With daily txs there is twice as much blood loss (blood left in the lines and dialyzer). What are the effects of this?
is there? I get my lines to run clear with my rinse back. Even after we have me off for awhile and start to break down the cartridge there is hardly any blood left in the circuit. I’d just about say I get more blood back then I did on InCenter.
LSB
I am saying twice as much blood loss as with daily dialysis there are 6 days of dialysis rather than 3. Maybe the loss is insignificant, but it seems like a lot of blood when one adds it up.
I am not sure what blood you are speaking of. Where is this blood lost? Logicly I assumed you meant during rinse back. As I said in my last post, I hardly lose any blood on my rinse back. My lines run clear even my filter is clear. there are some days when my blood seems extra sticky. On those days I rinse back some extra saline untill my lines run clear. When I clear my catheter of it’s heparin I only lose a fraction of a CC. So where am I losing blood on Six days of treatment versus 3 days of treatment?
LSB
Yes, rinseback. It has been a long time since I have observed the amount of blood lost with a catheter. I am referring to an arm access. I don’t know for sure how much blood remains in the lines and dialyzer if one adds it up over 6 txs/wk-can anyone take a guess?
Well I am sure there is not much difference between an arm access and a catheter. An arm access probably loses a tad less then I do with a catheter, but the does not have to do with rinse back. I missunderstood you at first, I thought you were talking about 3x a week in center. 3x a wk versus 6x a wk home tx, of course more is lost over 6 tx’s. How much, probably less then a cc or two. If you are using enough heparin and snapping the lines during rinse back then I think you should just about get all your blood back like I do. I guess I have one advantage, my partner also taps the cartridge and those lines while I run through the lines going to me. I use a very large bolus though, 8200 units, and I use a heparin pump that gives me a total of 5.6mls over a eight hour period. I have serious blood issues, low crit and hemoglobin, and yet I seem to be doing considerably better on home hemo six days a week. I think in the end you’d have to weigh out all the issues at hand. That is what we are doing everyday though. If anyone else wants to chime in with the perception of this then that would be great. I would like to here some other input on this too.
LSB
In my opinion, I think you lose alot more blood in-center…regardless its only 3x a week.
In-center I used twice as much EPOGEN than what I use at home. I also was anemic while in-center and now that I am home I feel way better!
Logically, you really lose alot more blood in-center BUT it has to do with several factors that may include not enough dialysis and nutrition.
I know you are always trying to discourage home daily hemo, or at least it appears that way, with the negative way you ask questions. However, I think it is quite obvious that daily hemo users either don’t lose a lot of blood (since we take the time to return as much blood as possible and are in control), or since we are so much healthier due to daily dialysis, that a large percentage of daily home hemo patients do not use any epo.
Myself, I am told to not return all my blood since my latest numbers were 15.9 and 50.2, both high. I hate to dump blood, which is what I have to do if the numbers stay low, so I simply adjust my return volume down a bit to leave a bit of blood in the tubing. Somehow this doesn’t bother me as much as leaving it all in.
FWIW what I mean about the negative tone of your questions is, and a positive example of how to have asked this question would be:
It would seem as if with doing twice as much dialysis that you would have more of a problem with hgb and hct, however, it appears that most of you do not need any or much epo. Any ideas why??
Cathy
a bit grumpy
but do wish everyone happy holidays
I would like to know if daily home patients’ heparin bolus is the same as it was in-center or if it has had to be adjusted, up or down? Also, I know the dialyzer should be lightly streaked after rinseback, but I am not clear on how much blood should be left in the lines and headers to know one has the appropriate amount of heparin. I understand the criteria of no bleeding post tx. But how does one know when the heparin rate is correct? I see where LSB states his lines and dialyzer go very clear with a high bolus. I would think the objective is to use as little heparin as is necessary.
Heparin is a physician-prescribed drug. I would think that the doctor (or nurse acting on the doctor’s behalf) should be the one that advises the patient how much much heparin to bolus at the beginning and/or during a dialysis treatment. Too much heparin can make someone at risk of bleeding. Too little heparin can make someone at risk of clotting the dialyzer/lines.
It’s important not to leave too much blood in the dialyzer and lines. I’d suggest that patients discuss with their training nurse and/or doctor what the dialyzer should look like after dialysis. You might want to ask the nurse if he/she can find a picture of what the dialyzer should look like at the end of dialysis after blood is returned and what it would look like when there’s too much blood left behind. When the dialyzer and lines are totally filled with blood, there is about a cup of blood outside the body so I suspect after a good rinse back, there’s very little blood left in the dialyzer and lines.
Does DOQI have guidelines for heparin administration, or would units have written protocols for how it is decided how much heparin to give?
I use a 8600 unit bolus and 700 units per hour over a eight hour tx. My bolus is very high considering it started out at 6000 units. One thing that should be considered is that I take tamoxifin. A side effect of Tamoxifin is blood clotting problems. Before I started home hemo I had been taking Tamoxifin for some time and had developed blood clots in many of my surface veins. They feel like little knots in the veins. After starting home hemo and using more heparin the clots broke up and are no longer there. I also have very blood levels, hemoglobin and Iron are very low and venofer and Epo don’t seem to help much. So I can not afford to lose any blood. This is why I use so much Heparin. I even put more in my Heparin pump syringe then I need for the tx. So at the end my partner can give me a little bolus to help clear the lines and the filter. I am not sure what the dangers are to using this much Heparin. My nurse doesn’t seem to have a problem with it. She did mention that I could be at a high risk of bleeding after a tx, but that should go down shortly after I am off the machine. Heparin apparently doesn’t stay in the blood all that long anyways. Hence the need for a Heparin pump when on Nocturnal. I remember that In-center they used to say that the streaks of blood in the filter after rinse back was normal. My filter is clear except maybe a small clot on the venous end and it is usually no bigger then a dime. I also only 300mls for my rinse back. On days before it rains I need to add some to my rinse back for some reason. The blood gets stickier or something.
Peace;
LSB
[quote=Leafsunbear;11797]I remember that In-center they used to say that the streaks of blood in the filter after rinse back was normal. My filter is clear except maybe a small clot on the venous end and it is usually no bigger then a dime. I also only 300mls for my rinse back. On days before it rains I need to add some to my rinse back for some reason. The blood gets stickier or something.
Peace;
LSB[/quote]
I can also relate to that, some streaks on the dialyzer is okay, but if those streaks are excess and the pressures during treatment are a bit high then you need to increase heparin dosage. In my case my dialyzer does have a few streaks here and there and return .3 as stated in the NxStage guidlines. I don’t even use heparin, only 3 baby asprin every other day. Its been a little over two years now and it has been going great.
I would think that home patients lose less blood with rinsebacks and losing blood through the extracorporeal circuit because they have time to assure better rinsebacks. In center staff cannot possibly have time to assure a better rinseback than a home dialyzor. As far as heparin the protocol I have used over my 20 or so nephrology nurse years is 1000U per 10 KG. ie 86.5kg, 8600U heparin. Of course every policy should take into consideration individual patient needs, ie post op, cataract surgery, etc. I say this after weighing 3 vs 6/x treatments weekly. No statistics to back it. I maintain that if the patient is anticoagulated properly they should be able to receive the majority of their RBC’s back through doing their own RB as taught in training. BTW Happy New Year!
Does anyone heparinize your dialyzer and lines prior to getting hooked up…this is done in-center, so wonder if home patients use this procedure too?
Can anyone venture a guess on what might be causing the following problem with my NxStage tx?: my returns are very nice and then I’ll have a tx where the blood hangs up and can’t get the blood to return…lose a big percentage. I learned that air which stays in or gets in during the prime is the #1 cause of poor returns. And I observed that when the return is poor, I see a few tiny air bubbles in venous cap. But don’t know how the air is getting in and why it is happening lately when it never happened before.
Prior to learning about the relationship of air, it was suggested that I go up on my heparin. I did that several times, but it has not solved the problem. It was also suggested that I extract the air with syringe. Tried that too with no success. Any ideas would be appreciated.
Personally I just have sticky blood days. I don’t think it has anything to do with anything personally. On these days I just rinse some more back. Maybe someone else has better info on this. Maybe it has something to do with barometric pressure or something. Usually my sticky blood days correspond with my bad arthritis days, then it rains.
LSB
[QUOTE=Leafsunbear;12121]Personally I just have sticky blood days. I don’t think it has anything to do with anything personally. On these days I just rinse some more back. Maybe someone else has better info on this. Maybe it has something to do with barometric pressure or something. Usually my sticky blood days correspond with my bad arthritis days, then it rains.
LSB[/QUOTE]
I have tried rinsing back with more saline by hitting rinseback again after the pump has stopped, but this does not work either-saline pours through, but blood is hung up in dialyzer heads and lines. On the days when I get good returns, the returns are excellent, about 95% clear. But then this pattern is occuring where I get several clear returns in a row and then I get a very poor return at about 35%. I would not be concerned if on the less good days it was at about 75%, but I feel there is a definite problem when that much blood will not return. This does not seem normal to me. Wondering if others experience days like this.
Ralph has been taking Fish Oil 1000 mc. This seems to help a lot.
We almost always have clear lines.
I did notice when we ran out of Fish Oil and he did not take it for a few days that we had a problem with the rinse back.
Pat
[QUOTE=Pat Colongione;12124]Ralph has been taking Fish Oil 1000 mc. This seems to help a lot.
We almost always have clear lines.
I did notice when we ran out of Fish Oil and he did not take it for a few days that we had a problem with the rinse back.
Pat[/QUOTE]
How many capsules does he take per day? I will ask my neph about it. Several people have suggested to me that the problem can be with the concentration of my blood on a particular day. But I have also been told that air in the system is the most likely problem. So, looking for any factual info.