Speed for Rinsing Blood Back

[integrativenurse]

Most company standard is 200 ml/min, some 100, or up to 250. What is the rationale for slower Qb? 

I cannot find any convincing rationale, mostly just "because they told me to do so" or "It's in the policy."

I find this question challenging to most dialysis floor staff.

[Hoosier_RN, MSN]

200 is about standard. The rationale is that any faster can cause cardiovascular damage. 

My question with that is the blood pump runs quicker during tx without cardiovascular damage, although out of control rates can do a number on a patient. How so is this different?

[parolang]

It's kind of an interesting question. One thing that is different is the rate of blood volume increase. During treatment, ideally, there is no change in total blood volume. But blood volume increase a small amount during blood return.

But that's just me trying to rationalize the policy. More likely it is for reasons of "abundance of caution" and the precautionary principle like most of the other policies. Maybe it is just so that you aren't accidently returning too much saline, a slower return rate makes it easier to judge when to stop returning.

[rzyzzy]

On 9/15/2020 at 2:05 PM, parolang said:

It's kind of an interesting question. One thing that is different is the rate of blood volume increase. During treatment, ideally, there is no change in total blood volume. But blood volume increase a small amount during blood return.

But that's just me trying to rationalize the policy. More likely it is for reasons of "abundance of caution" and the precautionary principle like most of the other policies. Maybe it is just so that you aren't accidently returning too much saline, a slower return rate makes it easier to judge when to stop returning.

I suspect the concern is saline vs actual blood coming back into the body & the possibility of flash pulmonary edema (with what could be effectively - a saline bolus if you weren’t watching carefully)..  Healthy people can often take a liter at 999, but ckd + chf adds a layer of danger..