how low of BP is too low to run a pt in chronic unit

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I feel silly asking this, but cannot seem to get an anwser when I have approached the charge nurses at my dialysis place of work (chronics). I am a RN with no prior dialysis experience and have NOT had the best orientation to dialysis. I feel like I am learning by trial and error. My question is at what point is it unsafe (with low BP) to run a patient in a chronic setting. We have a man that typically comes in high 80's/50's. His BFR is typically set at 400 (takes off 5 kilos), and he always drops 70's/40's and even as low as 68/39! He was angry with me for putting him into minimum and refused any saline. He sates he is "fine" and "dont touch me anymore". He does have +1/+2 trace pitting edema to LE's. I understand he is chronically low with BP, but at what point am I to worry about perfusing other internal organs (lack there of). Our protocal also is to leave with a systolic > 100 - this never happens with him. Is it safe to run patients with BP's in the 70's - still pulling fluid? ANY help is appreciated!!!! thanks:nurse:

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Specializes in Nephrology, Cardiology, ER, ICU.

I'm an APN in dialysis clinics. First, what's the pts MANUAL BP? Does he have peripheral vascular disease? Is he taking ANY BP meds? Could you get the provider to prescribe midodrine to help with the BP issue? If the pt is asymptomatic, I would tend to not believe the auto BP cuff.

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thank you for response! He is on cardiac meds (right off hand do not recall all involved). Manually I have gotten him low 80's / 40's and he is asymptomatic (he states). With that said, is there a "magic #" that is too low to be pulling fluid off a patient? Both of our charge nurses have stated they feel comfortable running pt's 80's/40's. Again any response is GREATLY appreciated.

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You may also want to have the physician review his meds (bp), ?chf. Remember to treat the patient and not the machine. Some patients chronically have low bp and tolerate it, others would be symptomatic. In dialysis you learn your patients and know who can tolerate fluid removal. Some patients develop chf to where they have low bp's, increased fluid gains and you are not able to remove fluid. Unfortunatly they can end up in the ER with fliud overload. Document, document, document.

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Specializes in Dialysis (acute & chronic).

I also would suggest Midodrine. If the patient's b/p is in the 80's coming into the clinic, that is probably his baseline. You are not going to get his b/p higher than that.

Over 20 years I have seen many patients that tolerate those b/p's and have been able to take off 5kilos with no problems.

Is the patient still talking to you during his drops? Treat the patient and not the machine!

Have you tried sodium modeling or UF profiling on him? How about turning the dialysate temperature down on the machine to create vasoconstriction? This tends to work wonders with diabetic patients.

If your policy states the patient's discharge b/p must be 100, I hope you have a physician order to allow to discharge the patient below that goal. I would also talk with the nephrologist to get an order to have guidelines on the patients b/p limits - this will "cover" you if anything happens!!!

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Thank you so much for the informtion - this is a wonerful site! I appreciate your time and assistance!

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The more experienced nurses in my clinic love to answer my questions with a question "...in your specialty?" You get it? In dialysis you have to throw a lot of "norms" out the window... my best advice is to ask your tech (who has most likely been caring for that patient for years) how the BP usually runs AND what the patient looks like/starts acting like when their BP starts dropping... if my tech tells me that the patient has been running that low for 5 years and sits straight up with an expression of panic before dropping- then I'm not so worried... if my tech tells me that the patient has been running that low recently and the patient sleeps all treatment... then I worry... no magic number- sorry.

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Specializes in Nephrology-Dialysis/Surgery/Orthopaedics.

There are patients who go like 80/50 and they can still manage 2-4 liters of UF goal. We have one patient, his normal BP is 60-70 palpatory, and he's just managing fine. So it really depends on the patient. Review the treatment sheets, there you will see the trend in his BP during treatment. if usually his BP is around 140/80, but once you take it you get 90/60, then that's low.

BP in dialysis take the extremes. both high and low.

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Specializes in Med/Surg, Rehab, Burn, dialys.

Some pt's we would recommend they not take their BP meds on day of dialysis if they always come in with low BP. Our Dr's wrote standing orders to do that. I would not send anyone home with BP

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