ABSTRACT
All nurses should possess core critical assessment skills in order to appropriately assess critically ill patients. It is anticipated that the possession of these core skills will enable nurses to appropriately assess and identify those patients who are at risk of deterioration. By comprehensively assessing individual patients and identifying problems early, nurses can initiate specific interventions that may stabilize and improve patient outcomes and help prevent unnecessary intensive care unit admission.
Subject(s)
Blood Circulation , Blood Pressure Determination , Blood Volume Determination , Critical Care/methods , Critical Illness/nursing , Nursing Assessment/methods , Blood Pressure Determination/methods , Blood Pressure Determination/nursing , Blood Volume Determination/methods , Blood Volume Determination/nursing , Clinical Competence , Early Diagnosis , Electrocardiography/instrumentation , Electrocardiography/methods , Electrocardiography/nursing , Heart Rate , Humans , Nurse's Role , PulseABSTRACT
There are two distinct facets of adequate fluid balance control in haemodialysis patients--estimation of dry weight (DW) as the target and adequate ultrafiltration (UF) strategy, i.e. the way to reach the target in a possibly symptom-free way. The article reviews the continuous blood volume monitoring (CBVM) based procedures to deal with the former facet-DW determination. The existing approaches are divided in three groups--methods defining certain alert value of relative blood volume (RBV) reduction, methods working with RBV response to constant UF rate, and methods evaluating dynamics of RBV response to UF pulse or chain of UF pulses. While the first and the third approaches are relatively easy to automate, the second group of methods are suitable mainly for observational evaluations only. All the discussed methods, without exception, need large-scale verification, as they all were evaluated in the majority by their authors only and on small patient cohorts.
Subject(s)
Blood Volume Determination/methods , Body Weight , Monitoring, Physiologic/methods , Nursing Assessment/methods , Renal Dialysis/methods , Water-Electrolyte Imbalance/diagnosis , Bias , Blood Volume , Blood Volume Determination/nursing , Dehydration/diagnosis , Dehydration/etiology , Dehydration/metabolism , Fluid Shifts/physiology , Humans , Linear Models , Monitoring, Physiologic/nursing , Practice Guidelines as Topic , Renal Dialysis/adverse effects , Renal Dialysis/nursing , Reproducibility of Results , Water Intoxication/diagnosis , Water Intoxication/etiology , Water Intoxication/metabolism , Water-Electrolyte Imbalance/etiology , Water-Electrolyte Imbalance/metabolismABSTRACT
Intra-dialytic hypotension is the most frequently occurring complication during haemodialysis and can lead to serious complications. Devices that continuously and non-invasively monitor relative blood volume (RBV) changes during HD are being advocated as a tool to maintain an adequate volume of the intravascular compartment in order to avoid dialysis hypotension. Nowadays, most manufacturers have incorporated a RBV monitor in their dialysis apparatus and two manufacturers have designed biofeedback devices that control intra-dialytic RBV changes. The goal of RBV based biofeedback systems is to prevent a severe or abrupt decrease in blood volume in order to prevent the development of dialysis hypotension. Biofeedback technologies can diminish the severity and/or frequency of dialysis hypotension. At present, however, a completely symptom-free HD is not a reality. The major reasons for this are patient characteristics such as cardiovascular co-morbidity and high UF rates and a lack of understanding of the relation between RBV changes and blood pressure/cardiovascular stability.
