What is the current trend for treatment of hypotension during tx. Where I work the practice is give a NS bolus (200cc) then repeat it if necessary. After that if hypotension remains or comes back you give Mannitol, then repeat if necessary. Of course all this is after applying 02, laying the patient down further and/or reposistioning the cuff.

What is considered "hypotension" varies from patient to patient. Some patients tolerate 90's or 80's and are asymptomatic and as long as they are asymptomatic we do not treat and a plan like this requires MD approval & order.

Either adding NS bolus or dropping the goal is a concern on how heavy the pt will leave. Currently we do not have Crit line monitoring.

What other interventions are people doing?

If by "laying the patient down", you mean Trendelenburg (head lower than, or same level as heart, and legs mildly elevated),then we do that too, first sign of hypotension. In someone who presents predialysis with mild to moderate to severe pitting edema of the lower extremities, elevating the legs from the start will help (but may aggravate cramping later). I have the darndest time teaching hemo techs the importance of lowering the head to the same level as the heart when the BP starts to decline!
We do not give anything other than saline as a volume booster.
We also use various sodium profiles, if the patient is normo- or hypotensive to begin with.
Some of our patients benefit from having the largest volume removed early in the treatment, with hourly breaks from UF for about 15" each.
No eating during the treatment, to avoid low BPs related to that.
I am trying hard to train people to assess the patient's "Big Picture" and not just the BP numbers, because there are SO many reasons that BPs may not be accurate. Ability to mentate, physical signs and symptoms (pallor, grey color, sweating, nausea, dizziness, etc.), changes in heart rate, and history of low BPs should all be considered when assessing the severity of a low BP reading.
We do use the Critline on patients who may need a change in their target/prescribed weight, and do find it very helpful.
Good luck!

We generally tend to give saline as a last resort unless the patient is experiencing sever hypotension symptoms. We use trendelenberg first, then turn off the UF secondly, and give saline if those two interventions do not work. We do use hypertonic saline or 50% dextrose solution to try to move the fluid out and to resolve severe muscle cramping. We also use UF profiling and sodium variation, but I think the best innovation we have used to prevent hypotension is the Crit-Line monitor. I have found in my years of dialysis that it is the best predictor for fluid volume overall.

Acutally Chronic Hemodialysis hypotensive and hypovolemic episodes will always occur because WE are still dialyzing patients to a number vs a true dry weight.The Crit-Line Monitor plus proper dialysis training to include uf and sodium profile monitoring will take care of these problems .More training is the key..