Tech had the blood pump speed too low by 30 points. Another tech noticed and asked if we wanted to increase it by 30 points over the correct speed to compensate for lost clearance. We said yes let’s see how it goes. But in about 2 minutes heart became very overwhelmed and the tech had walked away, so we had to turn down the blood pump speed ourselves. Wow, we always check everything, but somehow this got by us. It was a good learning experience as we had never turned the blood pump up 30 points before. That is not much at all, but was too much in our case. The heart was quickly in trouble. But turning the pump down quickly to the regular speed the heart recovered quickly. Has anyone every tried turning the pump up to see how fast a pump speed you can tolerate?
At home, we’re not allowed to go higher than 400 for short daily, and 300 for nocturnal. Even when I was in-centre, I never ran at more than 400, because higher than that and my heart skips beats. The first year I was on hemo, they routinely ran me at 450.
Pierre
The highest I was able to handle in-center was 375…anything higher would make me dizzy…
However, now that I am at home I can handle up to 430 without problems…I think there’s a reason why, you see in-center I was taking more than 2kg off and at home am taking alot less off, about .8 daily average…
So if you have alot of fluid to take off then certainly your gonna get sick and can’t even handle high pump speeds nor UFR rates within short times…
Back in the day I ran 450 incenter, then around 1996 I joined internet discussions and learned about heart and fistula health and asked to increase my time and lower my pump speed to 350.
These days at home I usually run at 350 but if I don’t have much fluid on -less than .5 kg - then I’ll run at 300.
Haven’t been past 300 yet. Usually on 225 for Nocturnal. 300 seems fast to me at present.
Gus and pierre, havent you both previouisly said that high pump speeds dont effect your heart?
I am on 225 for nocturnal. If I do a day run I do 250.
No, I don’t think I ever said that. In fact, I’ve said the opposite.
But you do have to keep in mind that the slower your blood is pumped through the dialyzer, the less dialysis you’re getting during the same amount of time. So, if you would normally run a daytime treatment at 400 for 2 hours, but you decide to run it at 200 instead, you will need double the amount of treatment time. So, it’s a compromise. As I said, in the home hemo program here, standard unless there are other factors involved is 300 ml/min for daily nocturnal, and 400 for short daily.
Pierre
There are patients who run at very high speeds of 500 something. How is it that some can only comfortably run at 300 and others have no heart problems at 500?
Where the fistula is can make a difference. A strong, large upper arm fistula is much closer to the heart.
Pierre
I truly believe the fistula has alot to do with it…I previously stated in another post that people with more mature fistulas that have excellent powerful flow can tolerate higher pump speeds…I have been running mine at 450 lately…for 2.7 hours…but I think those of you with small fistulas may encounter problems trying to run the pump high…
Appologies for that pierre, there was a bit of a debate in another thread somewhere about the effects of pump speed on the body. I asked my Dx nurse and he said the high pump speeds can contribute to rebounding blood levels, which can be dangerous. It happened to me quite a few times when I was on 3-4/wk treatments.
I have a pretty good size fistula so everyone says, but I usually cant handle speeds over 250. Occaisionally I have run at 300, but the venous pressure plays up too much. On nocturnal I run at 225, and the venous is slowly creeping up over time. Im having a doppler done just to make sure there is no stenosis there. Trouble is I have to wait 2 months to get it done :?
No problem Amber. Since you run 10 hour treatments, your slower blood pump speed should not be a factor, however, with slow blood pump speed, I know that some concern has been expressed about increased chances of clotting during treatment. As I said, for nocturnal, I’m not supposed to go higher than 300, but I wouldn’t want to anyway. I’ve run my 8 hour treatments as low as 250 and my blood work is still outstanding. What’s outstanding? Blood work results which give no hint that the person even has renal failure. It’s that good! In my case, I would not run lower than 250 because I like to keep my total blood volume for a treatment up above 110 litres. Lately, I’ve been running at 300 and that gives me a blood volume of over 135 litres for an 8 hour treatment. But, my neph says that when you get to those levels on a daily basis, it really doesn’t make that much difference if you run 6 hours or 9 hours.
Pierre
I am gathering Im on a low speed because Im female, and perhaps because Im not hugely overweight. I am overweight though, wont deny that lol I get a little clotting in the lines, but its never clotted off completely. I have more trouble with my cannulas clotting when I flush them :?
hello all,my hubby started home dialysis training two weeks ago and he was started at 200, now they have put him up to 300, they are saying that they want it to go up to 350 at some point during the training, we have been told that it should not go higher than 400, but i think it depends on your fistula. i could be wrong.
Helen01, how many hours per week will he be doing? I wouldnt think 400 would be necessary if he is dialysing more than 12hrs a week. It does depend on his bloods though, and I think your weight is a factor too.
hi amba_79, hubby {andy} is doing dialysis every day for 2/12 hr’s per day, just while we are doing the training, then when we go in home it will be 4 hr’s 3 time’s a week. i think the pump speed will change when we go home though.
Oh, gee 4hrsx3 that sux. I thought the idea of home hemo was to do more dialysis than what you get in-centre. That would explain why they want the higher pump speed, so he is actually getting more dialysis. Doing 2 1/2hrs a day while he is training will probly do him good, as it is one of the preferred forms of dialysis. I wouldnt want to go to a high speed either. Just keep an eye on his bloods and it will show what is needed. If he is offered the chance to do more hours or do nocturnal or short daily, then go for it!
Hi Helen. 
only 4 hours at homex3 times a week. I am surprised about that. I thought all the states did the same thing. Here in nsw, usually everyone does 5 hours in centre x 3 times a week. But, when doing home dialysis it is usually 6 hours unless you are doing nocturnal which I know it Melbourne you can do 6 nights a week. Here in nsw my husband is doing nocturnal and he is doing every second night for 8 hours. I think when you are at home, you can do as much as you like.
When Con was doing home dialysis during the day he was doing 6 hours x 3 days a week with blood pump between 340-360. The doctors said not to go much higher. Con never went higher because his blood test very good at that. Also, it is a good idea to keep an eye on the Arterial and Venous pressures… it isn’t good for the fistula if they running to high.
hope this helps.
cheers Queenie.
Queenie:
keep an eye on the Arterial and Venous pressures… it isn’t good for the fistula if they running to high.
What should the range be for art and ven pressures?
I was on 6hrs 4 days a week when I first came home. Everyone is different, some need more some need less. You really should only do the amount of hrs you have been prescribed, if you want to do more just ask if its possible. It may be the unit can only afford 4hrsx3.