I'm still fairly new to the chronic unit and I have a question about Clonidine use in the chronic setting.
We have several patients who come in for their treatments with hypertension, sometimes as high as the 210/110 range. I don't have as much fear of giving Clonidine to the younger, more stable patients and have done so from time to time. However, when I see BPs like this in an elderly patient, especially one who drives themself home from their treatment, and they tell me that they take their BP meds when they get home from dialysis, I am afraid to give them Clonidine, due to the fear that they will get home and their BP will crash after they take their meds on top of the Clonidine, or that the Clonidine alone will make their BP crash during the drive home.
What I am looking for is advice from other chronic dialysis nurses on if and how often you give Clonidine to patients with extremely high BPs and if you do give it, what is a typical reaction, is it effective, does it bottom out their BP, etc.?
I asked a couple of other nurses in our unit about this. One of them gives Clonidine liberally every time someone has a SBP over about 170, and the other has been a dialysis nurse for several years and said that she can count on one hand how many times she has given it because of the potential for hypotension post-treatment.
Right now I am sitting between the rock and the hard place of leaving the BP alone in hopes that the treatment brings it down and they don't stroke out (and in some of them, no matter how much fluid we remove it never drops, which is remarkable to me!), and giving Clonidine (our only ordered anti-hypertensive drug in the unit) and having their BP plummet. I have read that the half life of Clonidine can be as high as 41 hours in patients with renal failure and that this drug must be used "safely" due to being excreted mainly by the kidneys...scary!
Any advice, personal experiences, etc. would be much appreciated.
Guttercat, ASN, RN
1,353 Posts
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