İNTRADİYALİTİK HİPOTANSİYON VE ÖNLEMEYE YÖNELİK HEMŞİRELİK YAKLAŞIMLARI

ÖZETÜlkemizde ve dünyada hemodiyaliz tedavisine ihtiyaç duyan hasta sayısı her geçen gün artmaktadır. Hemodiyaliz tedavisi hayat kurtarıcı olmasına rağmen, akut ve kronik komplikasyonları da beraberinde getirmektedir. İntradiyalitik hipotansiyon, en sık görülen intradiyalitik komplikasyon olup, hemodiyaliz tedavisi sırasında, tedavi öncesine göre sistolik kan basıncında 20mmHg ve üzerinde düşme ya da ortalama kan basıncında 10mmHg ve üzerinde düşme olarak tanımlanır. İntradiyalitik hipotansiyon; bulantı, kusma, kramplar, huzursuzluk, yorgunluk, baygınlık gibi diğer komplikasyonları da beraberinde getirebilir. İntradiyalitik hipotansiyon acil hemşirelik girişimi gerektirmesi nedeniyle hemşireler için oldukça önemlidir. İntradiyalitik hipotansiyon durumunda hemşireler tarafından uygulanan bağımsız hemşirelik girişimleri olsa da, bu girişimler kanıta dayalı uygulama değildir ve belirli bir standardı yoktur. İntradiyalitik hipotansiyon konusunda hemşirelik araştırmalarının artması ve hemşirelik bakımının standardize edilmesi gerekmektedir. Anahtar Kelimeler: Hemodiyaliz; hipotansiyon; hemşirelik bakımı ABSTRACTNursing Approaches to Prevent Intradialytic Hypotension The number of patients in need of hemodialysis treatment in our country and in the world is increasing day by day. Although hemodialysis treatment is life saving, it also causes acute and chronic complications. Intradialytic hypotension is the most common complication of intradialytic complications and it is defined as in comparison with the pre-treatment a decrease in systolic blood pressure of 20 mmHg or more, or a decrease in mean blood pressure of 10 mmHg or more during hemodialysis treatment. Intradialytic hypotension can cause nausea, vomiting, cramps, restlessness, tiredness, fainting, and other complications. Intradialytic hypotension is ve0ry important for nurses because of the need for emergency nursing intervention. Although there are independent nursing interventions applied by nurses in the case of intradialytic hypotension, these interventions are not evidence based and do not have a specific standard. To conclude, it can be said that the number of researches made for intradialytic hypotension by the nurses is insufficient and it needs to be improved and nursing care should be standardized. Keywords: Hemodialysis; hypotension; nursing care

Anahtar Kelimeler:

İntradiyalitik Hipotansiyon, Hemodiyaliz, Hemodiyaliz Komplikasyonları, Hemşirelik

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Ahmad S. Complications of hemodialysis.(2009) In: Ahmad S, ed. Manual of clinical dialysis. 2. Baskı. New York, NY: Springer; 59-68.
Ahsen,A. (2011) Hemodiyalizin Akut Komplikasyonları. Kocatepe Tıp Dergisi 12: 54-60.
Altıntepe,L. Tonbul,HZ. Yeksan, M. Türk,S. (2003) Hemodiyaliz Hipotansiyonunda Farkli Sodyum Ve Ultrafiltrasyon Profilinin Etkinliği. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 2(1) 29-33
Beladi Mousavi SS, Moradi S, Hayati F, Safaee A, Beladi Mousavi M. (2011) Evaluation of Gabapentin effect on muscle cramps in ESRD patients during hemodialysis. Iran J Kidney Diseases 5(2):24–5.
Bergman SM.(2009) Hemodialysis in hypotensive heart failure using midodrine. Am J Med Sci. 338: 470-473.
Bossola M, Laudisio A, Antocicco M, Panocchia N, Tazza L, Colloca G, Tosato M, Zuccalà G. (2013) Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis. Renal Failure 35(9):1260-1263
Chang TI, Paik J, Greene T, Desai M, Bech F, Cheung AK, Chertow GM (2011) Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol 22: 1526–1533
Chesterton LJ, Selby NM, Burton JO (2009) Cool dialysate reduces asymptomatic intradialytic hypotension and increases baroreflex variability. Hemodial Int; 13: 189–196
Dasselaar JJ, van der Sande FM, Franssen CF (2012) Critical evaluation of blood volüme measurements during hemodialysis. Blood Purif 33: 177–182
Daugirdas, J. (2015) Measuring Intradialytic Hypotension to Improve Quality of Care. Journal of the American Society of Nephrology. 26: 512–514.
Davenport A. (2010) Can advances in hemodialysis machine technology prevent intradialytic hypotension? Semin Dial. 22(3):231-236.
Dumler F, Grandin G, Levin NW (1990). Sequential high/low sodium hemodialysis: An alternative to ultrafiltration. Trans Am SocArtif Intern Organs. 25:821-824.
Flythe JE, Inrig JK, Shafi T, Chang TI, Cape K, Dinesh K, Kunaparaju S, Brunelli SM (2013) Association of intradialytic blood pressure variability with increased all-cause and cardiovascular mortality in patients treated with long-term hemodialysis. Am J Kidney Dis 61: 966–974Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM (2014) Association of Mortality Risk with Various Definitions of Intradialytic Hypotension. J Am Soc Nephrol 26: 724–734.
Gross ML, Ritz E.(2008) Hypertrophy and fibrosis in the cardiomyopathy of uremia – Beyond coronary heart disease. Semin. Dial. 21: 308-318.
Jennifer E, Flythe J, Xue H, Lynch KE, Curhan GC, Brunelli SM. (2015) Association of mortality risk with various definitions of intradialytic hypotension. . J Am Soc Nephrol 26(3):724-34
Kotanko P, Stokes JB, Garg AX, Depner TA, Pierratos A, Chan CT, Levin NW, Tom Greene T, Larive B, Beck GJ, Gassman JJ, Kliger AS; FHN Trial Group: Intradialytic hypotension in 6x weekly in-center hemodialysis: Results from the randomized Frequent Hemodialysis Network Daily Trial. J Am Soc Nephrol 23: 457A, 2012
Leunissen KM, Kooman JP, van der Sande FM, van Kuijk WH.(2000) Hypotension and ultrafiltration physiology in dialysis. Blood Purif. 18: 251-254.Lin YF, Huang JW,Wu MS (2010) Comparison of residual renal function in patients undergoing twice-weekly versus three-times-weekly haemodialysis. Nephrology (Carlton) 14:59–64.
Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, Basile C,David S, Feriani M, MontagnaG, Di Iorio BR, Memoli B,Cravero R, Battaglia G, Zoccali C (2010) Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol 21: 1798–1807
Mousavi,S. Tamadon,M.(2014) Vasopressin and Prevention of Hypotension During Hemodialysis. Iran Red Crescent Med J; 16(11): e20219.
Nordio M, Giove S, Lorenzi S, Marchini P, Saporiti E.(1995) A new approach to blood pressure and blood volume modulation during hemodialysis: An adaptive fuzzy control module. Int. J. Artif. Organs 18: 513-517.
Owen PJ, Priestman WS, Sigrist MK (2009) Myocardial contractile function and intradialytic hypotension. Hemodial Int;13:293–300.
Palmer BF, Henrich WL (2008) Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol 19:8–11
Pani, A. Bragg-Gresham, J. Masala, M. (2014) Prevalence of CKD and its Relationship to eGFR-Related Genetic Loci and Clinical Risk Factors in the Sardinia Study Cohort. J Am Soc Nephrol.
Pinney JH, Oates T, Davenport A. (2014) Haemodiafiltration does not reduce the frequency of intradialytic hypotensive episodes when compared to cooled high-flux haemodialysis. Nephron Clin Pract 119: 138–144
Raimann J, Liu L, Tyagi S, Levin NW, Kotanko P. (2008) A fresh look at dry weight. Hemodial. Int. 12: 395-405.
Sezen,A. (2013) Diyaliz El Kitabı . Nobel Tıp Kitapevleri,Ankara
Sezen,A. (2013) Diyaliz Hemşireliği. Nobel Tıp Kitapevleri,Ankara
Shoji T, Tsubakihara Y, Fujii M, Imai E. (2004) Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int 66(3):1212-20 DOI: 10.1111/j.1523-1755.2004.00812.x
Stefansson, V. Brunelli ,M. Cabrera,C. Jensen,D, Anum,E. Rosenbaum,D.(2014) Intradialytic Hypotension and Risk of Cardiovascular Disease. Clin J Am Soc Nephrol 9: 2124–2132.
Sułowicz W, Radziszewski.(2007) Dialysis induced hypotension-a serious clinical problem in renal replacement therapy. Med Pregl. 60: 14-20.
Tai DJ, Conley J, Ravani P, Hemmelgarn BR, MacRae JM (2013) Hemodialysis prescription education decreases intradialytic hypotension. JNEPHROL 26(02): 315-322
Tai,D. Ahmed,S. Derflinger,L. Hemmelgarn,B. MacRae,J. (2013) Pneumatic compression devices during hemodialysis: a randomized crossover trial. Nephrol Dial Transplant 28: 982–990.