MISR UNIVERSITY FOR SCIENCE & TECHNOOGY

COLLEGE OF NURSING

Teaching unit Prevention of intradialytic hypotension in

Hemodialysis

Under supervision
Dr. Mohamed Adel

Academic year
2024/2025

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 Prepared by (G18)
Esraa Mohamed Abdelmaneim Khalefa 200019757
Elhusseiny Ghared Elhusseiny Elsaid 200019758
Mohamed Shahat Mosbah Abdelattef 200019789
Seif Al-Din Mohamed Mujahid Nasr Al-Din 200023435
Asmaa Mahmoud Nasr Abdo 200030917
Yasmeen Rabea Abdelftaah Abdelgawad 200019620

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1-Title / Teaching unit Prevention of intradialytic hypotension in Hemodialysis
2-Sujective / staff nurse

3-Setting / Renal dialysis unit in soaad kafafi hospital

4-General objective by the end of teaching unite staff will able to management
of hypotension during dialysis

5-Specific objective by the end of teaching unite nurse will able to

1- define and explain intradialytic hypotension

2- identify and categorize major risk factors of intradialytic hypotension
3- assess and document the sign and symptoms of intradialytic hypotension
4- implement and evaluate preventive strategies to reduce the incidence of
intradialytic hypotension.
5- To develop and distribute standardized guidelines for intradialytic
hypotension prevention and management.

6-Content

Here is a content outline for Prevention of intradialytic hypotension in

Hemodialysis structured to cover key topic and best practices and essential
consideration for safe and effective patient health and staff practices

➢ Introduction

Chronic kidney disease (CKD) is an important global public health concern that
often leads to end-stage kidney disease, requiring treatment with dialysis or
kidney transplant

➢ Definition

Low blood pressure during dialysis is a common complication that occurs when
the body cannot adapt to the loss of fluids during the session and treatment. It is
defined as a drop in systolic blood pressure to less than 90 mm Hg or a drop of

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20 mm Hg or more during the session. The drop can lead to a reduction in the
duration of dialysis sessions, which may affect the effectiveness of treatment
and cause serious complications, such as nerve damage, which increases the risk
of death in patients

➢ Importance of preventive and management of IDH

-To improve dialysis outcome

-insure patient safety and stability during dialysis

-reduce complication of IDH

➢ risk factors of intradialytic hypotension

Research and observations from medical professionals seem to indicate that

some patients are more likely to experience drops in blood pressure related to
dialysis treatment. In a study from 2017, researchers observed that patients with
sepsis and obstructive kidney disease seemed more likely to develop
hypotension

• High inter-dietic weight gain (IDWG)\

Excessive fluid storage goes to volume overload between sessions

IDH requires high ultra -flailing rates that increase the risk of IDH

Graduate liquid is required to maintain hemodynamic stability

• Serum osmolality

Sudden changes in osmoles during dialysis affect vascular stability.

Sodium levels can lead to height changes, which can increase the IDH risk

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 • Electrolyte abnormalities

Imbalance in sodium, potassium and calcium replaces vascular tone.

Hypocalcaemia and hyponatremia reduce vasoconstriction and cause

hypotension.

• Decreased cardiac output

Patients with heart failure or poor heart function must fight to compensate for
fluid change.

Low heart exit causes insufficient spraying and an increase in IDH episodes

Autonomy

Common in diabetes and elderly patients.

The reduced vascular reaction reduces the body's ability to fight hypotension.

• Splanchnic blood flow shift

During dialysis, the blood is reconstructed in the stomach canal.

Central reduces blood volume, contributes to IDH.

• Dialysis temperature

Hot dialysis causes vasodilatation, reducing blood pressure

Cooling of dialysis (0.5 ° C during the core body template) can help prevent
IDH.

• Chronic patient

Patients who have been on dialysis for a long time

• Diabetic people
• Female patient
• Patient with overweight

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 ➢ Signs and Symptoms of Intradialytic Hypotension?

Intradialytic hypotension manifests as a rapid, and obvious, drop in blood

pressure, but there are other subjective symptoms. Patients will often complain
of these symptoms Muscle cramps Back, chest, or abdominal pain ,Headaches

Nausea ,and vomiting, Lightheadedness ,Yawning , Sighing ,Fainting ,Anxiety

6- implement and evaluate preventive strategies to reduce the incidence

of Intradialytic hypotension
❖ Strategies to prevent intradialytic hypotension (IDH)

Although intermittent nature of hemodialysis (HD) makes nature completely

challenging to prevent intradialytic t hypotension (IDH), many evidence -based
strategies can help reduce the frequency and severity.

1 .assessment and preparation before dialysis

➢ Complete heart evaluation:

Identify high -risk patients by undergoing heart history, echocardiographic

results (eg Extraction fractions) and signs of autonomous lethargy

-Identify conditions that increase the risk of IDH, including heart failure,
diabetes neuropathy and vascular disease .

➢ Exact dry weight (EDW) Rating :

-Evaluate dry weight (EDW) regularly to prevent excessive ultrafilation (UF) .

-Adjust the constant dried weight to avoid volume deficiency

➢ Dietary Natrium restrictions :

-Limit sodium intake to reduce interdiltic weight gain (IDWG) and prevent
high ultra -failure velocities (UFR) .

-Educate patients about hidden sodium in processed food .

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2-Nursing intervention during dialysis

➢ Continuous monitoring of blood pressure :

-Monitor blood pressure before, during and after dialysis to detect initial
changes .

-Increase the monitoring frequency for high risk patients .

➢ To adjust the patient's condition :

-The status in the position of a semifool during dialysis .

-If there are important blood pressure drops, use the trendonberg position (with
high legs) to improve circulation .

➢ Limits the food intake during dialysis :

-Eating on dialysis derives blood in the stomach canal, which causes blood
pressure to get worse .

-Advice to patients to eat at least 1-2 hours before dialysis .

➢ Serial adjustment for ultrafiltration :

-In case of symptoms of IDH, you reduce the UF frequency immediately .

-For patients with fluid overload, you should only consider the UF-Say session .

➢ Register of fluid as essential :

-Gently manage small salt bolts (100-200 ml) to stabilize blood pressure .

- Avoid excessive fluid administration to prevent overload after dialysis.

3. Post-Dialysis Care and Patient Education

➢ Pre -charged blood pressure and re -evaluation of symptoms :

-Make sure your blood pressure is stable before the patient leaves the dialysis
system .

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-Monitor for delayed hypotension after the session .

➢ Patient education on lifestyle changes :

-Encourage fluid and sodium restrictions to reduce IDWG .

-Appropriate medication highlights the importance of time (eg taking blood

pressure medication at night) .

-Emphasize the need to complete full dialysis session to remove effective

fluid .

➢ Regular evaluation of dry weight :

-Change dry weight depending on trends in case of blood pressure and

hydration .

➢ Completely with nephrologists for cases of recurrent IDH :

- Adjust a prescription for dialysis as necessary for patients experiencing

persistent IDH.

7-Methods and media

face to face lectures using visual aids (powerpoint and video) to explain
hypotension, its causes, prevention . The trainees participated in role-playing
scenarios, taking on roles such as nurses, patients or doctors, according to real
conditions, decisions and increases engagement through discussion

8-Evaluation plan tools is used

pre-testing before we started the teaching unit to assess the basic knowledge
of the participants, who have knowledge of intraidenial hypotension, including
its causes, sign , methods of prevention and management strategies.

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After completing all educational activities, a post-testing was done with the
same material to compare the results and measure the improvement of the
participants in knowledge and skills. The test included multiple -choice
questions, true/incorrect statements and case -based landscapes to evaluate their
ability to handle real conditions.

Checklist for practical performance rating

A checklist was used to monitor the performance of participants under practical

procedures, which assess them based on the following criteria:

1-Assessment of the patient before dialysis

-Measurement of vital sign (blood pressure, heart rate, temperature).

-Identify risk factors for hypotension.

-Review the patient's medical history.

2-Monitoring the patient during dialysis

-Check common significant vital sign regularly.

-To identify early signs of hypotension.

-If the fall in blood pressure is detected, you must take immediate action.

3-Intervention for hypotension during dialysis

-To prevent or reduce the degree of ultrailiating degree.

-Adjust the patient's condition to improve blood flow in the brain.

-Administration of IV fluid if necessary.

-Evaluation of the patient's response and constant treatment as needed.

4- documentation

-Recording all comments and interventions.

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- To inform the health care system of a significant change in the patient's
condition.

-Provide a comprehensive report on the case after dialysis session.

Evaluation result

After comparing the results of pre-testing and post-testing, there was a

significant improvement in knowledge's knowledge and skills, which reflects

9-Participation among team ( collaboration )

We explicitly increased the Spirit and collaboration from the team by

conducting group discussions by assigning the roles, exchanging ideas and
solutions, sharing practical experiences and providing collective feedback after
each activity. These stages helped to create a collaborative task environment,
which allows trainees to handle issues about introducing hypotension more
effectively.

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