Kenchiro

We have a couple of patients that are extremly non compliant and bring in 7 - 8 kg of weight on a regular basis. They cramp every single treatment and there is nothing we can do about it. If we leave the fluid on them we risk CHF and other nasty things that go along with it. Now that being said the fluid shift will happen at different rates for different people, when someone has this much fluid on we see it happen on the machine where someone with only 3 kg on might not see it till sometime after treatment. Also, being diabetic will effect the rate fluid will shift. Our clinic uses a drug called Mannitol, this is a high powered diuretic. It helps the fluid shift that is happening from the tissue to the blood. We generally use this on patients that show signs of edema, periorbital and in the extremities. If a patient is having difficulty maintaining a BP and is 1 - 2 hours into treatment this will help out tremendously about 90% of the time. Now something to take into consideration is that Mannitol also works on the cerebral spinal fluid and actually is used to decrease intracranial pressure so there you go.

it may be slightly different depending on the machine you are using the unit I am with uses the Fresinius K type machines and I have never seen a patient go out heavier even with the UF off for an extended time. Again though some machines may work a little different so check out the documentation the machine comes with and do your own research. I tend to question any answer that is followed by "...because we have always done it this way."

Ok we dont use IV pumps in the clinic I work in. Our Physicians have said to run only Levaquin and Vancomyacin while the patient is still on the machine. They have told us not to start them until the last hour of treatment. We calculate drip rates the old fashioned way. Also we draw Vanco and Gent levels as they apply to the patient in question before each treatment they will be recieving that medication. Our facility has 36 chairs and we generally fill 32 - 34 of them Mon - Sat. So our clinic is very very busy.