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Why Do Dialysis Patients Have a Max UFR? Let me count the ways with Dialysis Nurse Lindsey
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- čas přidán 17. 08. 2024
- Why Do Dialysis Patients Have a Max UFR? Let me count the ways with Dialysis Nurse Lindsey
Max UFR= Maximum Ultrafiltration Rates = Max amount of fluid that can be removed in a dialysis treatment
Max UFR = ml/kg/hr
Max UFR Goals and Dry Weights
I want to clear a few things up
Max UFR means the maximum amount of fluid we can remove in 1 dialysis treatment
UFR = ultrafiltration rate
If you have questions on that please click on this What is UFR on the top right of your screen
1 L = 1 KG, 1 KG = 1 L
If I remove 2 Liters during dialysis
How much weight am I removing?
RIght, 2 kg in weight
Back to Max UFR.
The Max UFR order looks like this:
• 10 ml/kg/hour
• 11 ml/kg/hour
• 12 ml/kg/hour
• 13 ml/kg/hour
Per CMS guidelines (the people that reimburse us) The maximum amount of fluid we can remove during dialysis for reimbursement is 13 ml/kg/hour
But it’s not all about the money.
The National Kidney Foundation found with goals greater than 13 ml/kg/hour there is increased risk for morbidity and mortality.
OMG Lindsey what is with all the fancy words.
High goals leads to an increased risk of hospitalizations, cardiac events, not tolerating dialysis and death.
That’s enough of that, lets get to the fun part.
You are going to need your calculator.
We have the order 10ml/kg/hour
Lets break that down
10 ml--that’s the fluid part, one of the numbers you will key into your calculator
kg-that is your patients weight. Where I work, we use the weight they come in at. So like they just stepped on the scale, their wieght is 85 kg. I’m going to use that number
hour: that is their treatment time in hours. So if they are on the machine for 3.5 hours, I’m going to key in 3.5 into my calculator. If their treatment time is 3 1/4 hours, i’m going to key in 3.25hours.
We will multiply these numbers
ml/kg/hour
10ml times 85 times 3.5 hours
2975 ml/kg/hour (treatment time)
Lets do another one
11 ml/kg/hour
Patient is 110 kg
They are on the machine for 3.5 hours
11 x 110 x 3.5
max goal is 4235 mls/treatment
how much is this an hour?
4235/3.5
1210 ml/hour
Holy moly.
Just because you can remove this much, doesn’t mean you have to.
I have anxiety if I remove more than 1 liter per hour on a patient.
I will always use a crit line on these patients-and most of the time I end up decreasing their goal
And this comes from experience. Any many patients will agree with you. patients that have been on dialysis learn how much fluid they can remove and still have a good day. Their max goal might be 3.5 liters, but if we do that, they are going to have a crap day and be in bed all day and have to sleep it off. They might tell you 2.5 L is the most they can tolerate and have a good day.
And some of the other patients I’ll look and maybe they had 4 Liters removed on Monday, I’m struggling to pick a goal. And I’ll be like, we removed 4 L on Monday, how did that feel? And they might tell you great, or they might be like, oh man, i was in bed all day. Educate them, that’s from the fluid removal , i think we got a
I want you remember that you don’t need to get to their dry weight on Monday, you have all week.
One of the perks of this limit to fluid removal is it Helps enforce fluid restriction.
Example:
Doctors orders:
Max UFR = 10 ml/kg/hr per treatment
Patient Weight 100 kg
Treatment time 3 hours
Max UFR = 10 ml * 100kg * 3 hours
Max UFR = 3000 ml per treatment
The maximum UFR (fluid/weight) I can remove per dialysis treatment is 3000 ml/treatment.
Max UFR was first introduced to our dialysis clinic a little over 5 years ago. New research proved that long term high fluid removal goals increased the patients risk for cardiac death and problems toleratined dialysis in the future.
A lot of this points to decreased cardiac output, hypotension, and intradialytic symptoms at dialysis. Cardiac arrest.
DISCLAIMER: This video is intended for education purposes only and is not intended as medical advice
DISCLAIMER: Links included in this description might be affiliate links. If you purchase a product or service with the links that I provide I may receive a small commission. There is no additional charge to you! Thank you for supporting my channel so I can continue to provide you with free content each week!
00:00 Dry Weights and UFR
00:55 Practice Max UFR Goals
4:00 Hourly Fluid Removal
07:15 When to Notify Provider
08:45 Dry Weights
I'm just getting back into dialysis nursing after being out of it for about 3 years. Your videos have been very helpful with refreshing my knowledge. You break things down so that we can understand and I just want you to know I truly appreciate it! Thank you!
Ur welcome!! This means a lot, thank u!
What if computation with edema?
This is really nice explaination and dry weight is a very important thing that every Dialysis patients should know it properly.
💯 thank u Siddharth! 🥰🤓😊
Your video topics have helped me as a patient way more than my own nursing staff! Thank you so much. ❤
Hello I am a tech in dialysis and I’m sorry you don’t feel like your care team is adequate in dialysis. There’s a lot to learn and I try my best to educate myself and educate my patient. If they don’t care that’s one thing but please give us some grace because training it not enough and we are constantly learning.
Dialysis Max UFR and Dry Weights...don't worry if this language is sounds foreign. Dialysis is super niche 😀 It just takes practice
You are adorable! I’m making a career pivot, trying to learn as much as I can and I am so grateful for your vids 😘
At Fresenius, in Chairside (software for InCenter), it gives you the calculation. It's SWEEEET! I wish we used crit lines in our area clinics, I know so many patients that could really benefit from their use
Maybe someday 🙏 🤞🏻
Crit lines do help 😁
What is a crit line?
This is interesting. As a dialysis patient myself. I agree, sitting down for my than 3.5 hours is crazy.. In Singapore the standard dialysis time is 4hrs. Probably a handful of patients under the doctor's recommendation gets 3.5 hours.
thank you for sharing your experience, strength and hope!
In Thailand set up number 10 ml/kg/hr too 🧡🤍🧡💜❤️ love u and good video
👏
Thank u for watching! It’s nice to know things are done similarly everywhere! Must be the National Kidney Foundation! 😊
Excellent video!! 💗
Thank u!! 🥰 🤗
I liked your videos. Very helpful . Thank you so much.
Thank u!
thanks a lot for your videos
Ur welcome! Thanks for watching ♥️
Home nocturnal if possible is the best type of dialysis. If you can try it.
Thank you, it is clear.
you are welcome!
Love all the education. And love your glasses. Where did get them?
Thank you! I go to eyebuydirect for my glasses!
My dad is 81 and he recently just started experiencing blood pressure spikes. So they are having to give him meds to lower it. His current weight this morning was 79.22 and he said when he left it was 78. something. I am trying to figure out how we went from him not having blood pressure spikes to now all of a sudden its high. This is scary because he comes home with a bad headache after this. He has been on dialysis for 4 years.
Dry weight is never a exact number changes everyday
I hope you can discuss about sequential dialysis ❤
Can you do example of sequential
Very nice
Thank u!
I'm.new in HD work as a nurse. My head nurse didn't know the computation for drw weight x weight x ml.
We have back job already because our client is now in thier 90th or 34th dialysis. How can we be able to compute it if the my head nurse is only computing post weight of the client on his last HD minus the per weight of the client before HD
Question , I thought we multiply the 10-13mL by the dry weight not current weight ?
So, cleaning the blood is diffusion and pulling the blood is ultrafiltration?
Right on!
Can you explain how to choose which profile to use for a patient?
On it!
Doesn’t the doctor have to assign the profile?
I Use to remove 4 to 5 liter per dialysis season. As there is no urine output i gained 4 to 5 liter
You need to cut back on the liquids!
I'm glad I ran across this video. I went in at 85.9 my dry weight is 84.0... no heparin for me. I was set to remove 2.4 and flushing every 30 minutes. Machine clotted assigned tech wasn't flushing but other did twice. I had 20 minutes left, machine clotted and lines were changed 15 minutes remaining and I did them so why when I left I was 84.9? My gain was only 1.7k what went wrong here?
I’m not sure. How r u doing now? I know it’s frustrating not getting to ur dry weight when u leave the clinic
@@dialysisnurselindseyis it b/c he received saline (the increased weight)?
Hey! What kind of books can be good to read for A jobbat dialysis? Im starting to work at dialysis 2024 after motherleave and want to read and get knowledge ☺️
watching all your videos..they help so much thank u❤ what is crit line? I am not sure if we use that or maybe I haven't been shown this yet? so the less removal the better? I am still trying to understand
Sounds like u don’t use them…I’m working on another Crit line video right now…perfect timing 😃 hard too understand if you don’t use them for sure
fmcna.com/products/fluid-management/crit-line-iv-monitor/
fmcna.com/content/dam/fmcna/live/support/documents/fluid-management/crit-line-iv/Crit-Line%20IV%20Patient%20Booklet-English.pdf
Thank you💜
Which smartwatch u using? Thank you!
Apple 🍎 🍏 😃
Hi i want to know my dr say that my dry weight is 130 but every time i go dylasis i gain about 2 or 3 kilo n it took me 4 hr 15 but when i finish my dylasis i check my weight is 131.2 like that how much the nurse throw the water n how much surpose they can throw my water ? Tq
Do u eat on dialysis? That can have an effect on the post weight. Thank u!
Yup im eating coz during dylasis i will fasting n i had my meal at 7
Can you do a video on exsanguination and what you would immediately do to stop/control bleeding…😊
Great video topic! Added to my list! Thank u!!
@@dialysisnurselindsey wondering what is a crit line? Video?
MY ATTEMPT AT A SIMPLISTIC WAY TO EXPLAIN HOW A CRITLINE WORKS
czcams.com/video/JtrJ1aeANDc/video.html
How do we determine 10 ml or 11 ml or 13ml...?
This is a provider order. No need to worry!
Are 10ml/kg/h include 400ml normal saline return end of hd or not ?
At my clinic it does :)
@@dialysisnurselindseythanks for your help
I was wondering why u were using 10
Our providers us 10, 11, 12, or 13 ml/kg/hr 😃
10ml or 13ml?
Per provider order :)
@@dialysisnurselindsey Google said 13ml is max
The Jaime in u is strong still
We work across from each other now 😃
Can we collaborate???
Thank you, it is clear.
Oh good! Ur welcome 😃 thank u for watching!