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Using the 13 mL/kg/hr formula in a dialysis clinic

By Angela Mathis posted 07-05-2016 13:24

  

I am a nurse in a 28 chair dialysis clinic, and our doctors are implementing the new rule of removing no more than 13mL/kg/hr. I have read the NNJ article on this issue and how pulling more than this amount causes myocardial stunning. My question is concerning the exact calculation. The current calculation we are using is “Estimated Dry Weight  X  13  X Treatment hours”, then this number is used as the patient’s max. What this formula does not take into account is prime, flushes, or the patient’s pre-treatment weight. What I thought was more appropriate is

“(Pre-Treatment weight  X  13  X  Treatment hours)  + prime and/or flushes”. Can anyone tell me how you use this formula in your clinic?

Thanks,

Angela Mathis BSN, RN

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Joan Nardeo
04-19-2017 19:40

Angela- mi agree, prime and flush is not taking into account, and the 'LDO' is not taking into account., also-although, i agree with the Cardiac stunning, i think, we need to consider looking at each pt individually. 
Thanks
Joan
BSN, RN

Charles Coe
03-18-2017 17:06

Great discussion!  I had the honor of listening to several corporate Medical Directors speak on this a couple years ago at a Medical Symposium hosted by Renal Ventures Management... Dr. Tom Parker, Dr. George Aronoff,  Dr. Frank Maddux, and Dr. Allen R. Nissenson all participated.  The study reviewed related to the 13 ml/kg/hr and the presentation was very impressive on the amount of cardiac stunning that can occur if this is exceeded.

We have learned SO much over the past 10 years in dialysis.  I remember in the 1980's pulling as much fluid as possible from patients, as hard as we could.  We would add a C-clamp below the venous drip chamber to increase the pressure in the system to create a massive amount of UF.... on yes and the patients cramped, many became hypotensive.  Now, knowing what we do, I hate that.  How many times we unknowingly created patient harm.

In our pediatric population we adhere to the fluid removal very strictly, unless we are using CritLines and then we follow their tracing and clinical presentation.  Many of our younger children dialyze 4 days weekly as well, but we usually do this more to ensure they grow better.  Our teenagers are the ones we have to dialyze extra for fluid removal.  It is not uncommon, at times, to have a teenager on 5 or more days weekly... it is difficult.

For you folks in the adult community, are there any reimbursement issues for bringing patients in for extra treatments for fluid removal?  I know a few years ago it wasn't... just wondering if this has changed.

Nancy McAfee
11-11-2016 10:35

In our unit we too use this as the maximum removal per hour. If the patient has more to remove they will require extra time and or extra days. We have almost 50% of our pediatic patients on more than 3 days a week and two on 5 hours 3 days a week. Keeping patients safe and preventing cardiac damage  as they age is a high priority! 

Flor Solis
10-21-2016 22:46

At our facility the formula that we use is whatever their UFR is per hr/EDW. so, pt is taking off 1000 ml/hr and EDW is 100kg. So, 1000/100 = 10ml/kg/hr 

Christine Cuenca
10-03-2016 11:49

I've read that it's 10% of the body weight. for example, an 86 kg pt., the uf rate will be around 860 ml/hr.  

Barbara Cometti
09-20-2016 16:41

Found this article on fluid management and the 13mL/kg/hr protocol.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091945/

Kimberly Larsen
08-16-2016 14:51

Essentially prime and rinseback are irrelevant in this situation. 

An UFR of greater than 13ml/kg/hr is the rate at which stunning has been identified.  The key is to maintain a UFR <13ml/kg/hr to provide a safe ultrafiltration rate during treatment.  Adding Prime and Rinse back after the fact will then increase your UFR to greater than 13mg/kg/hr.

Your initial calculation is what will allow you to provide a safe treatment for the patient.