Hemodialysis: Sodium Variation and UF Profiling (Philippine Set-up)

dodoy, BSN, RN · Apr 12, 2011

What do you mean by Sodium Variation? On Bbraun machines, there are usually presets for different sodium profiles but we seldom use them. We usually 'modify' the Sodium Concentration depending on the status of the patient's BP. Increased sodium for patients with IDH and decreased conc. for hypertensives. However, some studies say that increasing the Sodium concentration during HD promotes thirst, thereby prompting the patient to drink more (which we know is not beneficial to CKD patients).

We've used UF profiling before for patients who come in the HD unit with SOB and unstable BP (probably because of pulmonary congestion), usually starting from a higher UF volume then gradually decreasing (depending on what profile you use, in our case we used a preset profile). Honestly, I have little knowledge regarding the reasons for modifying or "profiling" the UF. Hope someone can shed a "brighter" light on this matter.

rogue_maverick · Apr 12, 2011

Sodium variation or modeling is a way to control hypotension, cramps and disequilibrium syndrome. It is also used in conjunction with UF goals greater than 5 liters.

What you mentioned that you do in your area is manual modification of sodium levels in the dialysate. Those presets you mentioned are exactly what sodium variation is. They are done by the machine and automatically modifies sodium levels depending on the program. Programs are Step, Linear and Exponential. Depends on the order and situation, the physician on duty orders sodium variation prn, because each program has different ways of controlling sodium levels.

What I would like to know is that what are usually being practiced here. Because in our institution, we use the step program for hypotensive clients, and the linear program for clients who frequently experience cramps.

Regarding UF profiling, we usually use profile 2, 3 and 4 on Fresenius 2008H and K. But we do not use profiling on all patients, only on those with excessive weight gain, SOB, and hypotension.

dodoy, BSN, RN · Apr 15, 2011

Ok I get it now. Before we have used the preset with increasing Sodium level towards the end of the treatment (I guess it's the Step?) to patients with persistent IDH every treatment. However, we find increasing the Sodium manually more effective in reducing the risk for IDH so we seldom use it now.

Sorry, very few inputs. I still have a very long way to go. Let's see if we can receive more comments regarding this.

(Out of topic)

What technique of cannulation do you implement in your unit? Have you tried implementing buttonhole technique on your patients?

rogue_maverick · Apr 16, 2011

We do the ladder technique for cannulation.

julzrncrn · Apr 17, 2011

,based on my experience ladder technique is much OK .Lesser complications rather than button hole.

rogue_maverick · Apr 18, 2011

I agree.

It also lengthens the life of the patient's access by preventing "one-site-itis,"

Ayelesia, ASN, RN · Aug 4, 2016

Hello

On our unit, anytime we increase or decrease the sodium level in the dialysate, the value of other electrolytes also change. Is that how it's supposed to be?

zero. · Aug 4, 2016

Hi Ayelesia,

I think what you're doing is increasing or decreasing the "conductivity" as a whole. When it's the conductivity itself being modified, electrolyte content are also affected hence the increase and decrease of these electrolytes together with the conductivity.

With sodiium profiling, it's only sodium that gets elevated on the time period that the profiling is active. There is a peak, and a base. The peak is how high you want the sodium to be, for example 145 (as compared to the normal of 137 or 138). The base is the normal level you want the sodium to go back to after sodium profiling is done and automatically turned off (in most cases it's the default sodium level, 137 or 138). There is a time on how long the sodium profile is to be turned on depending on the program, namely STEP (recommended to turn off profile 30 mins prior to end of dialysis ), then Linear and Exponential (usually lasts the same time as the dialysis treatment time.)

On another note, current dialysis guidelines have gradually discouraged sodium profiling as studies have shown this led to increased thirst, and eventually increased fluid intake, therefore it was counterproductive. But it's not ruled out to be prohibited, it can be used ocassionally, one indication is for patients with chronically decreased serum sodium levels. It all goes down to the RN's and the MD's discretion.

Ayelesia, ASN, RN · Aug 10, 2016

Thank Zero, I really appreciate your reply. Thanks again.