For the last 5 years, I have worked in the Emergency Department at a very busy hospital in Miami, FL as well as a procedural department. The experience that I have chosen to reference for this post was during my time in Interventional Radiology. In this department, we provide services using all of the different modalities of imaging in order to complete biopsies, drainages, chest tubes, various line placements, and even catheter-directed infusions and embolization. The more common procedures center around hemodialysis catheters.
Hemodialysis patients are renal impaired and therefore metabolism and excretion are impacted. Renal disease affects tubular secretion and absorption, glomerular blood flow and filtration, and renal bioactivation and metabolism. (Gloe, 2016) During the procedure, patients are given conscious sedation using medications like Versed and Fentanyl. Renal drug excretion varies from patient to patient. Conditions such as chronic renal disease may cause profound alteration. (Rosenthal, & Burchum, 2021) For Renal patients, the doses administered should be adjusted significantly in order to avoid placing the patient in a hypotensive or prolonged hypoxic episode.
Typically, when a renal patient has any procedure ordered in our department. A baseline set of vital signs are obtained while the patient is being prepared in our pre-op area. This allows the nurse to assess the patient’s hemodynamic status before the procedure. During those procedures, two nurses should be present in order to constantly monitor and assess the patient during the procedure. Conscious sedation is administered initially at half the normal/usual dose in order to assess the patient’s reaction before the procedure. Once the medications are administered and the patient’s reactions are monitored and assessed, the procedure can begin. Once the procedure is completed, the patient is brought to our recovery area to continue to monitor the patient.
These processes were developed in order to constantly monitor and assure our patient’s safety. These processes were implemented after a traveling nurse administered an initial dose that was too much for the patient and a rapid response was called to recover the patient. Because this patient was a renal patient, the patient needed to be reversed and sent to dialysis for continued reversal.
References
Gloe, D. (2016). Medication Therapy Adjustments in Patients with Chronic Renal Failure. MEDSURG Nursing, 25(5), 325–328.
Rosenthal, L. D., Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
