Na Modeling--An asset to fluid removal or not??

Onekidneynurse · Oct 20, 2009

Working in the chronic dialysis setting and now in acutes, I have always found that when you have patients that come in with heavy fluid gains, that using Na Modeling with a UF profile is beneficial for blood pressure support. Anyone have thoughts on this or experience with Na Modeling? Do you feel it is better for the patient to use it? Looking forward to hearing from everyone.

I've always done chronics, but now I'm in an acute program. We don't use Na Modeling much. I don't like it. I believe it makes people thristy. If you are using the Fresenius model machine you can adjust the NA as needed. I believe many don't look at the plasma sodium on a patient and just do what ever they feel like.

I personally would rather use UF profiling. The sharp up down program is good for cardiac patients. Fluid is taken off in bolus type fashion and then the UF rate is drastically lowered for a short period of time to allow the heart to re-coup. We use the BVM monitor in our acute program. To me that is an invaluable tool. I use it equally with B/P measurements.

NurseKandi · Oct 20, 2009

I have had people tell me that but I have found if you set it to end an hour before the patient comes off the machine, it helps keep them from getting thirsty. I love using UF profiling and Na Modeling together. It allows for optimal fluid removal while sustaining the blood pressure. I am slowly working my docs into using it in the acute setting for those that need the fluid removed. I am asking this more from an evidenced based perspective. Do you know if there has ever been a study based on EDP about Na Modeling?

Onekidneynurse · Oct 20, 2009

I have had people tell me that but I have found if you set it to end an hour before the patient comes off the machine, it helps keep them from getting thirsty. I love using UF profiling and Na Modeling together. It allows for optimal fluid removal while sustaining the blood pressure. I am slowly working my docs into using it in the acute setting for those that need the fluid removed. I am asking this more from an evidenced based perspective. Do you know if there has ever been a study based on EDP about Na Modeling?

There are studies. I was gonna do a study myself in my home chronic unit but now that I'm traveling and in an acute program that study is on hold. My home doc doesn't believe in UF or Na modeling. Most of the studies I seen are using both. I'd like to see them used alone and see if one works better than the other. Or if they truely need to be used in conjunction.

Most nephro docs really know nothing about the workings of the machines. I've had many ask me if UF profiling is the same as Na Modeling. I've had to explain it to them.

If Na modeling works for big weight gainers why do we have to continue to use it every treatment. I believe it's because even with turning it off at the one hour mark they still get thirsty.

The Cobe3 machine has no UF profiling or Na modeling feature so how do those patients keep their weight gains in control?

You could do a google search about UF profiling and Na modeling. I have some literature around somewhere. At the chronic unit actually I believe. The problem with finding the lit is that you have to spend $$$$$ to sign up to read or print many of the articles. Some research has been done in Nephrology Nursing and you may be able to get ahold of that for free.