Department: Nursing Name of Document

COE specific SOP- Management of Nausea and Vomiting during

Hemodialysis

Prepared by: - Corporate Nursing Team Date of issue: 03/07/2021

Date of review: 02/07/2023
Reviewed by: - Capt. Usha Banerjee To be reviewed earlier in case of any
Approved by: Write name of the unit Nursing Head change in guidelines

Management of Nausea and Vomiting During Hemodialysis

Introduction

Despite the great progress has been made in the hemodialysis equipment,
but it is still associated with complications. Nausea and vomiting are
common complication of during hemodialysis, which lead to unpleasant
feeling in patients.

Definition
Nausea : Nausea is an uneasiness of the stomach that often occurs before
vomiting.
Vomiting: Vomiting is the forcible voluntary or involuntary emptying
("throwing up") of stomach contents through the mouth.

Scope
Dialysis Unit and All Critical care units.

Background
Longer treatment times and/or ultrafiltration in association with a large
degree of solute removal significantly enhance the incidence of nausea, and
 Department: Nursing Name of Document
COE specific SOP- Management of Nausea and Vomiting during
Hemodialysis

Prepared by: - Corporate Nursing Team Date of issue: 03/07/2021

Date of review: 02/07/2023
Reviewed by: - Capt. Usha Banerjee To be reviewed earlier in case of any
Approved by: Write name of the unit Nursing Head change in guidelines

vomiting during dialysis. It is important to emphasize that overcoming

these adverse effects may help in better patient experience at the dialysis
facility/unit.

Responsibility
Treating consultant, dialysis technician and nursing staff posted for the
care of patient on dialysis.

Causes
Nausea and vomiting during dialysis can occur for a number of reasons:

1. Motion sickness from the journey to dialysis.

2. Food consumed just before or during dialysis. Dialysis may divert
blood flow away from the gut.
3. Rapid fluid removal
4. Hypotension
5. Non-dialysis related reasons e.g. intercurrent illness.

Symptoms associated with Nausea and Vomiting

• Abdominal pain
• Diarrhea
• Fever
• Light-headedness
• Vertigo
• Rapid pulse
• Excessive sweating
• Dry mouth
• Decreased urination
• Chest pain
 Department: Nursing Name of Document
COE specific SOP- Management of Nausea and Vomiting during
Hemodialysis

Prepared by: - Corporate Nursing Team Date of issue: 03/07/2021

Date of review: 02/07/2023
Reviewed by: - Capt. Usha Banerjee To be reviewed earlier in case of any
Approved by: Write name of the unit Nursing Head change in guidelines

• Fainting
• Confusion

• Excessive sleepiness

Prevention and Management

• Address any intercurrent illness, seeking medical advice if required
• Advise patient not to eat prior to and during dialysis
• If nausea is related to travel, consider prescribing antiemetics for the
patient to take prior to commencing their journey.
• Commence dialysis slowly, increasing blood flow during first 30
minutes of treatment
• If related to hypotension or excessive fluid removal refer to ‘SOP to
guide weight and blood pressure management on hemodialysis’.

Nursing Alert:
Seek immediate medical care if any of the following situations occur with
vomiting:

• There is blood in the vomit (bright red or "coffee grounds" in

appearance)
• Severe headache or stiff neck
• Lethargy, confusion, or a decreased alertness
• Severe abdominal pain
• Diarrhoea
• Rapid breathing or pulse

Conclusion:
 Department: Nursing Name of Document
COE specific SOP- Management of Nausea and Vomiting during
Hemodialysis

Prepared by: - Corporate Nursing Team Date of issue: 03/07/2021

Date of review: 02/07/2023
Reviewed by: - Capt. Usha Banerjee To be reviewed earlier in case of any
Approved by: Write name of the unit Nursing Head change in guidelines

There is a relatively high incidence of nausea and vomiting in patients

undergoing hemodialysis, hence nurses must consider these problems by
suitable measures to prevent the occurrence of these unpleasant feelings in
the patients during hemodialysis. Early interventions and management can
help in ease of the hemodialysis procedure.

S.No Hospitals Validated by

1. Apollo Hospitals, Bengaluru a. Dr Deepashree
Consultant Nephrology

2. Apollo Hospitals, Chennai a. Dr Subba Rao –

Main Senior Consultant Nephrology

b. Dr Vivek
Consultant Nephrology
3. Apollo Hospitals, Kolkata a. Dr Manjit Kumar
Junior Consultant Nephrology

4. Apollo Hospitals, Navi a. Dr Amit Langote

Mumbai Consultant Nephrologist

b. Dr Ravindra Nikhalji
Consultant Nephrologist

5. Indraprastha Apollo a. Dr Anil

Hospitals, Nephrology Registrar
Delhi
b. Dr Kuldeep
Nephrology Registrar
Department: Nursing Name of Document
COE specific SOP- Management of Nausea and Vomiting during
Hemodialysis

Prepared by: - Corporate Nursing Team Date of issue: 03/07/2021

Date of review: 02/07/2023
Reviewed by: - Capt. Usha Banerjee To be reviewed earlier in case of any
Approved by: Write name of the unit Nursing Head change in guidelines

c. Mr Ahmar Khan
HOD Dialysis Unit