exhausted wiped out post dialysis

Specialties Urology

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We have a patient who c/o being wiped out/exhausted/tired and 'feels bad' post dialysis (several hours). One nurse suggested to Doctor to increase dialysis time by 15 minutes, another said 'just happens'. Any feedback.

Sounds like too much fluid is being pulled off of the pt during dialysis, i.e. his goals are too high. The nurse who suggested increasing his time obviously is not familiar with dialysis or what it does.

Have you taken the pt's standing blood pressure post dialysis?

His hemo nurses should be asking the pt how he feels after and between tx.

They can adjust the goals accordingly, or the pt can adjust his fluid restriction compliance or both.

Does the pt put on excessive fluid between tx, by not following his fluid restrictions?

Pt's who are non-compliant in this way can make tx very hard on themselves, as more fluid gain = larger goal during tx = tx is harder on the pt (and staff).

Most HD pts are restricted to no more than 40 oz of fluid in 24 hrs, and should gain no more than 2-3kg between tx.

Many pts that exceed this (and many do) have a much harder time during and after tx.

Also, has this pt been eating more than he used to? Has his appetite been good? If so, he may have gained "good" weight, i.e. body mass and not fluid. If so, his EDW (estimated dry weight) may need to be raised. If the hemo unit has Crit Lines, they can run him w/ a crit line and know if his plasma refilling is slow, or if they are trying to pull too much off, and adjust his EDW per the crit line.

Sounds like too much fluid is being pulled off of the pt during dialysis, i.e. his goals are too high. The nurse who suggested increasing his time obviously is not familiar with dialysis or what it does.

Have you taken the pt's standing blood pressure post dialysis?

His hemo nurses should be asking the pt how he feels after and between tx.

They can adjust the goals accordingly, or the pt can adjust his fluid restriction compliance or both.

Does the pt put on excessive fluid between tx, by not following his fluid restrictions?

Pt's who are non-compliant in this way can make tx very hard on themselves, as more fluid gain = larger goal during tx = tx is harder on the pt (and staff).

Most HD pts are restricted to no more than 40 oz of fluid in 24 hrs, and should gain no more than 2-3kg between tx.

Many pts that exceed this (and many do) have a much harder time during and after tx.

Also, has this pt been eating more than he used to? Has his appetite been good? If so, he may have gained "good" weight, i.e. body mass and not fluid. If so, his EDW (estimated dry weight) may need to be raised. If the hemo unit has Crit Lines, they can run him w/ a crit line and know if his plasma refilling is slow, or if they are trying to pull too much off, and adjust his EDW per the crit line.

This particular patient urinates and a minimal amount of fluid is removed and often her pre weight is same as prior post weight or slightly higher.

Sounds like they are taking too much fluid off during the tx.

Why not speak to the hemo charge nurse and tell them how the pt has been feeling, and ask them to increase the pt's EDW, and lower her tx goal?

Just some thoughts-

During the 3-to-4 hour dialysis treatment you are removing toxins that have accumulated over the last 2-3 days, it is called a saw tooth graph, but it is lop-sided since we clean the blood so quickly...sometimes this causes compartmental shifts that take time to correct post treatment....such as fluid shifts from the extravascullar to the vascular, from tissue to blood...and sometimes the peritoneal cavity holds extra fluid (ascities) that can only be removed slowly or via tapping the area using a needle and syringe,, problem here is many times lipids, globulains, and the like are lost, thus diet comes into play to correct for this, and that takes time also. So many, so many areas to consider....diabetes, heart, lungs, and sometimes the blood-brain barrier is involved---dialysis dimentia--disequillibrium syndrome...and just sometimes it is as the one above stated, some patients have an easier time and others do not....some patients never have a problem while others always seem to have problems, why? Let your physician/charge nurse know and ask them why--ask for suggestions....talk to your dietitian. But again, there are so many variables, again some people are allergic to certain dialysis membranes (dialyzers), if this is so then you have the body experiencing an allergic reaction which could be mild, and recovery takes time after exposure...you could search forever. Sometimes just kindness and letting them know you care can make their day better, as so many dialysis professionals forget whose there for who, and mental health is a big issue in relationship to being healthy. Good Luckski!!

Thanks. I try to be very kind and caring, not sure what I would do as a dialysis patient.

How long has the person been on dialysis?

I've been on hemo for 10 years, and for about the first 4 years, I was exhausted after dialysis. It didn't matter how much I ate, or if I exercised, I was just beat! After the fourth year I was gradually able to do more and more after my treatments, and after 6 years I was driving myself back and forth to dialysis.

I have spoken to many new dialysis patients, and that's the first thing they ask me: When will I stop feeling so TIRED all the time? And I have to tell them that it's really an individual thing-- it took me 4 years to learn how to adapt to it. Whatever you like to do, you should do that when you get home from dialysis so that you'll have something to look forward to... for me, it was walking my mother's dog around the neighborhood. Seeing that happy puppy wagging his tail as we strolled down the street made me forget all about dialysis! :)

I agree with all posters.

Zebra... most of my patients are very wiped out post dialysis when they begin. Some are over it in months.. others years. I am almost into my 7th year as a charge nurse.

Look at URR/Kt/v, pre and post labs, what is their albumin? phosphorus? potassium? calcium? ca/phos product? What other meds are they on? (Many are on bp meds that NEED REDUCED... )

I say, EDUCATE, EDUCATE, EDUCATE patient, patient, patient, family, family, family! They need to know the questions to ask.. good luck!

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