Published Oct 11, 2003
I am new to message boards. I am a RN in a Fresenius HD unit in SouthWestern Va. Anybody want to talk????
jnette, ASN, EMT-I
Hello there Virginia HDRN ! :)
Guess what? So am I !!! Which clinic are you at? I'm in SW Va., too... FMC... small world, eh?
Originally posted by VirginiaHDRN I am new to message boards. I am a RN in a Fresenius HD unit ....
I am new to message boards. I am a RN in a Fresenius HD unit ....
I'm sorry to hear that...
j/k I came to Gambro from Fresenius and I like it better over here. But, I'm a biomed tech so that may be the difference. Just seems like people respect me more on this side and I have more say on what goes on. Fresenius just seemed like they were getting too controlling and not appreciative enough and this move has been my (in my personal opinion) best move yet. Things seem to run a lot smoother over here for me. Anyhow, welcome to the board. If you have any tech questions in the future that I may be able to answer, shoot! I'd be more than happy to help. I've worked with both H and K's, Zyzatech SDS system, Zyzatech RO's (portable and clinic based) and Osmonics RO's. I've worked with more, but that's mainly what Fresenius uses if I remember correct. Holler if ya need me!!
This is my first time here. I wanted to get some info re the fresenius. My place just changed to the fresenius from the cobe3 and phoenix. I find the fresenius to be very loud. We didn't get a very good orientation on it, they figured we would learn as we go. If anyone can give me any pointers on it I would appreciate it. Thanks.
You are better off with Fresenius, we're stuck with Phoenix!!! It is also loud and alarms even more...unable to use for small kids...Needs more acid bath and bicart...
The alarms are easily adjustable on the "F" machines...screw adjust next to the red "service" switch on the back. Louder over to right, softer over to left. You can do it with a fingernail... just make sure you don't turn it down too low, You want to be able to hear it on the other side of the room:clown:
I've been working with the fresenius for about 1 1/2 months now. I find that there are too many lines to connect not like the cobe3 or the phoenix. I also find that it eats alot of the bicarb . And as to the sound, they are very loud and per protocol we are not allowed to lower the sound. I also find that if the arterial and venous chambers are too high at the start of tx, you will have problems thru out the whole tx. I also find it not to be catheter friendly, clots 85-90% of the time. Turnover is the pits because of the noise. We were told the fresenius would save us time between turnovers but I don't see it yet, it is the opposite. Anyone have suggestions about the fresenius?
What does the machine have to do with caths clotting? Can you elaborate on that?
Are you doing reuse? Are you only doing the pressure tests at turnover or both tests? If you did both tests in the AM you only need to do pressure tests at turnover. Also, some units still test dirty. Although it's against Fresenius policy it might not be in some other companies policy.
I did like the Cobe3 cassette with the art and ven lines all in one. But the Cobe doesn't do NA modeling or UF profiling. Nor does it have the twister lines for access flow or OLC testing. Fresenius K is a much more sophisticated ( sp) machine compared to Cobe3. Also, didn't Gambro stop making Cobe3 and isn't the Pheonix in limbo with the FDA?
Make sure you are closing all the pinch clamps on both the art and venous lines when you prime because if you get either transducer wet you will have problems with TMP and inaccurate ven and art numbers.
Good luck. The K machine IMHO rocks. It just has so many nice features. Heparin bolus feature, KECN, and heparin pump all able to be programed.
For some reason I find that we don't get the same blood flow with the catheters than we did with the cobe and phoenix. So they clot more unless we give saline flushes and even then they clot.
Protocol at my place is to do both tests not just the pressure tests between each pt. What do you mean by reuse? Is that when a dialyzer is reused for the pt? We don't do that, a new dialyzer is used for each pt for every tx. Another question I have is at the beginning of the tx the chambers are fine then they increase to the point that the transducers have to be changes. Is that normal? I've been doing dialysis for about 1 1/2 years and still have a lot to learn.
For some reason I find that we don't get the same blood flow with the catheters than we did with the cobe and phoenix. So they clot more unless we give saline flushes and even then they clot.Protocol at my place is to do both tests not just the pressure tests between each pt. What do you mean by reuse? Is that when a dialyzer is reused for the pt? We don't do that, a new dialyzer is used for each pt for every tx. Another question I have is at the beginning of the tx the chambers are fine then they increase to the point that the transducers have to be changes. Is that normal? I've been doing dialysis for about 1 1/2 years and still have a lot to learn.
Are you heparinizing your dialyzers during prime? If your chambers are filling up too much then you have something clamped either the arterial or venous line before you have turned off your pump or you aren't releasing your clamps when you turn on the pump and your chambers are filling up. If the chambers are filling up during treatment that is a sign of clotting. What are your TMP readings. If they are high that's another sign of clotting. Make sure your chamber on the venous hanson line, not your patient venous line, is upright and that the ball is free floating. Many ignore that aspect of the process.
Instill 2 cc's of 1000:1 heparin into the heparin pump pigtail during recirc.That should help with clotting.. Also, give a small bolus of heparin up front and then divide the rest into hourly doses and give right up to the end of treatment for cath patients and stop heparin one hour before the end of treatment for fistulas/grafts. You can use the bolus heparin feature on the K and the hourly feature too. All automated so you don't have to worry about it. Just make sure it's programmed and turned on...:trout:
Which Fresenius machine are you using? K or H. And are your blood pumps calibrated correctly.
Thanks for all the info. We have the K machine, so after the initial heparin bolus it does the heparin automatically. When do you do the bolus? Before you put the pt on or when they are attached but before you hit the tx button ? Also, noone said anything to us about the hanson chamber. I will have to check that. Alot of the times the hanson lines are twisted, I guess that can be a problem too. And I'll have to check about the calibration. How is that done? Does that have to be done by the tech?
thanks again ,
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