leg pain

  1. Hi all,
    I am not a dialysis nurse. I know a patient who gets severe leg cramps during dialysis. This has been happening more and more frequently. She is in her 90's and has been on dialysis for 10+ years. I have heard of people "not tolerating" HD...Is this what "not tolerating" looks like? Would PVD make it worse? Could this patient be hospice bound? I'm a peds nurse so I dont encounter this sort of stuff much, thanks for any insight you have

  2. 5 Comments

  3. by   Erikadawn RN
    Probably needs her dry weight adjusted, leg cramps happen when too much fluid is coming off. Call her nephrologist and talk to him/her about your concerns.
  4. by   Joni's Mom
    Sounds like this patient needs a higher dry weight, meaning that she probably lost some weight and they are taking to much fluid off of her each treatment. Does this patient have edema in the legs, does she have fluid on her lungs? She should not have bad leg cramping during or after dialysis.

    Hope this helps
  5. by   NurseRies
    Might just be that they are pulling off too much fluid in too short of a time period. The UF rate is the rate of ml/hour that is being pulled off the patient. One of my favorite doctors always said that the rate should be proportional to the patients weight. If this lady weighs 50 kg for example, the nurses should not expect her to tolerate more then a 500ml/hour fluid removal goal. So if she runs 4 hours, they can't remove more then 2 liters of fluid. If she is bigger, maybe 85 kg, they shouldn't be taking off more then 850ml/hour. Maybe she needs the fluid off but just needs a more gentle treatment with a lower UF rate. If she has swelling and wet lungs, maybe she is just jot tolerating the fluid shifts and needs longer or more frequent treatments. 2 liters is a very low goal for this population of patients, but if she is tiny and getting a short 3 hour treatment, that is way too much fluid to be pulled.

    Does she get cramps in the clinic or maybe after she gets home? The nurses may not even know the problem. This is a fairly common complaint but it doesn't mean that she needs to suffer.
  6. by   Chisca
    Dry weight is a pretty crude way to determine how much fluid to remove and a continuous hematocrit measurement during treatment would give a more accurate assessment of how much fluid removal this patient could tolerate. Remember most of the fluid in the body is not in the blood. As water is removed from the blood water from the tissues migrates back into the bloodstream. Unfortunately sodium and calcium is also carried out of the tissue and this can cause cramping. Nurseries is right that a longer treatment time or more frequent treatments would enable a gentler fluid removal. Also would be curious as to what her albumin level is. Low albumin is indicator of poor prognosis. Cramping is a very common problem and does not mean intolerance of dialysis as much as it means her therapy needs some fine tuning.

    Last edit by Chisca on May 2, '13
  7. by   smurfynursey
    Thank you everyone!