Nitro patch on HD?

[AcuteHD]

The acute HD nurse that I trained with would routinely remove the nitro patches from pts prior to HD and said they are incompatible with dialysis. With everything else that I was trying to learn at the time I just put that into my knowledge box without really questioning it. But now that I am questioning it I can't find anything online to support it. Is that really an absolute contraindication? Obviously it could lower BP, but is that enough reason to remove it? I'll ask the doc tomorrow, but just wondering what other nurses are doing.

[NurseRies, BSN, RN]

I have never heard of this... I don't think I would trust this without speaking to a nephrologist or a pharmacist.

[westieluv]

Nurses don't have the authority to just remove ordered medication patches. It's no different from holding ordered medications without a physician's order and she is acting out of her scope of practice unless she has an order to remove patch during dialysis. Like NurseRies said, she needs to speak to the nephrologist and tell him/her her concerns. The physician can then determine if they want to write an order to remove Nitro patch during dialysis treatments.

[nutella, MSN, RN]

Working in acutes is different from chronics because patients tend to be less stable, which can result in lower BP during or after HD.

Nitro causes vasodilation and can lower BP when you start pulling fluid, which in turn can cause other problems like chest pain, syncope, N/V. Patient who are in the hospital usually have some illness going on and are more "brittle". Also, most acute units do not use a crit line monitor (though some started with it) making it harder to judge how much fluid is available to pull.

Anyhow, long story short - if BP is already on the lower side or patient may have fluid deficit (because of acute illness) it can be better to remove the nitro patch. Usually the nurse will ask the MD. But let's say you HD an acute patient and they drop BP and you can not pull fluid (but have to because of overload) or the pat becomes symptomatic with low BP I would take the patch off and let the MD after the fact because it can become a safety problem. You do not want a patient to code on the machine because of PEA due to volume deficit....(vasodilation).

So - there is no easy answer to your question. I know some nurses who always want the nitro patch off and I know nurses who will leave it on if the pat BP is high and the pat always gets HD with patch on in chronics....

[NurseRies, BSN, RN]

I ran a patient on a nitro drip today, asked the nephrologist if he had ever heard of nitro being contraindicated for dialysis. He said he had never heard of that. As we all know, many nephrologists are different, one believes in mannitol, one doesn't. One dialyzes after contrast on ESRD, one doesn't.

Anyways... I think if the patient chronically wears a nitro patch they should keep on with what works for them. Some patients require a lot of Antihypertensives to stay away from

Stroke level BPs. So I would never take off a patch without talking to MD.

[Twinmom06, ASN, APN]

I dialyzed someone with a nitro drip the other day...he was going for a cardiac cath the next day - was able to pull quite a bit of fluid, and found that the BP just got better during tx.