risks?

[Onekidneynurse]

We prime and recirc with one bag and change bags before treatment is started. Unless a problem comes up we only use 2 bags.

We use 1 bag. Also do not do re-use. NASTY. And with the new Fresenius polysulfone dialyzers 1st use syndrome is a thing of the past. Poly dialyzers are innert and should not cause problems. They are not sterilized with any chemicals. We do have a few people who insist they are allergic to them and they do seem to be as we do use the Ashio Bio 100. "I" flush a full bag through that dialyzer and then hang a new one.

We prime with 300 cc's. Then dump 50 from the arterial line and 250 from the venous before hookup. We don't do a timed recirc anymore.

Get rid of re-use. You'll save money in the long run.

[DialysisTech76]

I think with DaVita, reuse is here to stay. Dry packs are so much better....I think.

[Lacie, BSN, RN]

We were cut down to limit total use per tx to only 1.1L per pt. Uf was turned off during recirc and to dump the prime only till the blood hit the venous chamber. Bags not changed out unless run dry. Flushes drawn from same bag and even told to reuse the needle from the heparin draws to do (our syringes didnt come with needles). If no heparin then we broke the line to draw. EEK! Kind of difficult to do with the old cobes. We used dry packs (thank goodness). Seen too many renalin reactions due to improper priming and people in too big of a hurry to get pts on in reuse. Cost cutting has become dangerous. Maybe one day medical facilities will be non profit lol (prays) so maybe pts will come first in lieu of those ceo bonuses or 3 day academy drunk fest.

[Onekidneynurse]

We were cut down to limit total use per tx to only 1.1L per pt. Uf was turned off during recirc and to dump the prime only till the blood hit the venous chamber. Bags not changed out unless run dry. Flushes drawn from same bag and even told to reuse the needle from the heparin draws to do (our syringes didnt come with needles). If no heparin then we broke the line to draw. EEK! Kind of difficult to do with the old cobes. We used dry packs (thank goodness). Seen too many renalin reactions due to improper priming and people in too big of a hurry to get pts on in reuse. Cost cutting has become dangerous. Maybe one day medical facilities will be non profit lol (prays) so maybe pts will come first in lieu of those ceo bonuses or 3 day academy drunk fest.

We DO NOT bleed on. Very dangerous. I saw a patient almost exsangiated (sp) in Cali. Not only sterilant reactions but wrong dialyzer for the patient.

Please don't be disillusioned by non-profit. Many N-P's make lots of money and so do their CEO's. They claim they need the added $$$$ for building improvement. Remember if the higher ups don't get an increase you surely won't either.

We don't recirc as there is nothing in the poly dialyzers to recirc. We do keep our system running to prevent stagnation.

[TraceyLPN]

you know I have an issue with this also. We used to do the 2 ns bag thing, and are now down to one bag. This is how it is supposed to be done....we prime with 300cc (yes, that's it, I've not seen any first use symptoms yet.) then dump 100 from the arterial line and 200 from the venous line when we put the patient on, then run 50 through prior to giving meds. I have had to start bleeding my patients off "backwards" in order to have enough saline TO bleed them back. I barely have enough. I work for a Fresenius unit, is anyone else having this issue?

[GeauxNursing]

We prime and recirc with one bag and change bags before treatment is started. Unless a problem comes up we only use 2 bags.

Yep, that's what we do.

[sweetpink]

umm... we use 3 bags of PNSS if it's reuse. 2 PNSS and 1 heparinized PNSS... We do the priming w/ PNSS and then the heparinized one... the other PNSS we use the rest of HD... If we're going to use a new dialyzer, it's just 2 PNSS...

[quackmoonstar]

In our unit, we normally use 1 bag in priming re-use dialyzers. We use 2 bags for new dialyzers.

We've already encountered the first use syndrome in our unit. Type A not to mention. The first incident in this certain patient...he was on a new F8 dialyzer, as fast as 14 minutes the patient became hypotensive, experienced chest heaviness and had red conjunctiva. They thought (it wasn't on my shift yet) the patient would go to an arrest. Second attempt, the NOD ordered the same dialyzer to be flushed and to use it again. Still, within 10 minutes the patient exhibited the same symptoms. Third attempt, the NOD ordered to use F6 dialyzer using 3 bags of NS for priming. As fast as 4 minutes, the patient exhibited the same symptoms again. Last attempt (on my shift), the NOD ordered to use the F8HFS dialyzer primed with 3 bags NS; the patient was able to finish his dialysis.

All in all, 3 vials of Solu-Cortef (Hydrocortisone) and 1 amp of Benadryl was given. Patient's Hgb level dropped to 12 from 17.7 (heck, we couldn't believe his Hgb reached that high)

[Chisca, RN]

I really want this and I am not quick to give up, so I will keep trudging along. I have had so many people tell me that even after a year that they were not 100% comfortable with all of it.

I think it takes about 5 years full time working to be a master at this. Dialysis is one of those things that looks fairly easy to the casual observer but alot is happening while your patient is connected to that machine.

http://jmoswalt.com/articles/10000-hours-to-genius

PS-one bag of saline where I work.