In our unit if the patient starts to feel bad, because he is too close to his dry weight , they seem to deal with it by giving he patient some saline. What would happen if they simply adjusted the goal and took less off?

In your scenario, the outcome would probably be identical. Turning down, or adjusting the goal, would result in less volume being removed. Keeping the goal the same, but giving the individual saline results in a larger volume removed, but then you must 'subtract' the amount of fluid given during treatment.

The real question, in my mind, is why someone would not want to adjust the goal before the treatment started. If it is known that a patient frequently becomes hypotensive at a certain weight, the likelihood is that the estimated dry weight needs to be adjusted a bit.

Using saline for volume replacement however in other circumstances is definately the way to go. If this is an unusual situation, seeing if the patient's blood pressure responds to normal saline infusions is a good way to make sure everything else is ok.

I hope this helps!
Carol

At my unit, I am on my own when it comes to adjusting my dry weight. Neither my doctor or the workers do an assessment from tx to tx to see where my weight should be. After cramping and passing out a couple of times, I figured out that there were math errors on my goal and no assessments were ever done. So, I talked to my doctor about it. At first he told me the RN should call him to tell him when an adjustment is called for, but since they get busy why don't I call him myslef. I thought that was off base as, although I'm willing to share the responsibility, it is afterall the RNs' job. And besides, there's no time to call the doctor at the beginning of a tx when the assessment should take place, so that could potentially cause me to cramp and it would be too late again.

I saw that this part of my care was neglected, so I have learned how to adjust my own dry weight. My doctor even told me to do this as he knows I'm capable and its the ony way its going to get done. I don't go along with this because I think its right, but only in order to protect myself. I have no choice.

In adjusting my dry weight from tx to tx, its not always possible to be exact. I do very well, but sometimes I;m a little off. One day I just got the idea to try taking a couple of points off my goal when I saw that I felt hypotensive early on in the tx. I did take off a .2 and it stabilized me. So that's why I've wondered if this step is acceptable as opposed to giving saline. Its faster.

Marge:

You hit the nail on the head when you said you adjusted the dry weight when you were slightly hypotensive, and not in a full blown crisis. Certainly you may adjust the target weight during treatment but this should not be in response to an active crisis. What I am saying is that decreasing the goal during treatment if someone is unresponsive or cramping is simply not going to work.

If you note that your goal needs to be frequently adjusted and it is not related to a math problem, your overall dry weight needs to be adjusted.

I am concerned that you are performing this task in your clinic. I admire you - and uderstand - why you are doing this. I am worried, however, about the other patients in your clinic. I hate to ask this, but have you discussed this situation with the administrator?

Carol