Patient Care and Assessment
Pre-treatment assessment
Every treatment begins with a focused assessment you perform and document before the blood pump starts. Establish identity, obtain the pre-weight on the same scale each time, and record pre-dialysis vital signs (blood pressure with the patient seated, ideally in the same arm), temperature, pulse, and respirations. Assess the vascular access: palpate for a thrill, auscultate for a bruit, look for redness, swelling, drainage, or bruising, and ask about pain. Review the plan-target weight, ultrafiltration goal, dialysate prescription, medications due, and any recent symptoms such as dizziness, cramping, or missed treatments.
During and after treatment
Monitor vital signs at set intervals and whenever symptoms appear. Intradialytic hypotension is the most common complication-suspect it when a patient yawns, feels nauseated, becomes diaphoretic, or reports dizziness. Cramping often reflects excessive ultrafiltration or a high sodium gradient. Disequilibrium syndrome (headache, confusion, seizures) is more likely with a first treatment or very high urea clearance. Post-treatment: recheck weight and vital signs, hold the access site until hemostasis, inspect the access, and give clear instructions about when to call.
Traps and a rule of thumb
Questions like to blur assessment (observation, palpation, auscultation) with intervention, and to ask what the technician reports versus what the RN decides. Remember that the technician collects and reports data; the RN interprets and revises the plan of care. Rule of thumb: a symptomatic fall in systolic pressure of about 20 mmHg (or a systolic under 90) during treatment is a hypotension event-stop or slow ultrafiltration, reposition the patient, and follow the protocol for fluid replacement.