Membrane size and cardiovascular status?

[MizChelleRN]

First, let me say, I LOVE that our subforum is really active lately! I am so passionate about dialysis and networking ideas with fellow nephrology peeps.

So.....recently I had a conversation with a colleague. We were trouble shooting ways to get fluid off of a hypotensive patient. We put the usual stuff out there, cold dialysate, uf profiling, na modeling, IUF treatment, etc. And he brought up that the patient was on the largest size membrane, possibly there is too much volume outside of his body, perhaps the dialyzer was contributing to the bp dropping. Doesn't add up to me, but would love to hear your thoughts? Is it significant enough to make a difference?

[AcuteHD]

The F200 has a prime volume of 112 mL, the F160 is 83mL. 29mL doesn't seem like enough to make a diff, but maybe. Also, unless you are wasting the prime, you're replacing blood with equal volume of saline at hookup. Can you challenge pt with a smaller dialyzer just to see?What about giving albumin to shift fluid? I feel your pain, hypotensive and overloaded is a bad combination.

[AcuteHD]

The F200 has a prime volume of 112 mL, the F160 is 83mL.

Too late to edit, but I should have said I am using what I have on hand as an example. Don't know what size dialyzers you are using. Thanks for the question.

[Chisca, RN]

I think it has to do with the larger surface area of the high flux dialyzers. Patients wanted shorter treatment times so filters with larger surface areas were developed. If a patient can't tolerate a regular dialysis treatment CRRT and SLED are used which use much smaller filters but longer treatment times.