Intradialytic Hypotension: Early Detection & Management for Hemodialysis Nurses

Desk with stethoscope and computer keyboard. Intradialytic Hypotension: Early Detection & Management for Hemodialysis Nurses.

Introduction. Intradialytic Hypotension (IDH): A significant drop in blood pressure during dialysis. Why It Matters: Common, often under-recognized, and can lead to serious complications. Our Focus: Early detection and practical nursing interventions..

Recognizing the "Usual Suspects" – Risk Factors. Patient-Related: Older age Cardiovascular disease (CVD) Diabetes Medications (antihypertensives, diuretics) Low body weight/malnutrition History of IDH.

Recognizing the "Usual Suspects" – Risk Factors. Dialysis-Related: High ultrafiltration rate (UF) Large interdialytic weight gain Short dialysis sessions Sodium profiling Dialysate temperature >36.5 Improperly set or functioning machine.

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Nursing Interventions: Prevention is Key!. Before Dialysis: Check Patient Blood pressure Assess dry weight accuracy Consider pre-dialysis hydration (if appropriate) Discuss dietary sodium intake.

Nursing Interventions: Prevention is Key!. IV. During Dialysis: Frequent vital sign checks (every 15-30 minutes) Individualize UF rate based on patient response Monitor dialysate temperature (consider cooling if appropriate < 36.5) Check machine parameters and alarm settings Make Normal saline available with you Patient education: Self-monitoring for symptoms Importance of reporting changes Low-sodium diet.

Managing the Drop: Quick Actions. If IDH Occurs: STOP or reduce ultrafiltration Trendelenburg position Saline bolus Oxygen (if needed) Notify physician Adjust dialysate temperature (if too warm) After the Episode: Document thoroughly Reassess dry weight Adjust future dialysis plans.

[image]. Beyond the Basics: Advanced Tips. Midodrine: Consider for recurrent IDH 1 Cool dialysate: May reduce incidence (if appropriate) 2 Sodium modeling: Individualize profiles 3 Stay informed: Check previous dialysis sessions 4.

Case Study 1. Mr. XY , 68-year-old male History of hypertension, type 2 diabetes, coronary artery disease On hemodialysis for 3 years Presentation: Pre-dialysis: BP: 150/90 mmHg HR: 72 bpm Weight: 85 kg (2 kg over target dry weight) During dialysis: 1 hour into treatment: BP: 110/70 mmHg HR: 90 bpm Patient reports feeling lightheaded and nauseous 2 hours into treatment: BP: 95/55 mmHg (decrease of >20 mmHg SBP) HR: 105 bpm Patient reports severe cramping and dizziness.

Nursing Assessment:. Suspicion of intradialytic hypotension (IDH) based on:Significant drop in blood pressure Elevated heart rate Presence of symptoms (lightheadedness, nausea, cramping, dizziness).

Interventions:. Immediate Actions: Reduced ultrafiltration rate to 50% Trendelenburg position Administered 200 ml normal saline bolus Oxygen administered at 2 L/min via nasal cannula Ongoing Management: Continued monitoring of vital signs every 15 minutes Administered additional saline boluses as needed to maintain BP Notified nephrologist for further evaluation Post-Dialysis: Thorough documentation of the IDH episode, interventions, and patient response Reassessment of target dry weight Discussion with the nephrologist about potential adjustments to future dialysis prescriptions (e.g., sodium profiling, midodrine).

Outcome:. Patient's BP gradually improved to 120/80 mmHg by the end of the dialysis session. Symptoms resolved with treatment. The patient was discharged home with instructions to closely monitor BP and report any recurrence of symptoms..

Teaching Points:. This case highlights the importance of early recognition and prompt management of IDH to prevent complications. Even patients with seemingly stable pre-dialysis vitals can experience IDH. Nurses play a crucial role in assessing, intervening, and educating patients about IDH..

Case Study 2. [image]. Mrs XX, 78-year-old female History of congestive heart failure, chronic kidney disease, and atrial fibrillation On hemodialysis for 5 years Known to have frequent intradialytic hypotension episodes Presentation: Pre-dialysis: BP: 130/80 mmHg HR: 82 bpm (irregular) Weight: 72 kg (3 kg over target dry weight) During dialysis: 30 minutes into treatment: BP: 100/60 mmHg HR: 98 bpm (irregular) Patient reports feeling tired and slightly dizzy 1.5 hours into treatment: BP: 80/40 mmHg (decrease of >20 mmHg SBP) HR: 115 bpm (irregular) Patient unresponsive, no palpable pulse Monitor shows ventricular tachycardia.

Nursing Assessment & Intervention:. Nursing Assessment: Cardiac arrest secondary to profound intradialytic hypotension (IDH). Interventions: Immediate Actions: Initiated CPR Called for a code blue Defibrillated patient according to ACLS protocol Administered epinephrine and amiodarone Despite aggressive resuscitation efforts, the patient did not regain spontaneous circulation..

Outcome and Analysis:. [image] •enoe•nneuoe. Outcome: The patient was pronounced dead. Post-Incident Analysis: The patient's underlying cardiac conditions, combined with her history of IDH, likely contributed to the cardiac arrest. Although the initial drop in blood pressure was recognized, the rapidity of deterioration into cardiac arrest was unexpected. The incident highlights the importance of anticipating potential complications in high-risk patients and being prepared for rapid decompensation..

Teaching Points:. IDH can be life-threatening, especially in patients with pre-existing cardiac conditions. Nurses must be vigilant for early signs of IDH and be prepared to escalate care promptly. A well-rehearsed emergency response plan is crucial for managing adverse events during dialysis..

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