Sodium Profile

My clinic has been forbidden to do sodium profiling on patients, but now, my Nephrologist is beginning to implement this profile.

Can anyone fill me in with sodium profiles because I've never done it before.

According to the manager, the reason why we are not allowed to do so is because during the HD, sodium is given to the patient and they fear that if at any point of time, if there's a pause in HD, the sodium given to the patient would not be taken back by the machine.

Sodium MODELING and UF Profile .. Which one do you mean.

Sodium MODELING ususally starts at 150 and linearly drops to 140. It's used as an adjunct to B/P if the patient can't tolerate large weight removal. Similar to giving hypertonic or NS..

What machines are you using?

Yeah I meant sodium modeling. The machines I'm currently using are Fresenuis ones.

Yeah I meant sodium modeling. The machines I'm currently using are Fresenuis ones.

K's or H's?

I have both...

Hi!

It seems to me there are "fads" in dialysis and that sodium modeling is one of them. A while back my company did a lot of sodium modeling as a means to keep BPs up during the runs. However, the overall opinion was that the fluid removal that was gained from the better pressures was clompletely negated by the fact that the patients on sodium modeling would gain much more interdialytic weight than other patients. It seems that regardless of how you set the machine, there always is a trace of sodium left in the patient when dialysis is over.

The most common profile used at my company was the sodium profile 145 linear in which the sodium is gradually removed to 140. At my unit, sodium modeling is not used anymore, except when we get transfers who are already on it and even then we wean them off it as quickly as possible. And even if pts are on sodium modeling we are never allowed to go over 145 as a start level. Personally, if it wasn't so impopular I would like to see what difference just a little sodium would do, say 143 down to 140 linear OR step. But since the opinion currently is againts I guess I will wait. I'm sure with time sodium modeling will come back, just like the bellbottom pants at the bottom of my closet.

Hi!

It seems to me there are "fads" in dialysis and that sodium modeling is one of them. A while back my company did a lot of sodium modeling as a means to keep BPs up during the runs. However, the overall opinion was that the fluid removal that was gained from the better pressures was clompletely negated by the fact that the patients on sodium modeling would gain much more interdialytic weight than other patients. It seems that regardless of how you set the machine, there always is a trace of sodium left in the patient when dialysis is over.

The most common profile used at my company was the sodium profile 145 linear in which the sodium is gradually removed to 140. At my unit, sodium modeling is not used anymore, except when we get transfers who are already on it and even then we wean them off it as quickly as possible. And even if pts are on sodium modeling we are never allowed to go over 145 as a start level. Personally, if it wasn't so impopular I would like to see what difference just a little sodium would do, say 143 down to 140 linear OR step. But since the opinion currently is againts I guess I will wait. I'm sure with time sodium modeling will come back, just like the bellbottom pants at the bottom of my closet.

My biggest problem with Na modeling is the blind faith care givers of all levels put in it. If a patient arrives with a B/P of 223/110 I'M NOT USING NA MODELING and I document it. I'm a travel nurse so I can't "fix" many of these things but I can use nursing judgement. In this case I believe I'm justified.

Sorry I'm getting down now. No offense meant to anyone. But I really do hate blanket prescriptions for the whole unit. At the unit I'm on now some at at 155 linear down to 140. I believe that's too high. I just wish SOMEONE would re-evaluate these settings on a regular basis.

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

My biggest problem with Na modeling is the blind faith care givers of all levels put in it. If a patient arrives with a B/P of 223/110 I'M NOT USING NA MODELING and I document it. I'm a travel nurse so I can't "fix" many of these things but I can use nursing judgement. In this case I believe I'm justified.

Sorry I'm getting down now. No offense meant to anyone. But I really do hate blanket prescriptions for the whole unit. At the unit I'm on now some at at 155 linear down to 140. I believe that's too high. I just wish SOMEONE would re-evaluate these settings on a regular basis.

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

NephroBSN!

Since I have used sodium modeling infrequently, I'm now very curious.... what will a sodium profile 155 to 140 do to a person? How does it alter the pressure and how are the fluid gains between the runs and the patients subjective experience of what I consider to be a quite extreme manipulation of their electrolytes?

I'm just really interested to learn more, since I will most likely one day be a travel nurse and will encounter all manners of strange orders.

NephroBSN!

Since I have used sodium modeling infrequently, I'm now very curious.... what will a sodium profile 155 to 140 do to a person? How does it alter the pressure and how are the fluid gains between the runs and the patients subjective experience of what I consider to be a quite extreme manipulation of their electrolytes?

I'm just really interested to learn more, since I will most likely one day be a travel nurse and will encounter all manners of strange orders.

That high of a Na Sodium modeling is used for patients needing to remove 6+ kilos in 4 hours. This is obviously a very non compliant patient to begin with. But also a fragile, CHF-wise patient. We are between a rock and a hard place. If we don't remove the fluid he's in CHF in the hospital and we lose that revenue. I do know that if we try to get 6+ kilos off him he won't tolerate it. Cramps badly.

I'm not a fan of hypertonic, I've not seen it work that well. Many times it is given during an elevated period of a UF profile that flucuates (sp) from very high to very low. Thus if you wait 15 minutes the UF goal drops dramatically and the patient recoups. b/p wise. Cramps are another thing. They need immediate response. I started doing dialysis in the late 80's. I still think the old pushing on the feet works.. If you have a cramp at home. How would you deal with it. I jump out of bed and push my heel down on the floor.

I don't have the luxury of NS IV.

It's a crap shoot many times and each prescription should be individualized. Many think you have to get a patient to their EDW with each treatment. Sometimes that's just not feasible. If you give too much NA or NS you risk the chance the person will come back just as heavy if not heavier.

I tend to try to get within a kilo or a kilo and a half at the beginning of the week, on the second tx of the week try to get to within one kilo or a half kilo and then on the last tx get to EDW.

As for the travel gig. My advise is "When in Rome do what the Romans do" . You aren't gonna make many changes in 13 weeks. Follow the prescription as it's written. If you really feel it needs to be adjusted be prepared to defend your reasoning. And document document document.

hi nephrobsn!

i totally agree concerning na profiles. i am traveler too and sure we know each other! the unit i am in currently has had 6 units on blanket modeling and uf profiles for years. i agree with you though that if a pt comes in with 220/111 pt i do not turn on the na and document bp too high. all pts are on na linear 148-135 and profile 4.

our new don has been brave enough to challenge these arcaic orders and be pt specific. like no profiles on small gainers, profile 2 on large gainers with elevated bp who are stable. and so on.

hi nephrobsn!

i totally agree concerning na profiles. i am traveler too and sure we know each other! the unit i am in currently has had 6 units on blanket modeling and uf profiles for years. i agree with you though that if a pt comes in with 220/111 pt i do not turn on the na and document bp too high. all pts are on na linear 148-135 and profile 4.

our new don has been brave enough to challenge these arcaic orders and be pt specific. like no profiles on small gainers, profile 2 on large gainers with elevated bp who are stable. and so on.

i tend to like profile 2 with big weight gainers. but i like 4 for the cardiacs.

We have had greater success in decreasing time with N's orders fro larger dialyzers and larger needles for well established accesses. 14 Gauge on several clients now. Labs are positively reflecting! The pts are sooo proud to have their times cut!

Juanay

We have had greater success in decreasing time with N's orders fro larger dialyzers and larger needles for well established accesses. 14 Gauge on several clients now. Labs are positively reflecting! The pts are sooo proud to have their times cut!

Juanay

Yeah I hear some are using 14's.. Gotta have good vascular surgeons for that. I've not seen too many in my travels. Have you?

I know Davita is trying to start and maintain it's own interventional units.. Seems to be the way to go.. One stop shopping so to speak.

How's the toe?