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. 2025 May 28.
doi: 10.1111/jan.17082. Online ahead of print.

Fluid Volume Assessment in Acute Haemodialysis by Dialysis Nurses Using Clinical Signs, Symptoms and Bio-Electrical Impedance-A Pilot Implementation Study

Ng Li Choo  1 , Cynthia Lim Ciwei  2 , Tan Sio Bee  1 , Tan Han Khim  2 , Barbara Swope Turner  3
Affiliations

Fluid Volume Assessment in Acute Haemodialysis by Dialysis Nurses Using Clinical Signs, Symptoms and Bio-Electrical Impedance-A Pilot Implementation Study

Ng Li Choo et al. J Adv Nurs. .

Abstract

Aim: To evaluate the acceptability and safety of a fluid volume assessment tool integrating clinical signs, patient-reported symptoms and bioimpedance analysis as a clinical decision aid in haemodialysis.

Design: Single-centre, 6-month clinical implementation feasibility pilot study.

Methods: A convenience sample of 50 healthcare staff and 50 hospitalised haemodialysis patients was recruited. The intervention involved a fluid volume assessment tool combining clinical signs, patient-reported symptoms and bioimpedance analysis. We utilised the Template for Intervention Description and Replication (TIDieR) checklist to describe the intervention. Nurses used a decision algorithm to guide them in setting the ultrafiltration target. Staff acceptability was assessed using the NoMAD survey, and safety outcomes, including intradialytic hypotension, intradialytic events and fluid overload, were monitored. Trends between Charlson Comorbidity Index scores and safety risks were explored.

Results: The tool achieved high acceptability among staff, with cognitive participation (100%) and collective action (92%) being the strongest domains. Safety analysis indicated minimal adverse events (intradialytic hypotension: 10%, intradialytic events: 12%). Participants with higher Charlson Comorbidity Index scores (> 6) were more likely to experience intradialytic hypotension or intradialytic events, highlighting the need for tailored approaches for these populations.

Conclusion: The tool was acceptable, safe and feasible, empowering dialysis nurses to deliver real-time, individualised fluid management, reducing dependency on nephrologists and addressing operational challenges in the acute setting.

Implications for the profession and/or patient care: The tool promotes nursing autonomy, enhances care efficiency and ensures safe, patient-centred fluid management in resource-limited settings.

Impact: Addresses fluid management challenges in haemodialysis care through introduction of an evidence-based fluid assessment tool. Support a scalable nurse-led protocol for ultrafiltration management, promoting patient safety and workflow efficiency in acute dialysis settings.

Patient or public contribution: No patient or public contribution was required for this work.

Keywords: bioimpedance analysis; clinical decision aid; dialysis safety; fluid management; haemodialysis; individualised care; intradialytic events; nurse‐led care; nursing autonomy; patient outcomes.

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References

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    1. Daugirdas, J. T., T. A. Depner, J. Inrig, et al. 2015. “KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update.” American Journal of Kidney Diseases 66, no. 5: 884–930.
    1. Finch, T. L., M. Girling, C. R. May, et al. 2018. “Improving the Normalization of Complex Interventions: Part 2‐Validation of the NoMAD Instrument for Assessing Implementation Work Based on Normalization Process Theory (NPT).” BMC Medical Research Methodology 18, no. 1: 1–13.
    1. Hoffmann, T. C., P. P. Glasziou, I. Boutron, et al. 2014. “Better Reporting of Interventions: Template for Intervention Description and Replication (TIDieR) Checklist and Guide.” BMJ 348: g1687.
    1. Hung, S. C., K. L. Kuo, C. H. Peng, C. H. Wu, Y. C. Wang, and D. C. Tarng. 2015. “Association of Fluid Retention With Anemia and Clinical Outcomes Among Patients With Chronic Kidney Disease.” Journal of the American Heart Association 4, no. 1: e001480.

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