Unable to take fluid without cramping????

[mxems]

I have seen 3 or 4 different patients that I have that are fluid overloaded that I am unable to take a decent amount of fluid off of.

Blood Pressures are great and sometimes hypertensive.

4-8kg fluid overload

Common theme is diabetes and neuropathy.

I've tried various fluid profiles for removing and nothing seems to work.

The most I can get off of this type patient is about 3-3.5kg without them cramping like crazy.

Anybody have this problem?

Yes I've done fluid education and yes they come in for extra treatments now to help get that fluid off.

Since most of the fluid is lower extremity has anyone asked patients to use compression stockings before coming into treatment to help push the fluid back into the blood vessels?

Thanks Everyone

[fragino]

Sometimes despite all the strategies employed that's all that some can take off unless we can increase the time to 5 hours or nocturnal. I know, and you know that 4-8kg is way too much to even gain for most people in the first place. We've all tried telling our patients to limit their fluid intake and educate the heck out of them to etc., etc. But we know some just won't. That extra treatment is even counterproductive for some patients because they will just take that opportunity to drink and eat all they want and gain that 3.5kg you took off yesterday plus 1-2kg more overnight! We don't have a lot of docs here that like to use sequential.

[Chisca, RN]

Sodium modeling or lengthening the treatment time. 5 + kg weight gain between treatments is really killing their heart but what are you going to do? One of the reasons dialysis patients have a high mortality. Compression devices on the lower extremeties isn't going to change the electrolyte shift that is occuring with large fluid removal.

[Guttercat, ASN, RN]

Diabetes + diabetic vasculopathy + cardiac insufficiency + fluid overload = recipe for mucho problemos.

Good luck! :)

[Coleebee]

^^ that

[DialysisRN34, BSN]

My MD is big into a extra treatment a week (not allowing for a two day break). It works for most patients (especially my cardiac comprised folks) and then they have incentive to control fluid to get back on a 3 day a week schedule.

[fragino]

Sodium modeling is gone for us.

[westieluv]

My MD is big into a extra treatment a week (not allowing for a two day break). It works for most patients (especially my cardiac comprised folks) and then they have incentive to control fluid to get back on a 3 day a week schedule.

How do you achieve this? Is your clinic open on Sundays, or do the MWF people come in on Saturday, and if so, then it seems that either your Saturdays would be insane or your Mondays would be if the TTS people come in on Monday.

[fragino]

Yes, some clinics run extra treatment days on Mondays and Saturdays. Yes Mondays sometimes got worse.

[westieluv]

Well, I guess if the clinic is willing to make accommodations for those extra treatments in the form of extra chairs and extra staff, then it wouldn't be so bad.

[jdethman]

If you have a Crit line establish a hematocrit threshold, and never go above it

If not consider weight for overall fluid removal, ask MD for 30 ml per kilo per treatment take it all in the first three and then reduce NA to 135 for last hour so they will not be thirsty UF to 300 hr, temp to 35 last hour for BP support if needed.

The problem might be their plasma refill is to low, when you are crashing their blood volume you are stimulating thirst via high plasma NA even if corrected before tx DC it is still stimulated, telling them to not drink after that is less effective then telling a heroin addict to go cold turkey.