why turn off uf?

i was trained not to turn off uf. if you don't want fluid removed we just do cleansing and and replace fluid set in the goal which rinse back is included and replace saline during treatment. the lowest we set our rate is 400. What reason would be to turn off uf? what harm is being done when uf is off during treatment? i was told by my DON that ingredients from the dialysate can get into the blood as it passes thru the dialyzer. would like input. thanx's so much i really enjoy this site.

Do you use volumetric machine? You need a certain amount of UF just to take washback. Also blood is more concentrated than dialysate so your patient could end up heavier post dialysis.

ch10

UF is put in minimum when the patient isn't doing well. If they start cramping, or the BP dips, we were trained to reduce the UF for 10-15 minutes to see if the cramps ceased or the BP returned to the normal range.

WE have for years been turning the UF off if a patient is having BP issues or cramping. There is always an exchange in the dialysate to the blood and back with things like K+, Ca+, etc. and fluid going from the blood to the dialysate. When the UF is off the only thing that is happening is clearances for chemistries. No fluid removal. We have patients that may have it off for over an hour, usually we will just drop their goal if they don't have a BP but even when they stay off they do not gain weight, you just don't get off what they originally put on. They go out heavy. The dialyzer works as an exchange unit but it only exchanges things needed to transfer. If the patient has a high K+ the dialyzer will pull off some but it will not transfer any in. I have been in dialysis for what seems like forever and have never had a problem with the UF off and have never heard about the issue your DON is talking about. If you find out where they got this info I would like to read it myself.

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."

At my company it is not allowed to turn off UF. I have been taught that it could cause a backflow with fluid from the dialysate going TO the patient just like ch10 was saying.

Our minimum rate is 300cc/hr. If the pts BP is really low and he or she is symptomatic we will give saline to substitute for this loss instead of turning the UF completely off.

I was told that the rationale for not turning the UF off is: with the new high flux dialyzers it may be possible for a transfer of infectious material from the dialysate into the blood. I haven't done a literature search of this yet so can't speak for or against. I would be interested in any references anyone might have about this.