Hi, and thank you in advance to anyone who attempts to help me with this...
I am wondering what the standard is with regards to medicating dialysis patients during and after hemodialysis.
I had a patient whose SBP just over 200 in the morning when I came on (and was apparently this high for the previous few hours). I immediately gave her am meds which brought her BP to the mid 180s (no PRN meds had been prescribed), and doctor was advised.
Later that morning, she was dialyzed. During dialysis, she had one episode of emesis (per the HD RN, she felt is was related to the drop in BP). She was still being dialyzed when her 1400 dose of hydralazine was due, so I held it, assuming it would dialyze out.
I waited about 30 minutes after dialysis to check her BP again, which was now down to 117/--. Because she threw up due to a blood pressure drop, and because there was such a huge difference between pre and post dialysis blood pressure, I decided to wait a while before giving the hydralazine (which I eventually gave at around 1730).
Primary MD later complained that I should never have held the hydralazine.
So my questions are these: do you give BP meds during dialysis? Also, do you worry about bottoming out a patient's BP by medicating immediately after dialysis?