Fluid runs

[kidneynurse]

At what point do you offer a fluid run to patients? At my clinic if a pt is 1 kg above their dry weight they are offered a fluid run on the next day. As we have a lot of fluid abusers, especially on MWF shift, we could easily have 3-4 exdtra patients on a shift that has empty chairs but max patients for the staffing. Just wondering what other units do in this case.

[soulofme]

We offer but most don't want to be bothered with another tx.

[corky1272RN]

If a pt leaves > 1kg of EDW then we are supposed to call the MD. I will also instruct the pt about watching their fluid intake between tx and document accordingly.

[pricklypear]

We don't have room to offer fluid runs to folks who only leave 1kg over. These are usually the people who come in WAY over their TW, are frequently late, want off early, etc... We have some patients who have severely abused the privilege of a fluid run and our manager has pretty much cut them off. And, as Soulofme mentioned, most non-compliant patients won't want to be bothered. Or they'll say their coming, and don't show. I don't think we have any set standard, it's pretty much our call, and usually reserved for true need.

I'm pretty new to dialysis, but thank goodness I have a great manager who doesn't put up with too much from non-compliants. I can't believe the rope some patients are given, all in the name of "keeping up the numbers."

[traumaRUs, MSN, APRN]

I'm an APN and I would not do a PUF tx for 1 kg.

[Valerie Salva, BSN, RN]

I have never heard of PUFing a pt for 1 kg over. Are the dry weights accurate? At many places where the doc has to change the EDWs they are highly inaccurate. This is also the case in some clinics where the staff have "tunnel vision."

I've only seen pts offered a PUF when they truly have s/s of fluid overload, and are not able to tolerate fluid removal d/t CHF and/or very poor plasma refilling. I don't think extra tx or PUFs should be given for the simple reason of "1kg over (supposed) EDW."