important things to know about/ monitor for in dialysis pt?

[miniangel729]

I am a new nurse working on a med/surg floor We have dialysis pt every now and then. Just want to hear from the experience or dialysis nurses - 1. what are some important things and tips to know/monitor/be mindful of when caring for dialysis patient?

2. what are some important things to report to dialysis nurse prior to patient start getting dialysis? - eg. BP?

My preceptor told me when change shift, its important to let next shift nurse know if the patient is new on dialysis, but didn't explain why.

3. What are some important things or signs and symptoms to monitor for new dialysis patient? and after receiving dialysis?

4. up till how long is the patient consider a "new dialysis" patient? eg. 3 days? 1 week?

I know low blood pressure is one thing to monitor for. but how low is consider too low? we had a patient whos baseline SBP was in the 100/90s, but just prior to getting dialysis, last BP was 87/46. Throughout dialysis, his BP was 70-80/30-40s .. honestly i was really worried! but my preceptor/dialysis said it's ok. even after pt's BP was still low like that.

so how low should I start worry about pt's BP? is it +/- 20 to patient's baseline? eg. baseline 120/80 and if pt's BP become 100/60..?

[Brookeylea]

I work as a dialysis tech. The thing we look for is recording vitals every half hour, during the half hour checks we review the machine ensuring all "chambers" are at the appropriate level and enough normal saline in the bag ( I'm assuming if your in the hospital the acute dialysis RN is doing this). We also do access checks, this is ensuring the fistula or graft has no dislodged needles or that any access is bleeding. For blood pressure it is different for each, most pt we won't let leave until there systolic is 100+. Heart rates tend to increase towards the end of tx. We have some pt who we can let ride in the 70s, others we can't. You need to watch their access hand, make sure there are no BPs being taken on that arm, no blood draws, pick lines, unless the DR has Ok. If they have a catheter then you need to find out if there is an arm being saved for a fistula or graft because if so we encourage no BPs to be taken on that arm. Signs and symptoms I would look for durning tax is yawning to indicate possible low BP. After fatigue in some PTs is fairly common, others feel great. They should not be lightheaded or dizzy, if so chances are they need a bolus of normal saline. I hope this helps. While I am a tech this is what WE monitor in chronic setting