Inpatient hemodialysis patients

[Stacy1199]

I am a newer nurse and I work on a med surg floor and I've started to get hemodialysis patients. I have several questions about when to give their meds. I feel a little stupid not to know these things but I want to do the right thing by my patients.If I have a patient going to hemodialysis at 9 I would give all but their blood pressure meds.I could hold their meds if they are getting vitamins , because their water soluble and will get washed out. I would also give antibiotics after dialysis.I also believe I should give their seizure meds and eliquis ,heparin, and insulin. If I'm wrong about this I would love to know and why I'm wrong. One of my biggest uncertainties is if the patient is scheduled to get heparin and 2pm and 10 pm and they come back at 4pm .Would you give the heparin 2 hours late or would you hold it? Also, If the patient is on a sliding scale of insulin and their scheduled to be checked at noon and they come back at 2 pm would you check their blood sugar and give them insulin then even if their scheduled to get it again at 5 pm ? Any advice would be appreciated .Thank you.

[traumaRUs, MSN, APRN]

Hi there - its pretty individual. In your scenario of the pt going to dialysis at 9am, I would ask what is their current BP? Is it normal in the 110-140 range, then I would hold their am bp meds because usually dialysis and volume removal is useful for controlling their BP.  For chronic hemodialysis pts, many times, their BP will come down with fluid removal at dialysis. Does that make sense?