I have a question for you experienced HD nurses. I have been working in an HD clinic for 3 months (newbie!) and need some advice.
Here Goes:
New HD patient, did not know he was ESRD until visit to ER = catheter placement and dialysis, w/ graft put in arm. Coming to clinic for last 3 ½ weeks. Last week, SBP dropped from 140's to 70's during 30 minute cycle, symptomatic. UF off, NS given, T-berg positioning and SBP back up (now 160's). Took 45 minutes to get him asymptomatic (T-berg, Semi-fowlers, High Fowlers, drop, back to Semi, High, standing = dizzy, semi, high, OK for 10 minutes, then tried standing = vomiting). The charge at the time said "I have never seen this before" and I kept working with him.
Mind you, I was not re-positioning like a roller coaster - we went from position to position slowly, with several minutes "recovery time" between so that he reported he felt "ok" between each - but talk about orthostatic hypotension!
So, EDW was reset by MD, and next 2 treatments we were conservative w/ the pull (over dry weight, but took only 5000 over 4 ½ hrs), with no complications.
Then yesterday, he comes in 7.4 over. Charge (different from before) sets him to pull max we can (6800) and I jumped in and was adamant about the probs we had in the past 2 weeks so we set him for 5000 again (since he had tolerated that for last 2 treatments). It was first time sticking graft and he tolerated it great, and pressures were excellent. When he had 59 minutes to go he said my "stomach feels funny", re-check of bp: SBP went from 140's to 80's. And we did the dance again. This time he never actually c/o nausea or vomited. But still, symptomatic. And we only got 3900 off by the time this happened.
I asked the charge about next time - should we try a profile for the pull? She said it was the RN's discretion, and since I was an RN "I guess you can if you want to".
So, since I have NO HELP from my charge and I want my client to have safe and effective treatments I am asking you guys out there who know what you are doing (because I surely DO NOT) - do you think I should try a profile? Do we need to call the MD about another EDW adjustment? Guidance please. Any advice appreciated.