Uf profiling

[ffliper27]

hello

im new to dialysis and have a question about uf profiling. sometimes the doc makes her rounds and she sometimes requests that pts be put on uf profiling, and she almost always requests profile 4. I work for Fresenius.

what exactly does uf profiling do? and what is the difference between profile 4 and the others ( as I believe there are several).

i'd appreciate any info on this topic.

thanks

[seppuku]

UF profiling basically adjusts the rate that fluids are taken out of a patient. With no UF profile on, the machine will remove fluids at a constant rate that is determined by your fluid goal and treatment time. With Uf profiling, you can alter the rate so that it takes out more fluid during the beginning of treatment and less at the end. If you look at the picture of the different profiles, it shows you how the UF rate will be altered throughout treatment. UF profiling helps with patients who are trying to remove larger than usual amounts of fluid and often cramp or go hypotensive near the end of treatment. It's very rare that a patient will cramp within the first half of treatment so might as well take out the most fluid during that part, then when the rate slows down, the body has an easier time replacing intravascular fluid. For me, if cramping or hypotension is the problem at the end of treatment, I would try profiles 1 or 3. I have not found a single patient yet who likes profile 2 or thinks it works better than the others.

Now, assuming you're using the fresenius K or K2 machines, profile 4 is the intermittent profile (looks like teeth on a comb). it alternates between periods of slow and rapid fluid removal, then levels out towards the last half of treatment. I've always imagined it like testing hot water with your finger. At first, you dip your finger in and take it out super fast because the waters hot. then the second time you leave it in a little longer, then the third time longer, until finally you get acclimated to it and can leave your finger in. Its the same way profile 4 tests the body, by rapidly taking out plenty fluids for a short time, letting it rest, and then repeating, until the body is acclimated to fluid removal. for some people it works well, and for others not so much. It is my go-to profile for people who start out with low bp and have medium or high goal settings.

[ausrnurse]

UF profiling basically adjusts the rate that fluids are taken out of a patient. With no UF profile on, the machine will remove fluids at a constant rate that is determined by your fluid goal and treatment time. With Uf profiling, you can alter the rate so that it takes out more fluid during the beginning of treatment and less at the end. If you look at the picture of the different profiles, it shows you how the UF rate will be altered throughout treatment. UF profiling helps with patients who are trying to remove larger than usual amounts of fluid and often cramp or go hypotensive near the end of treatment. It's very rare that a patient will cramp within the first half of treatment so might as well take out the most fluid during that part, then when the rate slows down, the body has an easier time replacing intravascular fluid. For me, if cramping or hypotension is the problem at the end of treatment, I would try profiles 1 or 3. I have not found a single patient yet who likes profile 2 or thinks it works better than the others.

Now, assuming you're using the fresenius K or K2 machines, profile 4 is the intermittent profile (looks like teeth on a comb). it alternates between periods of slow and rapid fluid removal, then levels out towards the last half of treatment. I've always imagined it like testing hot water with your finger. At first, you dip your finger in and take it out super fast because the waters hot. then the second time you leave it in a little longer, then the third time longer, until finally you get acclimated to it and can leave your finger in. Its the same way profile 4 tests the body, by rapidly taking out plenty fluids for a short time, letting it rest, and then repeating, until the body is acclimated to fluid removal. for some people it works well, and for others not so much. It is my go-to profile for people who start out with low bp and have medium or high goal settings.

I have been using the 5008's for a couple of years now...was profile 4 the intermittent one similar to profile 5 but the low and high UF rates weren't as extreme?

UF profiling basically changes the way fluid is removed from the patient - as explained above, it can help to relieve cramps and hypotension. Typically we would use profile 1, 3, or 5 (these are the only profiles available on the fresenius 5008s, btw). 1 is a gentle slope, it works for most patients, but I don't often see much difference between this and no profile. We had one patient who really did well with profile 2 - she was a very noncompliant diabetic and although she would be extremely overloaded, the hypotension due to the autonomic dysfunction from her diabetes meant that it took FOREVER for her BP to recover - so we had to get the fluid off quickly then have lots of time to recover at the end. Profile 3 is another good one for diabetics or people who like to get off before the end of treatment - at least you can catch up on their fluid balance. It is a good one for diabetics. My two favourites though would have to be 5 and 6, particularly for heart failure patients and patients with pulmonary oedema. 20 min of high UF so they can breathe again, 20 min of low UF for their BP to recover. Profile 6 steps down like profile 3. You do have to be careful with these two (as with all profiles), I have seen someone become profoundly hypotensive and unresponsive after less than 10 min on a profile 5 - not really suited to diabetics. When you start using profiles a lot you will get a feel for what people can tolerate - it can be a godsend for some patients, but others will have really horrible side effects as well.

[Anna S, RN]

Great explanations from both replies.

If you look at the trends screen and/or the uf rate on the home screen, you will know where you are in your profile.

I like profile 4 for most pts w/ low B/P and lots of fluid on. I also elevate their legs and turn the temp down a little on the machine. O2 helps, too, but we only have 2 concentrators on my unit, so we can't use O2 most times.

We use hypertonic saline for B/P support. I keep track of the trends screen and when the profile is about to start a hard pull (the teeth on the comb on profile 4) I'll push a little hypertonic- say, 3cc in most cases. This helps my pts better plasma refill and tolerate the hard pulls much better. Their B/Ps don't drop so much, and I can get higher goals off than I could otherwise.

[traumaRUs, MSN, APRN]

And don't forget the use of crit lines. Since FMC bought the crit line company I am seeing more crit lines - lol