I work in a Level IV NICU and we've run into an issue that's all uncharted waters for us. We have a 2 month old patient who was born with nonfunctional hypoplastic kidneys. We tried to manage her on peritoneal dialysis but her body was unable to achieve the desired fluid and electrolyte balance with the PD exchanges, and we ended up constantly needing to be either supplementing or attempting to purge electrolytes.
It was decided that she needed to be put on hemodialysis, which has been done on our unit only one time in the past, and it's been a rough road. I take care of this patient frequently due to my background experience in renal nursing, so I've been witness to a lot of her treatments. Trying to do hemodialysis on her is such a struggle. She screams herself purple nearly the entire time, randomly will start needing O2, and usually ends up on pressors due to bottomed out BPs. We give her back small fluid flushes to try to equalize her, but it's so difficult that we never end up coming close to our fluid removal goal. What's supposed to be a 60 min treatment always ends up lasting close to 3 hours because we're starting and stopping so much to troubleshoot.
I'm curious if any other NICU nurses out there have seen HD in your units, and if so, have you found any tips/tricks for helping improve tolerance to the treatment?
Babies like this (hemodialysis, complex sedation and pain) need to be managed in picu because they really aren't neonates anymore so they need to be managed by pediatric intensivists rather than neonatalogists. I feel like work older babies get stuck in NICU they keep getting treated like newborns when they shouldn't be.
I agree, it would be better to treat her less like a neonate and more like a peds patient! But our NICU keeps babies up to one year of age...it's believed that they get better developmental care during long term admissions in our unit versus the PICU.
Is this a Potters Syndrome baby who you are waiting to grow a bit in order to transplant? If this is, unfortunately the prognosis is not good once PD (peritoneal dialysis) isn't an option
The diagnosis just after birth was originally thought to be Potters, but that was later deemed incorrect. It is now diagnosed as renal tubular dysgenesis, which to my understanding is a component of Potters, but this baby doesn't meet all of the criteria for the full syndromic diagnosis. It went entirely undetected prenatally until the time of birth. She actually has decent lung function, which is pretty remarkable considering her grossly poor kidney function and mom's very low levels of amniotic fluid.
BrandNewBabyNurse
51 Posts
I agree, it would be better to treat her less like a neonate and more like a peds patient! But our NICU keeps babies up to one year of age...it's believed that they get better developmental care during long term admissions in our unit versus the PICU.