2.50
Hdl Handle:
http://hdl.handle.net/10755/211493
Type:
Research Study
Title:
CHANGES IN CENTRAL VENOUS OXYGEN SATURATION DURING OUTPATIENT HEMODIALYSIS
Abstract:
Purpose/Aims: The overall aim of this study is to determine whether central venous oxygen saturation (ScvO2) is related to changes in systolic blood pressure (SBP) and acute signs and symptoms in outpatients undergoing hemodialysis. The specific aims of this study are to determine the: 1.) change in ScvO2 as fluid is removed during outpatient hemodialysis; 2) relationship between ScvO2 and changes in SBP during hemodialysis; 3.) association between percent change in ScvO2 and acute signs and symptoms during hemodialysis; 4.) association between the percent change in SBP and acute signs and symptoms during hemodialysis; and 5.) change in ScvO2 in patients without symptomatic hypotension compared to those with symptomatic hypotension. Background: Symptomatic hypotension is the most common complication during hemodialysis. It can induce cardiac arrhythmias, predispose patients to coronary, splanchnic, and/or cerebral ischemic events, and negatively affects patients’ feelings of well-being.  Non-invasive intermittent blood pressure measurement is used to identify hypotension during dialysis, yet it is a post-facto indicator of intravascular hypovolemia. Continuous monitoring of ScvO2 is used routinely in critical care as an indicator of impending hemodynamic instability.  Central venous oxygen saturation monitoring may offer an innovative approach to early detection of symptomatic hypotension during outpatient hemodialysis. Methods: In this prospective observational study, data were collected from adult hemodialysis outpatients with a central line dialysis catheter. ScvO2, blood pressure, blood volume change, total fluid removed and acute signs and symptoms were recorded during one week of consecutive hemodialysis treatments. Descriptive statistics, multi-level regression and multi-level negative binomial regression models were utilized to analyze data. Findings: Subjects (n=39) were mostly male (56%), African American (49%) and White (28%) with a mean age of 60 +17 years. There was a statistically significant linear and quadratic change in ScvO2 over the duration of hemodialysis and the change trajectory was significantly greater in those patients with symptomatic hypotension.  Change in ScvO2 was significantly associated with SBP and acute signs and symptoms.  A five unit increase in ScvO2 % change was equivalent to a 29% increase in the presence of a symptom and a 10 unit increase in ScvO2% change was equivalent to a 66% increase in the presence of a symptom during outpatient hemodialysis.  Acute symptoms associated with hypotension occurred in 38% of patients and 24% of dialysis treatments. Implications: The change trajectory of ScvO2 during outpatient hemodialysis is relevant and related to SBP and acute signs and symptoms.  ScvO2 may be used by dialysis nurses to guide therapeutic interventions to avoid symptomatic hypotension in the outpatient setting. Further research is warranted to replicate these findings and broaden our understanding of strategies to mitigate hypotensive symptoms.
Keywords:
Central venous oxygen saturation; Systolic blood pressure
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5301
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleCHANGES IN CENTRAL VENOUS OXYGEN SATURATION DURING OUTPATIENT HEMODIALYSISen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211493-
dc.description.abstractPurpose/Aims: The overall aim of this study is to determine whether central venous oxygen saturation (ScvO2) is related to changes in systolic blood pressure (SBP) and acute signs and symptoms in outpatients undergoing hemodialysis. The specific aims of this study are to determine the: 1.) change in ScvO2 as fluid is removed during outpatient hemodialysis; 2) relationship between ScvO2 and changes in SBP during hemodialysis; 3.) association between percent change in ScvO2 and acute signs and symptoms during hemodialysis; 4.) association between the percent change in SBP and acute signs and symptoms during hemodialysis; and 5.) change in ScvO2 in patients without symptomatic hypotension compared to those with symptomatic hypotension. Background: Symptomatic hypotension is the most common complication during hemodialysis. It can induce cardiac arrhythmias, predispose patients to coronary, splanchnic, and/or cerebral ischemic events, and negatively affects patients’ feelings of well-being.  Non-invasive intermittent blood pressure measurement is used to identify hypotension during dialysis, yet it is a post-facto indicator of intravascular hypovolemia. Continuous monitoring of ScvO2 is used routinely in critical care as an indicator of impending hemodynamic instability.  Central venous oxygen saturation monitoring may offer an innovative approach to early detection of symptomatic hypotension during outpatient hemodialysis. Methods: In this prospective observational study, data were collected from adult hemodialysis outpatients with a central line dialysis catheter. ScvO2, blood pressure, blood volume change, total fluid removed and acute signs and symptoms were recorded during one week of consecutive hemodialysis treatments. Descriptive statistics, multi-level regression and multi-level negative binomial regression models were utilized to analyze data. Findings: Subjects (n=39) were mostly male (56%), African American (49%) and White (28%) with a mean age of 60 +17 years. There was a statistically significant linear and quadratic change in ScvO2 over the duration of hemodialysis and the change trajectory was significantly greater in those patients with symptomatic hypotension.  Change in ScvO2 was significantly associated with SBP and acute signs and symptoms.  A five unit increase in ScvO2 % change was equivalent to a 29% increase in the presence of a symptom and a 10 unit increase in ScvO2% change was equivalent to a 66% increase in the presence of a symptom during outpatient hemodialysis.  Acute symptoms associated with hypotension occurred in 38% of patients and 24% of dialysis treatments. Implications: The change trajectory of ScvO2 during outpatient hemodialysis is relevant and related to SBP and acute signs and symptoms.  ScvO2 may be used by dialysis nurses to guide therapeutic interventions to avoid symptomatic hypotension in the outpatient setting. Further research is warranted to replicate these findings and broaden our understanding of strategies to mitigate hypotensive symptoms.en_GB
dc.subjectCentral venous oxygen saturationen_GB
dc.subjectSystolic blood pressureen_GB
dc.date.available2012-02-20T11:58:22Z-
dc.date.issued2012-02-20T11:58:22Z-
dc.date.accessioned2012-02-20T11:58:22Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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