Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps?
A. Increase the rate of dialysis.
B. Infuse normal saline solution.
C. Administer a 5% dextrose solution.
D. Encourage active ROM exercises.
Correct Answer: B. Infuse normal saline solution
Treatment includes administering normal saline or hypertonic normal saline solution because muscle cramps can occur when the sodium and water are removed too quickly during dialysis. Saline and/or dextrose solutions, electrolytes, and NaHCO3 may be infused in the venous side of continuous arteriovenous (CAV) hemofilter when high ultrafiltration rates are used for removal of extracellular fluid and toxic solutes. Volume expanders may be required during or following hemodialysis if sudden or marked hypotension occurs.
Option A: Reducing the rate of dialysis, not increasing it, may alleviate muscle cramps. The central role of volume removal as the trigger for susceptible patients seems evident from the fact that intradialytic cramps are usually associated with hypotension and that prompt correction of hypotension by saline administration and discontinuation of ultrafiltration often improve the cramping.
Option C: Most patients surveyed (76%) reported that fluid removal by dialysis was decreased, was stopped, and/or fluid was given back as the main intervention used to alleviate their cramps. When asked about all interventions to alleviate dialysis cramps, the most frequent response (29%) was a combination of decreasing fluid removal, raising the lower extremities, and massaging the extremities.
Option D: Avoid trauma to shunt. Handle tubing gently, maintain cannula alignment. Limit activity of extremity. Avoid taking BP or drawing blood samples in shunt extremity. Instruct the patient not to sleep on the side with shunt or carry packages, books, purse on affected extremity.
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