How to Know When Your Blood Pressure is About to Drop

This blog post was made by Gale Schulke, RN, CDN on October 27, 2016.
How to Know When Your Blood Pressure is About to Drop

I attended the Home Dialyzers United conference recently, and while I was there, I learned that a lot of people are not aware of the early signs of pending BP drop and what to do if they occur. I would like to address some of the issues around blood pressure on home hemodialysis (HD).

Here is some basic physiology about fluid shifts:

  1. Our bodies contain a lot of water. Most of it, however, is in the interstitial (between the cells) and cellular (inside the cells) spaces. Only about 8-10% of our body water is actually in our blood vessels.
  2. The blood vessels are enclosed in a semi permeable membrane. This membrane is where the transfer of water and waste products from the cells and interstitial region into the blood vessels takes place.
  3. There is a delay in the time it takes to remove water from the blood and the time it takes for the water to shift into the blood vessels.

When you are removing even small amounts of water during hemodialysis, there may be a point where your body needs to “catch up”. The first signs of this can be:

  • Yawning
  • Visual disturbances
  • Feeling tired
  • Being just a little short of breath

The reason for these symptoms is quite simple: if your blood does not contain enough water to flow easily, it is no longer transporting oxygen from your lungs to the tissues in a timely manner, including your brain.

So, when you are dialyzing away and find yourself yawning, or feeling vaguely tired, you might pause your UF for a few minutes. This may prevent you from having to give yourself saline boluses (which is counterproductive to needing to take fluid off). It definitely may prevent you from having your blood pressure drop and having an emergent problem develop. As you know, most of you finish UF before your dialysis is finished, so pausing your UF for a few minutes (10 min) should not make a difference in how long you are dialyzing.

If you ALWAYS have hypotension during dialysis, you might, also, just pause your UF about halfway through your treatment to allow your body to return to homeostasis. (Of course, always let your nephrologist know of anything you are doing during dialysis.)

Please reach out to me if you have any issues you would like to see addressed in this blog forum. I will do my best to answer anything I can within the Nursing Scope of Practice.

Comments

  • Lilian Weru

    Jul 24, 2023 10:28 PM

    This happens to my mum every time the dialysis is going on. She starts yawning and then she starts sweating and gets hot temperature. The room is very hot also. But she urinates normally when she drinks. Is it that the dialysis is draining her too much and what should I do?
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    • Beth Witten

      Sep 24, 2023 1:22 AM

      It sounds like your mother may be having a drop in her blood pressure during dialysis. Is she gaining a lot between treatments and are you trying to take it all off in one sessions? If so, you could be removing too much fluid too fast for her body to adjust. Having too high ultrafiltration rate (UFR) can cause organ stunning. Is she eating better now than she was when the doctor set her target weight. Share her symptoms with the home training nurse and her nephrologist. If she's been eating better, she may have gained real weight. The doctor might see if increasing her target weight and might reduce those symptoms and s/he might want to have you adjust the treatment to not take off too much fluid too fast.
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  • tyler molzahn

    Nov 11, 2016 7:44 PM

    My wife has been fighting low BP for over a month Dr has her on meds fpr this but is not working ?? We wre told today that she should take in more salt ?? She has been in hosp. For it rely it wearing her down ??
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    • tyler

      Nov 11, 2016 7:49 PM

      And how do you stop uf with out clotting
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      • Gale

        Nov 11, 2016 8:03 PM

        When you stop the UF, the blood pump continues to work and you continue to dialyze, you just don't pull off fluid
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