INTERVENCIONES DE ENFERMERÍA EN EL USO DE UN PERFIL DE ULTRAFILTRACIÓN ASCENDENTE Y ALBÚMINA: INFORME DE 10 CASOS.

INTERVENCIONES DE ENFERMERÍA EN EL USO DE UN PERFIL DE ULTRAFILTRACIÓN ASCENDENTE Y ALBÚMINA: INFORME DE 10 CASOS.

"Vascular refilling" in hemodialysis refers to maintaining an adequate blood volume before, during, and after the procedure. This is crucial for effective hemodialysis. When the plasma volume decreases, the blood becomes thicker, which can affect circulation and the efficiency of hemodialysis.

The filtration coefficient is an important factor in the movement of fluids between capillaries and the interstitial space. According to the Starling hypothesis, this coefficient is added to the hydrostatic and colloidosmotic pressure gradients to determine changes in fluid flow through capillary walls. It is essential to note that this coefficient is not constant and can vary significantly from one fabric to another. These properties are not the same throughout the microvascular system, and the filtration coefficient varies considerably from one tissue to another. The body has compensatory mechanisms, such as increasing heart rate and vascular resistance, to maintain blood pressure. Various factors, such as: a) body size, b) fluid overload, c) plasma volume, d) regional distribution of blood flow, e) plasma protein concentration, and f) transcapillary pressure gradients, influence vascular refilling. Albumin is the primary protein in human plasma, produced by hepatic synthesis, contributing 70% of intravascular oncotic pressure, and is considered the primary nutritional resource for body tissues.

Nursing Interventions

The procedures performed by nursing in hemodialysis are responsible for carrying out these procedures and making appropriate decisions for each individual patient.

Ten patients (8 men and 2 women) were studied, with a total of 10 sessions conducted from August 1, 2022, to September 30, 2023. Each study consisted of 1 hemodialysis session. The patients' average age was 45 ± 9 years, and the dry weight could not be determined. Blood flow was 221 ± 50 ml/min, dialysate fluid flow was 300 ml/min, and the session duration was 360 ± 60 minutes.

A 1.6 m2 polysulfone filter was used in all cases. The dialysis scheme was similar in all sessions, with a conductivity of 14 mS/m, and a logarithmic ascending profile was applied to ultrafiltration.

The Fresenius 4008S machine was used, and albumin was administered at a rate of 1 bottle before and 1 bottle during hemodialysis at 10 ml/hr.

In our experience, modeling a logarithmic ascending profile of conductivity and ultrafiltration improves tolerance during the session. Systolic, diastolic, and mean blood pressure readings remained higher at the end of the session, which is due to better vascular filling by increasing osmolarity at the moment of maximum ultrafiltration rate. Adequate vascular filling prevents hypotension and other issues associated with a sudden reduction in blood volume. This is evidenced by a lower decrease in plasma volume at the end of hemodialysis. For all these reasons, we believe that this type of hemodialysis results in a lower incidence of hypotension, achieving effective toxin removal with the ascending profile. This can be explained by two factors: firstly, there is a greater osmotic removal of uremic toxins from the intracellular space to the extracellular space, and secondly, there is a lower frequency of hypotension, ensuring better tissue perfusion without causing third-spacing.