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  • Monitoring for intradialytic hypotension: An audit of nursing practice

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    McIntyre437923-Accepted.pdf (375.6Kb)
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    Accepted Manuscript (AM)
    Author(s)
    McIntyre, David
    Havas, Kathryn
    Bonner, Ann
    Griffith University Author(s)
    Bonner, Ann J.
    McIntyre, David P.
    Havas, Katie
    Year published
    2020
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    Abstract
    BACKGROUND: Intradialytic hypotension (IDH) is one of the most common complications associated with haemodialysis (HD), yet the frequency of patient assessment by nurses varies in practice. We sought to measure the frequency of nursing assessments before, during and after HD and to identify any predictors of IDH. OBJECTIVES: To audit the frequency, nursing management and contributing factors of IDH. DESIGN: A prospective clinical audit was undertaken over 4 weeks. PARTICIPANTS: Nurses completed audit sheets on 132 patients at three chronic HD units. MEASUREMENTS: The audit tool consisted of 34 questions related to demographics, ...
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    BACKGROUND: Intradialytic hypotension (IDH) is one of the most common complications associated with haemodialysis (HD), yet the frequency of patient assessment by nurses varies in practice. We sought to measure the frequency of nursing assessments before, during and after HD and to identify any predictors of IDH. OBJECTIVES: To audit the frequency, nursing management and contributing factors of IDH. DESIGN: A prospective clinical audit was undertaken over 4 weeks. PARTICIPANTS: Nurses completed audit sheets on 132 patients at three chronic HD units. MEASUREMENTS: The audit tool consisted of 34 questions related to demographics, HD prescription, frequency of monitoring and nursing interventions. RESULTS: A total of 1584 sessions were performed with 876 (55.3%) audits returned, of which 452 were useable. There were 74 actual episodes of IDH, and a further 72 potential episodes may have been prevented due to nursing intervention. Most nurses reported assessing patients before starting HD and as required before an actual or potential IDH event (n = 85; 63%); few hourly assessments were performed. Predictors of IDH were systolic blood pressure ≤140 mmHg, having more than four comorbidities, dialysate temperature > 36°C, calcium < 1.3 mmol/L and a shorter dialysis session (3.0-4.5 h). These predictors explained 14.1% of the variance in hypotensive episodes during HD. CONCLUSION: This clinical audit highlighted the importance of assessing blood pressure trends during HD to preemptively intervene before IDH developing. The audit has resulted in a practice change to hourly assessments. Follow-up audits of practice should occur.
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    Journal Title
    Journal of Renal Care
    DOI
    https://doi.org/10.1111/jorc.12343
    Copyright Statement
    © 2020 European Dialysis and Transplant Nurses Association/European Renal Care Association. This is the peer reviewed version of the following article: Monitoring for intradialytic hypotension: An audit of nursing practice, Journal of Renal Care, 2020 , which has been published in final form at https://doi.org/10.1111/jorc.12343. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
    Note
    This publication has been entered in Griffith Research Online as an advanced online version.
    Subject
    Clinical sciences
    Nursing
    Health services and systems
    Public health
    haemodialysis
    intradialytic hypotension
    monitoring
    Publication URI
    http://hdl.handle.net/10072/396159
    Collection
    • Journal articles

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