Sodium Profiling

Specialties Urology

Published

:confused: :o Hi, have a question for all you renal nurses re: your sodium profile use. We have the Fresenius K machines and they have programed Na profiles in the machine. The favored one in our unit is the linear starting at a Na level of 150 and dropping to 135 over the course of the treatment. The question arises - do we need to stop the Na profile with 1/2 hour remaining or is the gradual decline in Na level to 135 sufficient. Also, does anyone have any other profiles or suggestions to assist us with unfortunately high fluid gains interdialytically. We do not have alot of spare time and can't allow patients extra treatment time to remove fluid and have resorted to the Na pull to assist with this removal. What are your thoughts/suggestions.

Thanks,

K

We used to use UF profiling together with Na profiling. We start off with 145 and gradually down to 140. Patients seem to tolerate this quite well but we find patients will become overloaded easily after Na profile. And more patients got admitted for the same problem. So we stop Na profiling and continue to use UF profile during treatment. And we observed a decrease in no. of overload and admission.

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Havent had that many problems with overload, alot of the pts we do NA profile on are ICU pts and they are unconscious. We sometimes do the UF profiling (if the MD orders) and for those pts, they seem to tolerate it really well.

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Hi! I am in training to be a dialysis tech. In our classes we covered a lot about both UF and NA+ profiling. We use Althin Tina machines, and are able to adjust the profiles manually, which gives us many choices of combinations. It seems best to bring the NA+ back to baseline at least a half hour before end of tx to give the blood NA+ level a chance to normalize so the patient isn't thirsty after tx. We've found that if we also profile the UF to meet goal at least a half hour before the end of tx, it gives the intravascular space a chance to refill so that BP can be normal at end of tx. I am also a patient, and find that if I profile my UF to remove a lot of fluid the first half hour with minimal NA+ (since there's enough urea in the blood to support this), then bring the UF to .3 for 15 minutes then pull again (rest and pull in 15 minute intervals), plus bring the NA+ gradually to 148 over the first hour, then the last hour bring it back down gradually to baseline, and also meeting goal a half hour before the end of tx, then my BP and heart rate are normal at the end of tx and I never "crash" during the tx. We call this a "rest and refill" UF profile, and I think it would work well on many patients who have difficulty with hypotension with large fluid gains.

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I work in an acute dialysis unit and we routinely sodium model all patients, using 146-138 step (Fresenius F8H machnes). We increase to 148-138 step if the patient presents with a low BP or has history of poor LV function. We have had great success using the combination of sodium modeling and the crit-line. Haven't needed to treat a patient for hyotension with more than a 100cc NSS bolus for as long as I can recall.

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when I worked dialysis, we used both the linear and step. With the linear, we raised it 7 points above their baseline MD order, say 145 as the bath of the pt, wed raise it to 152. Same for both settings and we had Fersenius also. With linear we progammed it to turn off 5 " prior to their take off. With the step we programmed it at half hour prior to their ending tx. Hope this helps.

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