My introduction thread has quite a number of messages in it, so, I thought I had better start of new one for this specific question.
I’m on a Fresenius 2008K. At the end of treatment, first I rinse my blood back from the veinous side with the blood pump on. Once that’s done, I move a clamp near the saline T in order to rinse my blood back from the arterial blood line under gravity (pump off at this stage) from the saline bag.
Now, I have a very powerful upper arm fistula, and, as soon as I move that clamp and therefore open the pathway from my arterial needle, through the arterial bloodline, on through the saline line up to the IV bag, blood flows right back up into the saline bag itself. It’s that powerful, and it takes a nurse applying quite a bit of pressure on the saline bag (by squeezing it) in order to rinse my blood back from the arterial blood line (and at this point, the saline line as well all the way up to the bag).
Anybody else run into that? It’s not a big problem as long as someone is there to apply pressure on the saline bag, but, once I’m alone, there doesn’t seem to be any way to do it and at the same time intermittently apply pressure alone the line to free the blood. I’m sure my training nurse will figure something out, but surely, I can’t be the first patient this happens to.
I have always insisted that my blood be returned without sqeezing the bag as I read it can be an unsafe procedure. It works well for me to let it come back naturally. But a tech told me that the natural gravity return process does not work with some patients - I believe she said patients who run high blood pressures.
I return all my blood with the pump on at 200. Instead of opening the clamp at the “T” open the lower clamp where you connect your arterial blood line, then all the blood is returned. I use the same machine as you, so know this works. I believe it also works if you open both clamps but that is over kill and probably takes more saline to return the blood.
I never disconnect my venous blood line until all blood is removed. I draw about 7ccs of fluid into a syringe prior to treatment and keep it on the IV line with the line clamped. When treatment is over I clamp my arterial line and disconnect and put it on the IV line where the syringe is and put the syringe on my arterial line. I then open the lower clamp turn the pump to 200, open all the clamps and saline bag and turn on the pump, that starts returning blood to me through the venous line while clearing all the blood from the arterial and venous lines.
While it is returning I open the arterial needle and return the blood using the syringe of saline and reclamp. I then go back and start shaking the dialyzer to ensure as much blood as possible gets returned, when my lines are essentially clear I turn off the blood pump, clamp the venous and disconnect.
All blood returned, easy as pie!! Takes maybe 3-4 minutes.
When I first started on home daily on the B Braun I too rinsed back the way Cathy does Pierre but I’m wondering something if you raised your arm - above your heart but below the saline and or raised the saline higher would that work? It seems like there would be an answer in fluid dynamics. One time I was part of a group showing someone around my unit when what you described happened, turning the saline bag red. The person who was being given the tour remarked “oh, you give blood too” - at the time I didn’t know what was going on, I knew I was looking at a saline bag but I had no idea why it would be diluted with blood. I was told that one of the contributing factors was that the saline pole was not fully extended.
The Aksys handles the rinse back in a unique way. With Aksys it’s nice because it rinses back from the kidney out - clearing both lines at the same time - with a push of a button.
I did it that way Cathy but I know that some units have changed from that method or advise using a different technique because they don’t want to disconnect/reconnect the lines - to minimize the chance for contamination. When I did it, the way you described if I thought that I in any way slipped or something I would just discard the small amount of blood in the needle line. I have been to units abroad where the blood in the arterial needle line was discarded as a matter of course.
I asked about the height of the pole, etc. because I was just thinking that if I had a better understanding of fluid dynamics there would be a solution. It could be it is just the way it is for some people, btw Pierre what are your blood pressures running?
My BP’s are running a little on the high side at the moment, because we stopped my single BP med (Atacand, 8 mg) the day I started the training in week 1. My BP was too low. My BP always tends to be higher at the end of treatment, so it’s in the 150 range when I’m doing that rinse back. We’re going to start lowering my dry weight tomorrow.
I presented Cathy’s method to my nurse, but she wasn’t too crazy about the extra disconnection and connection. It’s hard to deviate from the policy manual, at any rate. The solution at this point may be to use a manually inflated BP cuff on the saline bag.
Bill, Yes. Only thing you have to do is push the mute button because you will get venous alarms until you move the what I call sissor clamp. It only takes about a minute to rinse the arterial line this way.
Actually when the program was started they used to do it; as it was done in Canada. Then a nurse from Scotland got them rinsing the arterial side first via gravity. The purpose was so if air got in the line it would be caught by the air detector.
Coincidentally a Fresenius rep was here today changing out my air detector/venous holder. I asked him about this and he said my way is the “newer” way, that the risk of infection is less than the risk of getting air and the “difficulty” of returning the blood via gravity. Who knows, I just know it works well for me, if I dropped it I would use a betydyne wipe and run out a little of the blood before reconnecting, but I never seem to. I just like how easy it is and quick.
Marty’s system sounds okay, but you must have to either use gravity or push the saline bag to return the arterial blood, which is a supposed air risk.
Yes Bill, I am dialyzing daily for 2 hours and 20 minutes while training. During week 1, we continued with 3 times per week dialysis and used the days in between for practising and understanding the setup, and then on the first day of week two, I started the daily dialysis. So, today was only my 4th daily treatment. I can’t say i feel that different yet. I would even say I feel more tired with going there every day for 8am. I’m used to relaxing on off days
I’m sure there will be benefits after a while though.
I do my husband’s home hemo runs, and I also return his blood via the method you described. Personally, I don’ t believe that the risk of contamination is significant. The arterial line has spent the entire dialysis session connected to the system, and the time it takes to attach it to the red end of the saline line isn’t more than a second or two. As for the saline line itself, rinse back is the first time this line is opened at that spot, and again, only for a moment. And as you said, the entire rinseback can be accomplished with between 300 and 400 ccs of saline of which 200 stay in the blood lines.
Anyway, that’s how our unit trained us, and so far no problems. I also have to say that I believe the contamination risk at home is much, much less than at an in-center unit. After all, we have complete control of how clean things are, and there’s no risk of cross-contamination between patients. Something I’m darned glad of since it looks like Michael’s fistula may be failing and there could very well be a new CVC in his future.
To be clear, my rinsing back the blood in the arterial line via gravity from the saline bag problem is in the context of dialyzing by myself. If I have a helper, there’s no problem, because it’s just a matter of someone squeezing the saline bag.
The health pros don’t seem to care much for the solution that Cathy and Deb use, ie. doing it all in one shot by connecting the arterial line to the saline line and putting a saline syring on the arterial needle line. They can see how it works, but, they are concerned about the risk of contamination. While I was on dialysis today, I tried to see just how possible it would be to do this. With my upper arm fistula, I would not have enough arterial needle line length to be able to do this. It’s too short to comfortably reach my hand. Because of that, I remove my own needles by attaching a scissor clamp near the end of the needle line, so I can grasp one of the hole with my thumb and like that, pull the needle out.
Another possible solution for my arterial needle backing right up into the saline bag when rinsing back would be to switch the veinous and arterial blood lines for rinse back, the idea being that my veinous needle site isn’t as powerful as my arterial site. However, again, there’s the problem of not being able to do this with any security, due to the needle lines not reaching my hand.
It’s looking like the only solution will be to put a pressure cuff around the saline bag, but, we haven’t tried it yet.