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Prevention Of Hypotension During Dialysis. Essay

1913 words - 8 pages

Hypotension during dialysis is a common complication in haemodialysis patients,which typically occurs during the later stages of dialysis. It is estimated thathypotension occurs 25 to 50% of dialysis treatments (Victor and Henrich 1994 pg196-208). Many factors involve in hypotension during dialysis including volumedepletion, high ultrafiltration rate, autonomic dysfunction, antihypertensivemedications, bioincompatible dialyser membrane, low dialysate temperature,declining serum osmolarity etc. (Daugirdas 1991 pg 233). However, in spite ofappropriate treatment, many patients still suffer from hypotension duringhaemodialysis. Collins et al (1990) when hypotension occurred the cardiac outputdrops sharply and there were concomitant sudden decrease in the mean arterialpressure and are attributed to a decrease venous return and considered to be caused byrelocation of circulating blood, possible associated a sudden decrease in venous tonewhich will result in hypotension. The etiology and prevention of intradialytichypotension has become an increasingly complex issue and the volume depletion dueto ultrafiltration remains the predominant underlying etiologic factor, Sherman et al(2002).I remembered I had one patient, and many of the patients as youknow, don't have a lot of symptoms. He was telling that he was feeling good and thatand that everything was getting worse in his face. I took his blood pressure and it was70/40 mmHg but the patient had none of the typical symptoms of hypotension likevomiting, dizziness, headache etc. (Ramsy et al 1999) defined hypotension ofblood pressure lower than 90/60 mmHg and varies from persons age, time ofrecording and different sphygmomanometer, and the way different people use theequipment can give different readings and individual tolerance. Most of the staff whotreat patients know that sometimes the symptoms can be quiet subtle. Now, Why doesit happen? Well, normally staff will remove 2 to 4 litres of fluid in a given dialysistreatment over 3 to 4 hours. The blood volume in a typical dialysis patient isapproximately 4.5 L and the patients plasma is only approximately 3 litres (Tortora2002). So the staff tries to remove the whole plasma volume from a patient in thespace of 3 hours. It's truly wonder that the patient survives and maintains their bloodpressure. The reason the patients do survive, it is that there are compensatorymechanisms like refilling, changes in venous capacity and changes in arterialresistance. (AJKD 2001 pg 38). The initial compensatory mechanism is refilling ofthe plasma water space from the sorrounding tissue spaces and the source of refillingfluid is primarily extracellular space, although this depends on the dialysate sodiumlevel. Using a higher dialysate sodium concentration will result in mobilization ofintracellular water and better maintainance of plasma volume during dialysisDialysis hypotension occurs because large volume of blood water and solutes areremoved over a short period of time,...

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