Fluid Management

Leadership Learning Experience

A1. Problem or Issue

Research shows that dialysis patients who have problems with fluid management have an increase in hospitalizations, disease processes, and poor clinical outcomes. Research has also proven that fluid is a strong predictor of mortality and morbidity.

A1a. Explanation of Problems or Issues

We have noticed in our clinic a trend of increasing fluid overloaded patients over the last few months. This trend has also resulted in multiple hospitalizations for congestive heart failure, pulmonary edema, and respiratory distress resulting from fluid overload. This problem was selected after a patient expired in our clinic with cardiac arrest after a long code attempting to revive. This topic of discussion made a big impact in our dialysis clinic because it is an open area that can be seen by all the patients. Seeing a desperate attempt to save a life, it is not soon forgotten in the minds of a room full of people who all share the same disease. The fear of what they have just seen could almost be read on their faces, most thinking that could have been me. After every code, there is a review of what could have been done differently, as far as the code was concerned the process was correct. However, looking back you wonder if there were something more you could have done to prevent the code altogether. Not only was the patient someone whom I was given the responsibility of caring for, he was also my friend. I did not want one more patient sharing that same fate without knowing I had done everything I could have done to prevent it. The patient we lost in the code was notorious for high fluid gains and a few admits for congestive heart failure and a visit to the ICU for respiratory distress resulting in the patient being placed on a vent. These were issues many of our patients shared