Ultrafiltration Profiling

Specialties Urology

Published

can somebody explain to me all bout ultrafiltration profiling? this is a common practice in ours..have been doin some research bout this but couldnt find an extensive article discussing about the indication, contraindication and effects of ultrafiltration profiling..the practice in our unit is if the patient is hypertensive at the start of the dialysis and edematous and congested, we usually employ the ultrafiltration profiles of our machines...are we right to be doin this?

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Specializes in Med Surg, Home Health, Dialysis, Tele.

Well UF does only one thing, pull off fluid. But it doesn't clean the blood which is the other part of HD. Sometimes the patient may need alot of fluid pulled off but can't tolerate the fluid pull and the cleaning. So the UF is used, so usually the doc will either schedule an extra day for only UF or the order will be for 2 hours UF and 1 hour HD. Because remember the HD is the patient's kidney so they do need the blood to be cleaned.:nurse:

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did the last post answer your question or are you talking about uf and svs profiling?

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Specializes in cardiac surgery and nephrology nursing.

hi

i'm a renal nurse from australia.UF profiling mainly for the way you want to take the fluid off. For instance, you might be planning for 2 Kg off over 4 hours , you can decide that 2L off in many ways , firstly in a steady rate 500ml/hr which means no profile. i believe you are using fresius machine, proflie 1, 3, 5 0r 6. So when you use profile you are giving time for good vascular refill. there is no point in using profile if the serum albumin level is lower than 32mmol/l

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Looks favorable here. Been searching for answers along this line. Hard to get a direct response, although I can mostly understand the reason. I would like to know if 'ultrafiltration' does only remove fluid. I (from my point of view) find it difficult to understand why two processes are required here, when the blood is already being processed.

Why not a filter that removes fluid along with any thing else that needs removing.

Yes, if true, that 'ultrafiltration' removes only fluid, then I see how ones dialysis session needs to be in two stages.

One stage of removing excess fluid. (if above normal dry weight, more time here, less in cleaning)

One stage for cleaning the blood. (if normal dry weight, more time here)

The actual 'needs' of the patient would be a huge variable for each patient every session, yes/no!

All this would need to be consistent for those with either low, or high blood pressure.

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Specializes in Dialysis.

Dialysis works by passing blood through a semipermable membrane. Blood molecules are too big to pass through this membrane. Water passes through based on the hydrostatic pressure on the other side of the membrane. Solutes pass through based on the chemical composition of the dialysate through a process called diffusion. If there isn't any dialysate passing through the other side of the membrane only water will be removed from the blood. While it is nice that we can squeeze water out of blood if it isn't replaced by water from the tissue blood pressure will fall. Dialysis can only remove water from one compartment of the body, blood, while most of the water in the body is the cells or in the tissue. We get into trouble when we try to do too much in too little time. Getting a patient to a dry weight goal takes months and I would much rather do it with extra treatments and longer times but it's hard to convince patients of this. So instead we either make the blood salty to pull water (sodium modeling) or alternate the rate of removal during the treatment (UF profiling).

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Ah, an explanation that is beautifully done.

It triggers memories of osmosis, microns and a need for me to revive those thoughts.

Thank you

Be Well

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Well now, am making progress on my quest for an explanation as here shown and was posted on another forum:

It's slowly sinking in but, .....

Aren't all three modes, in one way or another, part of every dialysis!

ultrafiltration (as used in normal dialysis)

Ultrafiltration Profiling

Sodium Profiling

Reading through the very informative posts here (allnurses.com) the pieces are slowly coming together, on what I need to know.

Remaining as questions are:

1- Is there a meaning difference, between 'Profiling' and Modeling', as used in dialysis ?

2- There are at least (4) four phases used in each of the Ultrafiltration Profiling and Sodium Profiling.

What are they and what does each actually do, and how long a time period for each Phase?

3- Answers are showing up here, as individual answers, would beneficial for me and the nurse students asking the same questions, to have them in one place.

Be Well

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First of all, no not all three modes are part of every dialysis. Ultrafiltration, yes. But UF and sodium profiling are only used for certain patients. Majority of patients do not.

Now, to answer your questions:

1- No. As far as I know, profiling and modeling are used interchangeably.

2- Not necessarily. Although I really don't know what you mean by phases and how it is relevant to UF profiling. In general, UF profiling removes a large amount of fluid at the beginning of treatment, and a small amount towards the end (to give the body time to refill the vascular space). Each dialysis machine has its own unique profiles and if you look at them, it will show you the rate fluid will be removed from the patient over the course of treatment.

Sodium profiling has three main profiles that I know about: linear, step, exponential. Basically, sodium profiling will start treatment with a higher sodium level in the dialysate and lower it back down to normal by the end of treatment. It increases a patients serum sodium level to help support blood pressure during treatment, and also thought to help prevent cramping. Can be very useful when used in conjunction with UF profiles.

3- Is this even a question?

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Specializes in Dialysis.

While it may be interesting to understand the difference between sodium modeling and UF profiling ultimately they are nothing more than tricks that have no evidence based benefit on morbidity or mortality. Patients achieved the greatest benefit from longer and more frequent dialysis sessions but that doesn't fit our corporate model of dialysis delivery. Research what happened in Tassin, France back in the 1960's. We know the answers but it doesn't fit into a for profit model. Renal Fellow Network: The Secrets of Tassin

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Specializes in hemo and peritoneal dialysis.

Just make sure you have s doctor's order for the sodium deviation, because it is a medication. Our docs don't allow sodium modeling, because it can be tough on the heart, and doesn't completely clear in the last hour for many patients. I'm a critline guy. I rarely see a crash.

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Usually need an order. I like one for people with high bp in beginning of tx. 4 is for cardiac and works well with amputee. The one that looks like a ladder may be 5 is good for diabetics and people who have low bps because it allows time for vascular filling. Its not on all my machines though. Biomed has to program them.

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