Dialysis patient and IV fluid

[haiyen]

Hello, I am a new grad working on a med/surg unit in Torrance, CA. I admitted a patient that was just started on hemodialysis the week before admission. The patient was receiving IV fluid and the order was in the MAR. An experienced RN taking over the care told me that dialysis patients are not supposed to be on IV fluid because of their kidney functions. Is this true ? Can anyone explain this to me ? Would greatly appreciate.

[Double-Helix, BSN, RN]

The answer is, "it depends."

Patients with impaired renal function are usually on fluid restriction, and IV fluid has to be calculated in to their total fluid intake. But that doesn't mean they can't ever have IV fluid, especially if they are dehydrated or NPO. You can't deny them all hydration if they aren't allowed any fluid by mouth. But you do need to be careful about fluid overload in patients with poor renal function.

[Iammblessed2011]

I think this is so because of their inability to filter water out. This can cause other issues such as fluid overload, and possibly heart failure.

[MoisesRN]

This is not a yes or no question; the general principle is that you have to be careful on how much fluid to give to a patient who has an impaired kidney function and on Dialysis. They are at a higher risk of fluid overload with all the consequences related.

But a patient with Acute Kidney Injury due to dehydration, infection or else need some fluid right the way to reset their kidney function; in this case fluid is critically important(do not stop it w/o Dr order), just count the patient' I & O's.

[Vespertinas]

Well I hope you do see how the experienced RN is thinking which is not incorrect: the patient retains fluid to a detriment, therefore more fluid would be a greater burden. That's the short story.

Since we have the opportunity to discuss everything at great length here at AN, the caveats above are also important to note. Like what Moises said: if the pt was just started on HD, it could be for acute tubular necrosis (a type of acute kidney failure) which despite the many causes, most of them do require hydration.

And to echo what Ashley said.. the patient could be chronic and still require some hydration if he's NPO and especially if he's diabetic (meaning the IVF would also have dextrose).

[Miss Kitty00]

I agree with the previous posters. I would not question IVFs on a dialysis pt unless they were admitted with Fluid Volume Overload and/or anuric.