bfr return rate for hypotensive episode

Posted
by dbeckner222 dbeckner222 (New) New

Hello! Thank you for taking the time to read this. I am just off orientation and am flying solo now as the only nurse on third shift in chronic clinic. Techs are not sure of me yet. Anyway, cath patient dropped her bp, tech went over, raised pt's head as she was getting sick, clamped the arterial line with hemostats, floored the bfr to 400 or 480 and gave her almost 500 cc ns. Instructed her to lower the bfr to 200 since she was a cath and the blood was only going in...none going out. Tech said this is how I was told to do it. All happened in a matter of seconds. I know I need to take control in this situation and you can bet this won't happen again; however, is she correct to turn the bfr up that high when the blood is clamped on arterial? I don't think so. Work for FMS, placed call to education, no return yet. Thank you so much for your help!!:yeah:

pricklypear

pricklypear

Specializes in Telemetry, ICU, Resource Pool, Dialysis. Has 11 years experience. 1,060 Posts

A. the tech shouldn't have done anything except turn the pt to her side to allow her to vomit without your instruction.

B. look up your policy on BFR with catheters. I'm pretty sure it's 350-400. There's really no need to increase the BFR beyond the current rate to give a bolus.

C. 500cc?? You should show your tech the policy on standard treatment for hypotensive episodes as well.

Good Luck

Lacie

Lacie, BSN, RN

Specializes in jack of all trades. 1,037 Posts

#1 she should have informed you immediately and allowed you to direct the intervention. It's one thing for the pct to respond to shutting off the UF, turning pt on side but I always informed my staff they were not to start bombarding a pt with saline without first informing the RN. Now if the RN was very tied up and not immediately available they could infuse 100-200cc's and retake the pressure until the RN could respond. I find many times people are so quick to start pouring saline into people when it really isnt needed. It's awful to see pts leave weighing more than they came in at or at the same weight because of a pct who feels they can run the show and know better. Boluses of saline isnt always the solution. Determine the cause. A great book I would recommend for anyone in dialysis is "Handbook of Dialysis" by John T Daugirdas. I wouldnt be without it!! If you are new then it's important they learn quickly you are the charge nurse and ultimately the one responsible. It's your license on the line not thiers (they dont realize they dont have one to loose).

traveler RN

traveler RN

Specializes in NICU CM LNC MB HHC, Flight nurse. 29 Posts

It's like Lacie said. I also have the handbook and another good one is "Review of Hemodialysis for Nurses and Dialysis Personnel" by Kallenbach/Gutch. I got both of these from Amazon.com, good luck to you! :wink2:

Lacie

Lacie, BSN, RN

Specializes in jack of all trades. 1,037 Posts

It's like Lacie said. I also have the handbook and another good one is "Review of Hemodialysis for Nurses and Dialysis Personnel" by Kallenbach/Gutch. I got both of these from Amazon.com, good luck to you! :wink2:

Got mine on Ebay at a really low cost. I got the international copy which was much cheaper than the US and has everything except not all the pics. If I remember correctly it ran me about $30 compared to the $80 elsewhere.

traveler RN

traveler RN

Specializes in NICU CM LNC MB HHC, Flight nurse. 29 Posts

You are so right, just saw a handbook for $10 on ebay, they didn't have any when I bought mine last year. New nurse go for it!:yeah:

Tish88

Tish88

Specializes in Dialysis (acute & chronic). 284 Posts

The amount of NSS to infuse should be ordered by the nephrologist for the treatment of hypotension. Our MD's order the amount just as they order the amount of Mannitol to give a patient.

As far as the BFR - what does your P&P say about treating hypotension.

I have turned their Qb up when a pt has become unconscious and I needed a rapid infusion to recover the patient quickly. Turning them on their side - if possible to prevent aspiration, however, some of these patients are too large to get them rolled over in a hemo chair.

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