Renal: Ideal Body Weight Re-assessment for Haemodialysis patients_document No.
HNE Local Health District
Clinical Guideline &
Procedure
Renal: Dry weight Re-assessment for Haemodialysis Patients
Sites where Clinical Procedure applies
Target audience:
Description
All HNE facilities where a patient undergoes haemodialysis
Nephrology clinical staff, who provide care to haemodialysis
patients.
This document comprises part of the clinical information
package for care for haemodialysis patients.
This Clinical Procedure applies to:
1. Adults
Yes
2. Children up to 16 years
No
3. Neonates – less than 29 days
No
Keywords
Renal Haemodialysis, Ideal body weight
Replaces Existing Procedure
Yes
Registration Number(s) and/or name and HNEH GandP 10_41
of Superseded Documents
Related Legislation, Australian Standards, NSW Health Policy Directive, NSQHS Standard/EQuIP
Criterion and/or other, HNE Health Documents, Professional Guidelines, Codes of Practice or Ethics:
 NSW Health Policy Directive 2007_079 Correct patient, Correct procedure, correct site
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_079.pdf
 NSW Health Policy PD 2005_406 Consent to Medical Treatment
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf
 NSW Health Policy Directive PD 2007_036 Infection Control Policy
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf
Prerequisites (if required)
Registered Nurses who have been deemed competent in the
performance of haemodialysis
Procedure Note
This document reflects what is currently regarded as safe and
appropriate practice and requires mandatory compliance. If staff
believe that the procedure/s should not apply in a particular clinical
situation they must seek advice from their unit manager/delegate and
document the variance in the patients’ health record.
If this document needs to be utilised in a Non Nephrology Area please
liaise with the local Renal Service to ensure the appropriateness of the
information contained within the Clinical Procedure.
Renal Stream Leadership Group
Position responsible for the
procedure and authorised by
Procedure Contact Person
Contact Details
Date authorised
This Procedure contains
advice on therapeutics
Issue Date
Review due date
TRIM Number
Version 3
Tina Straker & Kelly Adams (Renal Coordinators)
Ph. 67769912 ph49 048800
No
October 2016
October 2013
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Renal: Ideal Body Weight Re-assessment for Haemodialysis patients_document No.
Consultation has occurred across the HNELHD Renal network utilising a group of
identified haemodialysis specialists as well as broader consultation with the general
nephrology workforce, nephrologists and the HNELHD Renal Leadership Group.
Note: Over time links in this document may cease working. Where this occurs please
source the document in the PPG Directory at: http://ppg.hne.health.nsw.gov.au/
RISK STATEMENT
This clinical procedure has been developed to provide guidance to staff and to ensure that
the risks of harm to patients and staff associated with performing Haemodialysis are
identified and managed.
Staff may potentially be exposed to body substance and needle injury when carrying out
this procedure. Therefore strict Infection Control and Occupational Health and Safety rules
should be followed when attending this procedure; including wearing recommended
Personal Protective equipment and following the procedure steps.
Any unplanned event resulting in, or with the potential for, injury, damage or other loss to
patients/HCN/visitors as a result of this procedure must be reported through the Incident
Information Management System and managed in accordance with the Ministry of Health
Policy Directive: Incident Management PD2007_061. This would include unintended injury
that results in disability, death or prolonged hospital stay.
RISK CATEGORY: Clinical Care & Patient Safety
OUTCOMES
1
Provide safe efficient dialysis
2
Minimise risk of adverse event(s) to the patient intradialytically
3
Minimise risk of adverse event(s) to the patient on discharge
4
Decrease adverse effects of chronic fluid overload through accurate and consistent
assessment of dry weight.
ABBREVIATIONS and GLOSSARY
Abbreviation/Word Definition
UF
Ultrafiltration
IBW
Ideal Body Weight
JVP
Jugular Venous Pressure
GUIDELINE
Dialysis therapy is a treatment option for patients with end stage kidney disease. The goal
of each haemodialysis treatment is to ensure optimal fluid and solute clearance with
minimal or nil adverse reactions from the treatment such as hypotension or cramps (San
Miguel, 2010). There are certain aspects of a patient’s condition that require ongoing
intervention by renal nursing staff. One of those aspects is ideal body weight (IBW)
assessment.
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Renal: Ideal Body Weight Re-assessment for Haemodialysis patients_document No.
The patients’ IBW refers to the absence of any clinical signs or symptoms of oedema or
dehydration and the patient is normotensive post the completion of the haemodialysis
treatment (Thomas, 2008). The IBW can change periodically with seasonal changes – that
is heavier clothing throughout the winter months and seasonal variations to body fat
(Daugirdas, Blake & Ing, 2007). The IBW may also change with current illness, changes to
nutritional intake, changes to medication and haematocrit (Palmer & Hendrich, 2009).
The renal nurse must be able to recognise changes in the patient’s condition that require
assessment of their fluid status. Poor assessment will lead to complications related to
excessive chronic overload or dehydration of the renal patient. A patient’s fluid status
should be assessed by the attending renal nurse each dialysis session.
It must be noted that IBW cannot be assessed in any patient by using only a single
parameter. To accurately assess a patient’s ideal body weight a combination of clinical
signs, biochemical assessment and technology assisted assessments such as blood
volume monitoring should be utilised (San Miguel, 2010).
Initiation of a change in the patient’s IBW should come from the nurse post a
comprehensive fluid assessment. IBW adjustment should not exceed 0.5kg for each
dialysis treatment, unless authorised by a Medical Officer or Nurse Practitioner.
Medical or Nurse Practitioner review is to be organised if a patient is unable to weigh or
has no established dry weight. This is to support the suggested amount of fluid removal by
nursing staff post a full fluid assessment.
PROCEDURE
This procedure requires mandatory compliance.
Patient Preparation
It is mandatory to ensure that the patient has received appropriate information to provide
informed consent and, that patient identification, correct procedure and correct site
process is completed prior to any procedure.
Staff Preparation
It is mandatory for staff to follow relevant: “Five moments of hand hygiene”, infection
control, moving safely/safe manual handling, and documentation practices.
Equipment Requirements





Alcohol based hand rub
Personal Protective Equipment
Stethoscope
Scales
Blood pressure monitor
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Renal: Ideal Body Weight Re-assessment for Haemodialysis patients_document No.
Procedure Steps
1. Patient’s weight is to be attended and recorded on the haemodialysis treatment
chart
2. Patient’s blood pressure should be measured both sitting and standing and
recorded on the haemodialysis treatment chart
3. Interview, review and record patients’ current physical condition and interdialytic
history (including symptoms of breathlessness, unable to sleep lying down, moist
cough, thirsty, dizziness, vomiting and diarrhoea)
4. Review current anti-hypertensive medication (including recent changes to
medication) and evaluate for possible interaction with UF strategy
5. Discuss with patient their current nutritional status and also check most recent
blood result
6. Physically examine the patient to assess fluid status. This will require an
examination of the patients’ body (predominantly the lower limbs), to check for the
presence of oedema, auscultation of the patients’ lungs and review of the JVP
7. Review recent intradialytic history (response to UF strategy), inclusive of postural
blood pressures pre and post treatment
8. Review previous weights pre and post treatments to check for discrepancies in
regard to the current IBW
9. If the Registered Nurse making the assessment of fluid status decides that the dry
weight should be altered discussion with the nurse in charge prior to implementation
should be attended.
Note: Modification of dry weight greater than 0.5kg should be discussed with a
Medical Officer, the patients Nephrologists’ or the Nurse Practitioner prior to
implementation.
APPENDICES
Nil
REFERENCES
Daugirdas. J., Blake. P.G. and Ing. T., (2007) Handbook of Dialysis, Lippincott Williams & Wilkins,
Philadelphia
Palmer, B.F & Hendrich, W.L, (2009) Chapter 19: Hemodynamic stability and autonomic
dysfunction in end stage renal disease in Principles and Practice of Dialysis (4TH Edt), Hendrich,
W.L. Lippincott Williams & Wilkins, Philadelphia
San Miguel, S. (2010) Haemodialysis Dry weight assessment: A literature review. Renal Society
Australasia Journal, 6(1), 19-24.
Thomas. N. (2008) Renal Nursing, Bailliere, Tindall & Elsevier, Philadelphia
FEEDBACK
Any feedback on this document should be sent to the Contact Officer listed on the front page.
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