joey
Full Member
Posts: 186
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Post by joey on Jan 19, 2022 15:59:04 GMT
By "them" I meant the ICU MD. Since both of the methods above were done using a Fresenius machine, Monday morning I set up one of our Braun machines to make sure that it could do this also without any alarms. I used the Cleveland Clinic method though I did not collect the solution in bags, there were no problems at all. I didn't think there would be any difference but I drew electrolyte samples from the dialysate line and of the "CRRT Solution". Ca++ and Mg++ were both 0.08 mEq/L higher in the CRRT Solution and all others, including CO2 were identical. On my way home I started feeling not too good and by 6:00 I felt like I got hit by a truck. I did a rapid home test and tested positive for COVID so.... I have not been back to the office to get any updates. Oh man I hope you feel better....when you are on the mend I'd like to know if what you did was a prime, then started a simulated therapy with a 800 dialysate flow and just took the red hanson off and placed it somewhere and let the dialysate go into a bucket instead of back to the machine?
Like you I like learning new stuff and trying to be prepared just in case.
Thanks and once again...feel better!!
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Post by Chuck Weddle on Jan 19, 2022 17:15:55 GMT
I did it all while in Preparation using a Revaclear 400 dialyzer, our standard 2K/2.5 Ca bath, 137 Na, and 33 bicarb. Our machine's default DFR is 500.
Arterial and venous blood lines were attached to the dialyzer with their ends in a jug inside the sink that had a hose filling it with RO water. Both lines were clamped near the dialyzer. Note, the blood lines were not strung on the machine.
When the machine prompted to connect the dialysate lines, I connected the blue hanson to the bottom dialysate port and the red on the top. Once the dialysate compartment was full, the top blood line was unclamped, red hanson moved to the jug, and a dialysate port cap attached to the dialyzer.
When their was no longer air coming out of the top of the dialyzer, I unclamped the bottom line and clamped the top one. I alternated a couple of times till I was sure all air was purged from the dialyzer.
Theoretically, it shouldn't matter whether the solution is collected from the top or bottom. That said, I would probably collect from the bottom to minimize the chance of errant air bubbles.
If we would need to do a different Na or bicarb or want to do 800 DFR, I would probably probably change the defaults instead of setting up another dialyzer and lines and doing a semi-mock treatment in order to change the levels.
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Post by ALMOST on Feb 3, 2022 17:13:44 GMT
How is everyone doing with this debacle now? We are starting to talk about cutting treatments and QDs.
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lost
Junior Member
Posts: 77
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Post by lost on Feb 4, 2022 5:32:33 GMT
Big D is going to a centralized ordering system for the impacted FMC products. Most clinics are cutting down to DFRs of 500 (with medical director approval). It'll be interesting how this plays out over the next few months.
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Post by ALMOST on Feb 4, 2022 11:40:26 GMT
I take care of an acute and chronic (34 station) unit. We have enough to last 22 treatment days but have no idea when the next shipment comes. In my 20 years of doing this, we plan for emergency situations but I never thought it would be like this.
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Post by gnurk on Feb 4, 2022 13:48:50 GMT
looks like we are switching trates from k2 ca 2.25 to k2 ca 2.5 and k3 2.5
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Post by ALMOST on Feb 4, 2022 17:14:45 GMT
gnurk- Good luck. That is what we are currently using and we are having a difficult time getting full orders.
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Post by Chuck Weddle on Feb 4, 2022 18:45:01 GMT
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Post by guest1234 on Feb 5, 2022 1:11:15 GMT
Acid isn’t the issue there’s always a substitute but bicarb will be a thing to overcome here. Ultimately they have the market in there hand and they know it. The patients will be harmed more by this than anything else. I have no idea what we will do.
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stuff
Full Member
Posts: 136
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Post by stuff on Feb 7, 2022 11:40:55 GMT
We are hitting an issue on fistula needles now in this area
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Post by ALMOST on Feb 7, 2022 14:12:21 GMT
i wonder if the chemistries for the patients running at 500 flow will be ok. all the studies i have heard about say that 800 flow is just wasting concentrate We have been doing the comparison for the clearance of both dialysate and dialyzer size. So, patients that are able, we are going to up the dialyzer size and lower QD. According to the dialyzer insert, there shouldn't be much of difference doing that. There are some more variables in there but our MD is ordering chems on every patient that we change at intervals. |
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Post by gfreely on Feb 8, 2022 14:19:09 GMT
Big F just said that their acid/bicarb lines are running full-bore and shortages will begin to wane.
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Post by Chuck Weddle on Feb 8, 2022 14:27:35 GMT
Big F just said that their acid/bicarb lines are running full-bore and shortages will begin to wane. If so, will warehouse and delivery be able to keep up? |
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Post by gfreely on Feb 8, 2022 17:46:33 GMT
Big F just said that their acid/bicarb lines are running full-bore and shortages will begin to wane. If so, will warehouse and delivery be able to keep up? Was told that they are working on that at the moment but within a month or so things should be more "normal". They said that the allocations, temp reduction in bath variety and return of workers to an open-throttle schedule helped them build up their inventory again. Now that they have product, they are focusing on logistics.
Not putting money or anything on it, just wanted to share some potentially positive words from this morning.
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Post by Chuck Weddle on Feb 8, 2022 18:24:29 GMT
I predict a recall within 2 months.  |
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