12_4_1
Volume 12, Number 4, pages 19 - 23
Case success with midodrine for intradialytic hypotension
Julie Ann Lawrence-Murphy, RN(EC), MScN, CNeph(C), Sue Tereschyn, RN, CNeph(C), and Donna Zimmerman, RN, CNeph(C)
Abstract
Despite advances in technology, hemodialysis delivery techniques, and adjunct therapies that enhance understanding and treatment of intradialytic hypotension (IDH), the management of these events is a common challenge faced in hemodialysis by the multidisciplinary team. The effects of IDH are significant. Clearly, deleterious patient effects are the most concerning, and include symptoms ranging from nausea and headache, to more severe manifestations such as loss of consciousness, seizure, or cardiac/cerebral event. The impact on staff and surrounding patients can also be significant; including delayed station turnover, adverse unit ambience, and staffing challenges. This article will summarize one team's experience with a refractory case of IDH. The successful management of IDH with the use of midodrine will be recounted, with highlights on preintervention diagnostics that are useful prior to the introduction of this medication. Empirical evaluation on the effectiveness of this intervention will be reviewed, as well as anecdotal support for the improvement in quality of life. The case presentation will be a useful account for all members of the multidisciplinary team who struggle with issues surrounding refractory intradialytic hypotension.
Author Affiliation(s): Julie Ann Lawrence-Murphy, RN(EC), MScN, CNeph(C), is a Nurse Practitioner/Clinical Nurse Specialist Nephrology, at London Health Sciences Centre, South Street Campus, London, Ontario. Sue Tereschyn, RN, CNeph(C), is a Hemodialysis Registered Nurse at London Health Sciences Centre, South Street Campus. Donna Zimmerman, RN, CNeph(C), is a Charge Nurse at London Health Sciences Centre, South Street Campus.