DEFINITION
A decrease in blood volume will result in decreased cardiac filling, which in turn will cause reduced cardiac output and, ultimately hypotension.
MOST COMMON CAUSES
1. Excess decrease in blood volume
Too low dry body weight
High UF and TMP
Low conductivity (Low Na dialysis solution)
Anti-hypertensive drugs therapy
Acetate dialysis solution
Hot dialysis fluid
Eating food during dialysis
2. Other causes
Due to cardiac failure and un-ability to increase cardiac rate
Due to hemorrhage
CONDITIONS
1. Applies to all Registered Nursing Personnel working in dialysis centers in Oman
2. This procedure can be performed by a nurse undertaking nephrology / dialysis training program, provided he / she is closely supervised by an experienced dialysis nurse at all times
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | Keep the patient in supine position with feet slightly elevated. | To maintain sufficient blood supply to vital organs of the patient. |
| 02 | Minimize ultra filtration (UF). | To prevent further hypotension. |
| SN | Nursing Action | Rationale |
| 03 | Reduce blood pump. | To prevent further hypotension. |
| 04 | Check blood pressure and pulse. | To assess the degree of hypotension. |
| 05 | Initiate fluid replacement as prescribed. e. g. Normal Saline. | |
| 06 | Monitor blood pressure and pulse. | To monitor the patient’s condition and assess whether hypotension has been corrected or not. . |
| 07 | Start hypertonic solution if needed. e.g. dextrose AND albumin. | To increase oncotic pressure. To attract fluid from extra cellular space. |
| 08 | If the patient vomits, turn him / her to the side. Clean the vomiting and elevate slightly the patient’s head. | To prevent aspiration. |
| 09 | Communicate with the patient and reassure him. | To allay fears and gain patient confidence and co operation |
| 10 | Monitor the condition of the patient and report progress to the treating physician. | For further management e.g. review therapy, reassess dry weight etc . |
| 11 | Educate the patient about his / her condition and prevention of hypo tension e.g. avoid taking hypertensive drugs on the day of dialysis. | To prevent further hypotension, during dialysis and improve well-being of the patient. |
| 12 | Document patient’s condition, medication given, and response to treatment. |