Dialysis is a common treatment method used to replace patients with renal insufficiency. However, during dialysis, hypotension is a common complication that brings discomfort and risks to patients. As a nurse responsible for caring for dialysis patients, it is crucial to promptly respond to the occurrence of hypotension through monitoring and observation. This article will introduce from the perspective of nurses how to cope with hypotension through monitoring and observation during dialysis.
1、 Understanding the definition and causes of hypotension during dialysis
1.1 Hypotension during dialysis
Patients undergoing dialysis experience a decrease in systolic blood pressure>20mmHg or a decrease in mean arterial pressure of 10mmHg or more, accompanied by symptoms of hypotension (drowsiness, hearing loss, blurred vision, nausea and vomiting, indifferent expression, bowel movements, etc.).
1.2 Reasons
(1) Capacity related factors: including too fast ultrafiltration speed (0.35ml · kg-1 · min-1), low set dry weight, dialysis machine ultrafiltration failure, or low sodium concentration in dialysate.
(2) Vasoconstriction dysfunction: including high dialysate temperature, use of antihypertensive drugs before dialysis, eating during dialysis, moderate and severe anemia, autonomic nervous dysfunction (such as patients with diabetes neuropathy), and those who use acetate dialysis.
(3) Cardiac factors: such as diastolic dysfunction, arrhythmia (such as atrial fibrillation), cardiac ischemia, cardiac tamponade, myocardial infarction, etc.
(4) Other rare causes include bleeding, hemolysis, air embolism, dialyzer reactions, sepsis, etc.
2、 Monitor the blood pressure of dialysis patients
2.1 Regularly measure blood pressure
During the dialysis process, nurses should regularly measure the blood pressure of patients according to medical advice or the standard procedures of the dialysis center. Generally, blood pressure should be measured before, during, and after dialysis. This can obtain comprehensive blood pressure data and understand the patient's blood pressure condition throughout the entire dialysis process.
2.2 Pay attention to changes in blood pressure
Nurses need to closely monitor changes in patients' blood pressure, especially during dialysis. Hypotension may occur at the beginning or during dialysis, so nurses should pay special attention to changes in blood pressure during these time periods. Any abnormal blood pressure fluctuations require the attention of nurses and may require further evaluation and intervention.
3、 Observing the clinical manifestations of hypotension
3.1 Pay attention to the patient's discomfort
Hypotension may cause discomfort such as dizziness, fatigue, and nausea in patients.
3.2 Observing the patient's skin condition
During hypotension, the patient's skin may appear pale, damp, cold, and other abnormalities.
4、 Nursing Measures
4.1 Position Adjustment
Elevating the patient's head or changing their position, such as semi sitting, can help improve blood return and cardiac blood output. This can help increase the patient's blood pressure and alleviate symptoms of low blood pressure.
4.2 Increasing Blood Volume
According to medical advice, nurses can administer an appropriate amount of intravenous infusion to supplement insufficient blood volume. Attention should be paid to the composition and flow rate of the fluid when administering intravenous infusion to avoid causing blood to become too thin or overloaded.
4.3 Adjust the temperature and flow rate of the dialysate
Adjust the temperature and flow rate of the dialysate appropriately to reduce the occurrence of hypotension.
4.4 Observe fluid intake and urine output
Closely monitor the patient's fluid intake and urine output to avoid excessive or insufficient fluid intake.
4.5 Communicate with the doctor
Report low blood pressure to the doctor in a timely manner so that the doctor can adjust the dialysis plan.
5、 Prevent the occurrence of hypotension
5.1 Evaluate the situation before dialysis
Conduct a comprehensive assessment of the patient's signs and symptoms before dialysis to identify high-risk factors for hypotension.
5.2 Individualization of Dialysis Plan
Develop an individualized dialysis plan based on the patient's condition, including dialysis time, dialysate formula, etc.
5.3 Properly limit fluid intake
Depending on the patient's condition, limit fluid intake appropriately to avoid excessive fluid intake.
5.4 Early Prevention of Hypotension
During dialysis, appropriate intervention measures should be taken to prevent the occurrence of hypotension in advance.
6、 Conclusion: Hypotension is a common complication during dialysis, and nurses can respond promptly to its occurrence through monitoring and observation. By regularly measuring blood pressure, observing clinical manifestations, and taking corresponding nursing measures, nurses can effectively prevent and treat hypotension in dialysis patients, improve the quality and safety of dialysis for patients. In daily nursing work, nurses should continuously improve their professional knowledge and skills, work closely with team members, and jointly ensure the health and well-being of dialysis patients.