Discrepancies in performing target weight assessments in haemodialysis patients

Roberts and White (1) state that the main reason for hospitalisation of dialysis patients is due to 'fluid Volume excess'. Fluid/target weight assessments should routinely be carried out for chronic haemodialysis patients prior to each treatment by experienced renal nurses, but Welsh (2) states that the assessment of the patient and clinical skills may be underused because of poor staffing levels. Using a qualitative design study based on a group of experienced renal nurses, the author sought to determine which clinical signs and symptoms were assessed, how often they were carried out and what similarities were demonstrated. Elements such as the patient's blood pressure, evidence of peripheral oedema and dyspnoea were used as benchmarks for good practice, based on literature and the author's extensive experience. The author also believed that the standard fluid assessment could be improved by expanding the nurse's role to incorporate chest auscultation. Results demonstrated that a variety of reasons determined whether such assessments were carried out, and that there was wide variation as to what nurses considered essential in performing the assessment.