Need Help

[TELEpathicRN]

just wondering if any of you have suggestions for dialyzing normotensive or hypotensive pts?? we have a couple of people that come in severely hypotensive, 80's/50's and usually have about 3 kilos on. we usually end up putting them on Na+ profile and giving them sodium choloride at the beginning of the treatment (which makes them thirsty during/after tx and leads to more wt gain) and still have to give fluids and cut the UFR down. i know this sounds like a bunch of babbling, but I just got off from a 14+hr shift!! any input is greatly appreciated. :)

[joannep]

Hi, they are very difficult patients aren't they.

We don't use sodium profiling, but we do use fluid profiling and generally put them in a profile five (Fresinius machine) which has a cycle of a brief high ufr then drops to a very low ufr as a rest phase.

I had my all time record weight gain today with a patient coming in 8 kilograms ( I don't know what that is in pounds) above his ideal body weight. Of course he doesn't know how he could've gained all that weight!

Joanne

[TELEpathicRN]

8 kilos is roughly 16 pounds. we have a pt that routinely gains 18 to 22 pounds between treatments. and like most renal pts, he has no idea how it happens. we try to educate him on ways to reduce fluid intake, etc... but he never listens!! We dont have fresennius machines yet, but are scheduled to get them. I think our machines have the option to profile UFR, but we dont use it.

[3651bht]

treatment is to lower the temperature of the dialysate to 35-35.5.. Causes body to work to conserve body heat and increases B/P or at least keeps it stable.. Also make sure there are no nitrates on chest, no B/P meds taken before dialysis.. etc...

bobbi