Managing hypotensive episodes during dialysis part 3

Haemodialysis 5

 

Prevention:

  • Ensure  all patients have  a personalised fluid intake guide that they can understand. Engagement of other family members/ carers may be necessary. This should be reassessed regularly taking into account residual urine output, size, degree of physical activity and any other fluid loss. Dietetic advice should be employed to aid salt and water intake
  • Regular assessment of dry wight using clinical parameters and bioimpedance measurements if available
  • Regular assessment of use of antihypertensive medication
  • Consider use of haemodiafiltration if not already prescribed
  • Consider use of blood volume monitoring to guide ultrafiltration
  • Consider full cardiac assessment to identify severe left ventricular failure, valvular abnormalities, marked ischaemia or rhythm abnormalities
  • Considering further cooling dialysate; it is unlikely that reduction to below 35,5ºC will be helpful
  • Consider increasing frequency of dialysis in patients with significant cardiac disease
  • Consider home haemodialysis and increased frequency/prolonged hours dialysis for patients who struggle with interdialytic weight gains
  • Consider cautious changes in dialysate sodium
  • Consider alternative ultafiltration schedules. Sodium profiling should not be used as tends to sodium load patients and worsen interdialytic fluid gains
  • Advise against eating and drinking during dialysis
  • If hypotension occurs at the beginning of dialysis, consider a fluid bolus at start of dialysis
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