What blood pump speed do your run? We read articles months back that stated a speed of no more than 300-350 is recomended for fistulas. Do not recall the rationale. Can excessive blood pump speeds damage a fistula in the long run? Does the recomended speed differ with buttonholes?
I think the pressures are morre important than anything else. At 350 on the Fresenius I was running Arterial at around -180 and Venous at 200; at 450 on the NxStage my Arterial is around -150 and Venous 180, so I am thinking the 450 is actually easier on my fistula than the 350 on Fresenius.
My buttonholes are doing wonderfully, I stop bleeding in a flash, no clotting, no alarms, and I feel good with no obvious strain of any kind based on my 70s-80s heartrate and b/p around 100/70, at the beginning and end of treatment.
Cathy
This question is a good one. I thought that one of the claims of nocturnal was the slower the blood pump speed the easier on the heart. Which is why doing nocturnal dialysis for 8 hrs. patients are told to use a Blood Pump Speed of 200 to 300.
Heather, I don’t know the rationale but the reason they run the pump speed higher in center is to get more blood cleansed during the treatment time. I think the reason NxStage patients run at higher BPS is to process more blood per hour as the treatments are short.
Depends really on pressures, if you have very good pressures then you can run as high as you can handle…
I run mine up to 430…my pressures are really nice! 175-225
Can you believe that I don’t even use heparin!! 
Eek! - NO Heparin!!?
ON daytime I ran on up to 350 (depending, as was said above, on pressures). On nocturnal they told us 250 max! THis allows for a bit more ‘leeway’ if/when you move about (so it’s less likely to alarm) as well as being easier on the bod. Normally I now get -80/120. If it creeps a bit I drop to 240 at the start.
I think that’s the way it is for most of us? At first pressures are bit high at the start but once you relax or lay down flat then pressures normalize…that’s the way it is for me, without heparin…well, I do take an asprin now and then…2 baby asprin or 1 normal asprin every 3 days…
There are various factors at work when we talk about blood pump speed. Bear with me, as I try to set this up ( and I know most of the people here already know all this stuff).
Given the same dialysate speed, it’s not really the time you spend on dialysis that counts, but the amount of blood that has flowed through your dialyzer by the end of the treatment. The machine itself is really just a support, with tubes, sensors, computer, etc. The real work is done in the dialyzer.
Removal of fluid (called ultrafiltration) is strictly a function of time, ie. the longer you are on, the less fluid has to be taken off you per hour (and the easier it is on your body). But in terms of removing toxins and such, the actual dialysis in other words, it’s not really time, it’s the blood volume. It’s how much blood you are putting through the dialyzer during that time. So, given two identical 2 hours treatments, the person running the blood pump at 400 will get more dialysis than the person who runs it at 300. This is why in the dialysis centre, the nurses are always trying to run your blood pump as fast as your fistula and your heart can take it. They want to give you the most dialysis they can for your 3-5 hours on treatment, since with only 3 relatively short treatments per week, you’re only getting barely adequate dialysis as it is, and they don’t want to run you slower unless they have to for other reasons.
If you are doing relatively short “short daily” treatments, you really don’t want to run your blood pump much lower than 400, because if you do, you will be getting less dialysis, and you might be defeating the purpose of doing your dialysis daily. With the longer treatments such as with nocturnal, you are on so long that even if you only run your blood pump at 200, you are still getting way, way more dialysis than those on short daily or conventional hemo. You would not want to run your blood pump at more than 300 on daily nocturnal because then you would be getting too much dialysis, and you probably would not be able to get a good night’s sleep because it would be too easy to generate pressure alarms as you try to sleep. But, why run it faster when you don’t have to?
But there are practical limitations that affect blood pump speed. First of all, there’s your heart. The faster the blood pump runs, the greater chance there is that this flow of blood in and out of your body will start affecting your heart. For example, in my case, when I was in-centre, we discovered that whenever we ran the blood pump faster than 400, my heartbeat would skip all over the place, and I would start feeling short of breath. Under 400 was Ok. Then there’s the fistula itself. The faster your pulling blood out of one needle and pushing it back in with the next, the more stress you’re putting on that vein. It depends on how much flow you’re getting through your fistula, but if you go faster than that flow can allow, you’re going to get venous and arterial pressure problems, and probably a lot of alarms and resets. You can also get spasms in the fistula vein, or the vein will start collapsing on itself as it can’t keep up with the demand, which will also cause frequent alarms. It terms of whether higher speeds affect the fistula in the long term, realistically, I have to say there’s very little data about that. So, nobody really knows. We can only guess that not too fast is better over the long haul.
So, generally speaking, whatever the duration of your treatments, you want to run the blood pump at the fastest speed you can within those limitations, because you want to get the most dialysis for your buck. I don’t know about other machines, but on the Fresenius 2008K, you can easily find out how much blood volume went through the dialyzer simply by looking at the blood volume number on the K/TV screen. If your machine doesn’t show this, you can calculate it fairly easily because you know how much blood you’re pumping be minute, and you know how many total minutes long your treatment is. When you know your total blood volume, you can very easily see what difference slower or higher blood pump speeds makes. If you’re on nocturnal, the treatments are so long that it make no difference whatsoever - so your as long as you’re pumping blood somewhere between 200 and 300, you’re Ok.
By the way, many people find they have fewer problems with the fistula if they start on the slow side and then increase the blood pump speed gradually during the first half hour or so. On nocturnal, it doesn’t really matter as much, because even your fastest running speed is pretty slow.
Theoretically, as long as the needles are the same gauge, it shouldn’t make any difference between whether you’re using a sharp or a buttonhole needle, given identical needle placement in relation to the fistula. In the real world though, it seems to, at least for me. For some reason, I get better pressures from my buttonhole needles, than when I have to use a sharp one. Why? I don’t know, but I’m guessing there’s something about those Medisystems buttonhole needles that improves the blood flow. Maybe the gauge is slightly bigger, maybe the needle lines are a little wider, maybe they have more slippery insides, etc. I just don’t know.
Also, another factor is that blood pump speed must not be higher than the dialysate pump speed. It can be equal, but not higher. This is one reason why on nocturnal, the blood pump speed prescription is usually 300 (or lower), since the dialysate pump speed is 300 on nocturnal.
Pierre
P.S. We don’t often use disclaimers on here, but I wouldn’t advise anyone to change anything about their dialysis prescription without consulting their nurse. Unless you really understand all aspects of dialysis, you could potentially affect the efficacity of your treatment, and your health. It’s good to know things, but a little knowledge can be a dangerous thing.
I dont let my venous pressure go past 150. Arterial usually is around -40, doesnt change much.
I run at 200 on nocturnal, and on incentre I ran at 250 and occaisionally 300. I usually get pressures of -40/80