Lowering legs during dialysis treatment

[thelittlenurs]

I am an new HD nurse , just got off orientation this week :) During my training, I had a patient who was uncomfortable, her back was aching and she wanted to reposition herself, she asked me to put her legs down to do that and I thought I was helping her by doing that . Well she started feeling short of breathe, I asked her if she wanted oxygen and went and got it. I let my preceptor know about her complaint , so she goes to see her and noticed legs down. She quickly acted and had me lay her supine , while she gave 200 NS bolus. She explained putting her legs down caused the BP to drop. So now that I'm on my own I recalled the situation , but I still am not sure and I'm hoping someone can answer this. When is it okay to lower the legs? Is it good for when the BP is high and is it only ok to lower the legs right after you return the blood???

[Healerforlife]

My advise would be "get to know your patients" What how they respond to dialysis. Look for the ones' whose blood pressure often dips a lot during treatment. When putting their legs down, set the machine to check their blood pressure every 10 minutes instead of 30. Stay with the patient the first few minutes their feet are down and then hit their b/p to see if it is starting to go down. Ask them how they feel. and then keep close eyes on them. We had a lady with PVD who always wanted her feet down. We would watch her vitals every 10 minutes and then she knew that if she started trending down, feet had to go back up. Like it or not.

[Cmiles]

As the previous person said, PLEASE get to know your patients. But in the most simple terms considering I KNOW the patient:

What goes up must come down. If I know the patients BP doesn't come down without meds, I let them put their legs down.

If a patient is over their dry weight (EDW), that means they have more volume of fluid in their normal blood volume. More volume causes more pressure thus increasing a persons blood pressure. During treatment, we remove fluid so of course the BP SHOULD drop (this is why you should know who's BP drops easily and which pt's require meds). If you put their legs down, the blood/fluid in their body will rush to their lower extremities causing the BP to drop....gravity.....

Everyone should have their legs up during treatment simply because we are removing the blood from their body. If my patient has a sky high BP I let them keep their legs down until I see the BP dropping too fast. Keep in mind that a person with chronic HTN will feel the effects of hypotension (light headed, nausea, etc) even if their blood pressure seems "normal"to you because they're not use that lol.

Give them their blood back, check the BP, if it's WNL and they feel fine, put their legs down then check your sitting BP.