Holding meds for dialysis patients

[rn undisclosed name]

If a patient is having HD I will hold their meds and I always thought this was generally accepted care but now I am finding out it may not be.

If a patient gets meds like Clonidine and Hydralazine tid I will give those but if it's a 1 time or 2 time/day medication I will hold it. I also think about how their BP is and if they won't be getting HD until much later I give them their meds. I just take a look at the whole situation.

A nurse I spoke with yesterday talked with a nephrologist and while he knows we hold meds he doesn't agree with it and states we should be giving the meds and if anything give an extra dose when they're done with dialysis. He says it doesn't ever say anywhere to hold meds yet all nurses do this. There was a situation I heard of recently where a pt bp was sky high during dialysis and the patient was close to stroking out. The docs were so mad they wanted this nurse written up because policy is not being followed.

I've always been taught to hold the meds so now I'm confused. I know certain meds don't get dialized (sp?) out with dialysis but really I don't know which ones don't. Also I'm worried if I give all the meds then the patient can bottom out. What is the standard of care and where can I find out?

[diabo, RN]

Common sense is really the key. If dialysis pulls it out and the doctor wants it given, then the DOCTOR needs to write orders to give an exta dose if that's what she, or he wants. Obviously, a patient with fluid overload to run for four hours that has an elevated bp should not get the bp meds at before tx. However, 240/125 is probably more than just fluid. At 175/92, you may want to hold. Always check with the doctor for his preference. You need to get this book. It comes in a wall chart also.

http://www.nephrologypharmacy.com Dialysis of Drugs

Hope this helps.

Steve

[jnette, ASN, EMT-I]

Common sense is really the key. If dialysis pulls it out and the doctor wants it given, then the DOCTOR needs to write orders to give an exta dose if that's what she, or he wants. Obviously, a patient with fluid overload to run for four hours that has an elevated bp should not get the bp meds at before tx. However, 240/125 is probably more than just fluid. At 175/92, you may want to hold. Always check with the doctor for his preference. You need to get this book. It comes in a wall chart also.

www.nephrologypharmacy.com Dialysis of Drugs

Hope this helps.

Steve

Agree with the above. Dialysis outpatient clinics have these little booklets and wall charts on drugs that dialyze out as well. If you have any questions and know the pt. will be going for HD shortly, it also wouldn't hurt to call the HD clinic to ask one of the nurses there for advice... then still use your own judgement or call the doc. Most nephrologists would prefer you hold any meds that could lower the BP.

[Dialysis RN1]

genzyme puts out an annual booklet that is called "dialysis of drugs" you can get it delivered to you free of charge by going to www.genzyme.com or www.nephrologypharmacy.com

my thought is just as the above person stated we need to use common sense if the patient is fluid overloaded and has a high b/p maybe temper them a bit with clonidine. use b/p meds only after you see that volumetric removal doesn't seem to be having an effect. b/p meds can wreak havoc on a dialysis nurse trying to remove fluid from a patient but sometimes that's all that works to provide safe patient care. antibiotics should be held until after the run.

[5toedragon]

Check Your Nursing Med Book It Has A Section On Meds Dialyzed Out.