Vermeidung der Komplikation intradialytische Hypotonie – Umsetzung pflegerelevanter Forschungsergebnisse

Die häufigste Komplikation während einer Hämodialysebehandlung ist die intradialytische Hypotonie. Diese resultiert nicht nur in Unwohlsein und Kollaps des Patienten, sondern birgt auch ein höheres Mortalitätsrisiko. Elementar für eine Fachpflegekraft der Dialyse ist es daher zu wissen, welche prophylaktischen Maßnahmen ergriffen werden können, um intradialytische hypotone Episoden des Patienten zu minimieren und zu vermeiden. Diese Recherche in einschlägigen Datenbanken stellt die aktuellen Forschungsergebnisse zu dieser Thematik vor. Studien zur Nahrungsaufnahme, dem Volumenentzug an Hämodialyse, der Elektrolytverschiebung, verschiedenen Dialyseverfahren, der Temperatureinstellung sowie dem Blutfluss werden angeführt. Trotz teilweise kontroverser Ergebnisse der angeführten Studien, gibt es Hinweise auf diverse Möglichkeiten zur Prophylaxe der intradialytischen Hypotonie. Die Entscheidung, welche Maßnahme im Einzelfall eigenständig von einer hochqualifizierten Fachpflegekraft ergriffen werden kann, muss jedoch immer patientenindividuell erfolgen.

The most common complication in the course of hemodialysis sessions is the so-called intradialytic hypotension. During that episode, patients experience discomfort and there is an increased risk of pronounced cardiovascular collapse, resulting in an increased mortality. As a consequence, care givers of these patients, especially hemodialysis nurses, have to be aware of this complication and of prophylactic methods to prevent it. It is the aim of this study to collect the latest research results in this field using available international databases. Most of the analyzed studies focused on intradialytic nutrition, volume withdrawal, intradialytic electrolyte shifts, different dialysis procedures, dialysate temperature and the chosen blood flow during hemodialysis session. Despite of partly controversal results in the reported studies, it can be concluded that certain measures to prevent intradialytic hypotensive episodes do indeed exist. In the case given, however, it will be necessary that a well-trained dialysis nurse decides which of these available measures should be taken in the individual hemodialysis patient.

Key words

hemodialysis - complication - intradialytic hypotension - implementation - care - research

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