dumping the prime

In the acute unit we would dump the prime on someone in massive pul edema that we were dialyzing to keep off the vent. If the pt was frothing that extra 250 ml of fluid could be to much. We would also sometimes dump the prime if we were resetting up a system after someone clotted and their B/P was stable. This was a decision made only on a case by case basis after a thorogh assesment. I don't know that the outpt units ever dumped the prime.

The prime would also be dumped if the center utilizes "reuse" of dialyzers. This provides another, albeit small, way of protecting people from sterilant that may have not been completely rinsed out of the kidney.

I worked for a large national company in outpatient dialysis from '99-'05. For the first 2-3 years (I'm not exactly sure), P&P required that we dump the prime. Then suddenly it was changed and we were no longer allowed to do so (no choice in the matter!) The reason we used to dump the prime was (a) to avoid giving additional saline that would just have to be removed, and (b) as pp mentioned, to help flush any trace chemicals (Renalin) from the system. Rumor had it that the reason for the policy change was patient death(s) due to careless workers - at least one patient exsanguinated as their blood was flushed down the drain bucket or WHO!*

In my acute unit we routinely dump the prime (although we use dry packs only) and would only give it for BP support or if the pt needs additional volume.

HTH!

DeLana

*"Waste Handling Option" of Cobe machines

All the companies I have worked for required "peeing" the lines before hooking up the pt. Even those with a dry pack dialyzer. "Peeing" the line consisted of dumping about 500 ml of saline through the lines immediately before hooking the pt up. We were told this was to remove any residual chemicals in the line and dialyzer that may have come out during recirc. The national companies tried to make policy the same for inpt and outpt. So inpt we used a dry pack, set up at the bedside and were ready to immediately initiate the treatment but still had to do a 15 min recirc and then pee the lines of 500 ml of saline. The companies then wondered why we couldn't set ourselves up, tear ourselves down, move all the equipment from one bedside to another and do 2 four hour treatments without going over the 10 hour shift. The real fun came in when you had to drive across town to another hospital. I had one out of town manager tell me his nurses were able to return the blood on one pt, drive across town, set up and have blood through the dialyzer on their second pt all within one hour. I told him then his nurses were cutting corners and were unsafe. Needless to say I wasn't terrible popular.

There had better not be any residual Renalin in the kidney! Even if you dump the prime the patient may get some if there is even a trace left in the kidney. Bad bad. Happened once in our unit several years ago- the patient survived thankfully. The dialysers should be checked and documented by two people; at least one licensed nurse and someone else. Many many units are doing away with reuse altogether and finding the overall cost to be cheaper.

We rarely dump except on specific orders from the doc. It's a lot easier to spread the 250-300 ml. over the course of the treatment rather than to pull it off right at the beginning. Too much chance of having some light headedness or initial BP. drop that you have to fight with.

Steven

Steven,

I completely agree! There SHOULD be NO Renalin left in the dialyzer but since we are dealing with human beings - any opportunity we have to protect the patient should be done. I personally do not like using REUSE. I know one of the large companies are completely REUSE free (however, they also make the dialyzers) and wish they all were!

Regarding Renalin in the system, I was talking about trace amounts - many times I have seen my coworkers sign off test strips that were not completely clear. Need I add that sometimes the tests weren't even done, and it's just a miracle that no major incidence (dialyzer full of Renalin) happened (yet?). I was also very disgusted when the reuse numbers were changed from a maximum of 13 to 100 (!), but I digress.

DeLana :)

The real fun came in when you had to drive across town to another hospital. I had one out of town manager tell me his nurses were able to return the blood on one pt, drive across town, set up and have blood through the dialyzer on their second pt all within one hour. I told him then his nurses were cutting corners and were unsafe. Needless to say I wasn't terrible popular.

He lied, and/or was full of it! :roll I have seen some serious, horrific corner cutting by some sorry, burned-out nurses, but even they wouldn't be able to pull that one off.

BTW, that's why I'm glad that I don't work for a national company anymore. My inpatient/acute unit is owned by the non-profit hospital, and that makes all the difference.

DeLana

We always "dump the prime". It is only ever returned if the pt is clinically dehydrated or hypotensive.

You should check the package insert that comes in the box of dialyzers to see manufacturers instructions. I know that the Optiflux dialyzers insert specifies that the prime be dumped prior to HD to prevent 'fibers' from going into pt blood stream.

As I previously said. We always dump the prime.

marc

We never dump the prime unless specified by the doctor. We don't re-use any more either. In most cases, it's probably not a big deal either way.