2.50
Hdl Handle:
http://hdl.handle.net/10755/157739
Type:
Presentation
Title:
Preventing Hypotension in Hemodialysis
Abstract:
Preventing Hypotension in Hemodialysis
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Goulding, Debra S., DNP, FNP-BC, CNN-NP
P.I. Institution Name:Scottsdale Healthcare, Nephrology
Title:Family Nurse Practitioner, Nephrology Nurse Practitioner
Contact Address:7400 E. Osborn Rd, Scottsdale, AZ, 85251, USA
Contact Telephone:480-882-6599
Background: The United States Renal Data System (USRDS) (2005) projects the incidence of End Stage Renal Disease (ESRD) will continue increasing 5% annually. Hemodialysis, the hallmark treatment for ESRD has a 5-year survival probability of 40.5%.  Hemodialysis-induced hypotension has been identified as an independent risk factor for mortality in the ESRD patient population.  Preventing hemodialysis-induced hypotension has the potential to reduce long-term mortality (Shoji, Tsubakihara, Fajii & Imai, 2004). Rationale: Multiple research studies (Dasselaar, 2007; DeVries, 1993; Howard, 1998; Inrig, 2007; Pillon, 2007; Rodriguez, 2005; Schroeder, 2004; Sego, 1997; Steuer, 1996) have identified the Crit-Line III as a safe, reliable non-invasive blood monitoring device for identifying and predicting hypotension in the outpatient hemodialysis population. Limited studies document its use in the inpatient setting. Therefore, knowledge gained studying the Crit-Line III in the outpatient setting will be transferred to the inpatient setting.  Purposes: The overall aim for this study was to compare the number of occurrences of hypotension with the addition of the Crit-Line III to standard telemetry monitoring data in patients receiving hemodialysis. In addition, secondary aims were to compare length of stay, occurrences of transfers to higher level of care (i.e. transfer from a Medical/Surgical floor to an Intensive Care Unit), and hypotension symptoms for the two groups. Methods: This evidence based clinical project compared two hemodialysis monitoring practices; standard telemetry blood pressure monitoring and the Crit-Line III. Baseline data was collected from twenty-six ESRD patients who were admitted and dialyzed from May 6 to June 6, 2008 with only standard telemetry blood pressure monitoring. Crit-Line III data was collected from fourteen ESRD patients admitted and dialyzed from June 10 to September 3, 2008 with the Crit-Line III and standard telemetry blood pressure monitoring. Outcome variables were compared before and after the implementation of the Crit-Line III.  Outcomes: Comparison of the outcome results for standard telemetry blood pressure monitoring and Crit-Line III groups are as follows: 1) occurrence of hypotension , 12 (21.8%) for 55 hemodialysis treatments and 4 (28.6%) for 14 hemodialysis treatments,  2) hypotension symptoms, none documented and 2 (14.3%) reported cramping, 3) admission to higher level of care, 1 (1.8%) vs. no admissions to higher level of care, and 4) average length of stay, 5.59 days and median 4.0 days vs. mode 3 days and median length of stay 3.5 days in the Crit-Line group. Conclusions: A small sample size was a limitation of the study. Two of the four subjects in the Crit-Line III group became hypotensive after receiving analgesic and/or anxiolytic medications affecting the overall incidence of hypotension. The Crit-Line III is not designed to predict/prevent non-volume related hypotension. Crit-Line utilization resulted in a decrease in admissions to a higher level of care and length of stay. It is recommended that further study be conducted with a larger randomized sample.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePreventing Hypotension in Hemodialysisen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157739-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Preventing Hypotension in Hemodialysis</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Goulding, Debra S., DNP, FNP-BC, CNN-NP</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Scottsdale Healthcare, Nephrology</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Family Nurse Practitioner, Nephrology Nurse Practitioner</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">7400 E. Osborn Rd, Scottsdale, AZ, 85251, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">480-882-6599</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">dgoulding@shc.org</td></tr><tr><td colspan="2" class="item-abstract">Background: The United States Renal Data System (USRDS) (2005) projects the incidence of End Stage Renal Disease (ESRD) will continue increasing 5% annually. Hemodialysis, the hallmark treatment for ESRD has a 5-year survival probability of 40.5%.&nbsp; Hemodialysis-induced hypotension has been identified as an independent risk factor for mortality in the ESRD patient population.&nbsp; Preventing hemodialysis-induced hypotension has the potential to reduce long-term mortality (Shoji, Tsubakihara, Fajii &amp; Imai, 2004). Rationale: Multiple research studies (Dasselaar, 2007; DeVries, 1993; Howard, 1998; Inrig, 2007; Pillon, 2007; Rodriguez, 2005; Schroeder, 2004; Sego, 1997; Steuer, 1996) have identified the Crit-Line III as a safe, reliable non-invasive blood monitoring device for identifying and predicting hypotension in the outpatient hemodialysis population. Limited studies document its use in the inpatient setting. Therefore, knowledge gained studying the Crit-Line III in the outpatient setting will be transferred to the inpatient setting. &nbsp;Purposes: The overall aim for this study was to compare the number of occurrences of hypotension with the addition of the Crit-Line III to standard telemetry monitoring data in patients receiving hemodialysis. In addition, secondary aims were to compare length of stay, occurrences of transfers to higher level of care (i.e. transfer from a Medical/Surgical floor to an Intensive Care Unit), and hypotension symptoms for the two groups. Methods: This evidence based clinical project compared two hemodialysis monitoring practices; standard telemetry blood pressure monitoring and the Crit-Line III. Baseline data was collected from twenty-six ESRD patients who were admitted and dialyzed from May 6 to June 6, 2008 with only standard telemetry blood pressure monitoring. Crit-Line III data was collected from fourteen ESRD patients admitted and dialyzed from June 10 to September 3, 2008 with the Crit-Line III and standard telemetry blood pressure monitoring. Outcome variables were compared before and after the implementation of the Crit-Line III.&nbsp; Outcomes: Comparison of the outcome results for standard telemetry blood pressure monitoring and Crit-Line III groups are as follows: 1) occurrence of hypotension , 12 (21.8%) for 55 hemodialysis treatments and 4 (28.6%) for 14 hemodialysis treatments,&nbsp; 2) hypotension symptoms, none documented and 2 (14.3%) reported cramping, 3) admission to higher level of care, 1 (1.8%) vs. no admissions to higher level of care, and 4) average length of stay, 5.59 days and median 4.0 days vs. mode 3 days and median length of stay 3.5 days in the Crit-Line group. Conclusions: A small sample size was a limitation of the study. Two of the four subjects in the Crit-Line III group became hypotensive after receiving analgesic and/or anxiolytic medications affecting the overall incidence of hypotension. The Crit-Line III is not designed to predict/prevent non-volume related hypotension. Crit-Line utilization resulted in a decrease in admissions to a higher level of care and length of stay. It is recommended that further study be conducted with a larger randomized sample.</td></tr></table>en_GB
dc.date.available2011-10-26T20:09:29Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:09:29Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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