March 22, 2023

Understanding the amount of Potassium in the Dialysate Bath is clear and simple when you understand the Rule of 7.

Hello everybody nurse lindsay here and today i want to do a quick video about dialysate baths what dialysate bath should they be on and if you are new to my channel haven’t subscribed yet please hit that subscribe button below so you can stay up to date on all the new videos i post about dialysis education and dialysis nursing community if you haven’t heard

About the rule of seven get ready to have your mind blown and i’ve got a visual for you rule of seven is patience potassium plus the dialysate bath should equal around seven and when i say dialysate bath i mean specifically how much potassium should be in the dialysate bath so to put it another way seven minus the patient’s potassium will equal what their dialysis

Bath should be this is a good rule in the clinic for our long-term patients in the hospital you might see that the physicians are a little more conservative and you might see more 3k baths than 2k because they’re a little more unstable and they might be a little more sensitive cardiac wise to the 2k bath if you do see someone on a one potassium bath usually it’s

For a one-time treatment or maybe you’re in the acutes and you’re doing an emergent treatment for a high potassium and even then it’s been my experience that if i start them on a 1k bath you will check their potassium an hour 90 minutes into treatment and then reassess what their bath should be a lot of the research out there says that a patient should not be on

A 1k bath long term and what i mean by that is if they’re on a 1k bath it should be on for a one dialysis treatment they should not have an order for one potassium bath for their chronic dialysis treatments for every dialysis treatment and this is definitely a cms guideline too a lot of the research says that the 1k baths will increase a patient’s risk of having

A cardiac event and that’s where you really have to be mindful of the potassium level where if the patient’s potassium level goes too high they’re at high risk of having cardiac event and the same is if it goes too low so those 1k baths will raise that person’s risk of having a cardiac event because that bath will drop the potassium too low so here is an example

Seven minus the patient’s potassium will equal their dialysate bath so if the patient’s potassium is five you would expect them to be on a around a two potassium bath if their serum potassium level is four seven minus four is three you’d expect them to be around a three potassium bath this is just a general rule some physicians might be a little more conservative

Especially with the elderly community and the elderly community with a cardiac history if they have a history of afib or any kind of cardiac arrhythmia usually those patients will keep them on a three potassium bath to help kind of prevent their potassium from dropping too low so i’m going to put this another way if our patient’s potassium is five what should their

Dialysate bath be to equal seven so five plus two equals seven if they had a potassium of five and they’re on a 3k bath that means same equals eight so that might be too high of a bath for them and you might want to talk to the physician about lowering their dialysate bath so when i do talk to the physician i might talk to them like this patient their potassium

Has been running around five 5.2 they’re on a three potassium bath do you think that we should go to a two potassium bath and they might say yep change them to a 2k bath or they might give me an answer like well you know this person has afib they’re 82 years old i want to keep them on a three potassium bath and that’s just a conversation that you have to have

With the physician there might be some facilities out there that have a sliding scale potassium policy that you can follow and you can change the potassium bath based on the sliding scale my clinic does not do that if your clinic does that put a comment below i’m interested to hear how that works in your clinic and that’s pretty much the rule of seven seven minus

The patient’s potassium should equal about what their potassium level should be in the dialysate bath that’s my quick take on the rule of seven thank you so much for watching i can’t wait to talk to you guys again i am having so much fun with this youtube channel and i hope you are too you

Transcribed from video
Dialysis Nursing: Rule of 7 and Potassium in Dialysate By Dialysis Nurse Lindsey Sippl