Figure 610

FACTORS RESULTING IN A REDUCTION OF THE Each of the factors listed may play a major role in the reduction of

PRESCRIBED DOSE OF HEMODIALYSIS DELIVERED delivered dialysis dose. Particular attention should be paid to the vascular access and to a reduction in the effective surface area of the dialyzer. Perhaps the most important cause for reduction in dialysis time has to do with premature discontinuation of dialysis for the convenience of the patient or staff. Delays in starting dialysis treatment are frequent and may result in a significant loss of dialysis prescription. Finally, particular attention should be paid to the correct sampling of the blood urea nitrogen level and the site from which the sample is drawn.

Compromised urea clearance Access recirculation

Inadequate blood flow from the vascular access Dialyzer clotting during dialysis (reduction of effective surface area) Blood pump or dialysate flow calibration error Reduction in treatment time Premature discontinuation of dialysis for staff or unit convenience Premature discontinuation of dialysis per patient request Delay in starting treatment owing to patient or staff tardiness Time on dialysis calculated incorrectly Laboratory or blood sampling errors Dilution of predialysis BUN blood sample with saline Drawing of predialysis BUN blood sample after start of the procedure Drawing postdialysis BUN >5 minutes after the procedure

BUN—blood urea nitrogen.

Increasing

Increasing

Urea reduction ratio, %
0 0

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