A Creatinine Level Has Been Ordered: What Does the Nurse Prepare To Do?
When a creatinine level has been ordered, the nurse prepares to draw a blood sample, ensuring proper patient identification, preparation, and vein selection to obtain an accurate and reliable result for assessing kidney function.
Understanding Creatinine and its Importance
Creatinine is a waste product produced by muscle metabolism. The kidneys filter creatinine from the blood, and it is excreted in urine. Measuring creatinine levels in the blood is a key indicator of kidney function. Elevated creatinine levels often signal impaired kidney function, prompting further investigation and treatment. Therefore, when a creatinine level has been ordered, it’s typically due to concerns about renal health or as part of a routine checkup, particularly for patients at risk for kidney disease.
Reasons for Ordering a Creatinine Level
Several situations may warrant ordering a creatinine level:
- Monitoring Kidney Function: Assessing the progression of kidney disease.
- Diagnosing Kidney Problems: Investigating symptoms like swelling, fatigue, or changes in urination.
- Assessing Medication Safety: Certain medications can impact kidney function, requiring monitoring.
- Pre-operative Assessment: Ensuring kidney function is adequate before surgery.
- Evaluating Dehydration: Severe dehydration can impact kidney function and creatinine levels.
- Monitoring Chronic Conditions: Diabetes, hypertension, and heart failure can affect kidney health.
Nurse Preparation: The Step-by-Step Process
When a creatinine level has been ordered, the nurse’s role is crucial in ensuring accurate and safe sample collection. This involves several steps:
- Verify the Order: Confirm the physician’s order in the patient’s chart, noting any specific instructions (e.g., fasting status, medication considerations).
- Patient Identification: Use two patient identifiers (e.g., name and date of birth) to positively identify the patient. This is critical to prevent errors.
- Explain the Procedure: Clearly explain the procedure to the patient, including the reason for the blood draw and what to expect. Address any questions or concerns.
- Assess the Patient: Check for any allergies to antiseptics or adhesives. Ask about any bleeding disorders or anticoagulant use. Assess for preferred venipuncture sites and avoid sites with edema, hematoma, or injury.
- Gather Supplies: Collect all necessary supplies:
- Appropriate size blood collection tubes (usually serum separator tubes – SST or red-top tubes)
- Tourniquet
- Alcohol swabs or chlorhexidine prep pads
- Gloves
- Needle and syringe or vacutainer system
- Gauze pads
- Adhesive bandage
- Sharps container
- Laboratory requisition form
- Perform Venipuncture: Select a suitable vein (typically in the antecubital fossa), apply the tourniquet, cleanse the site with antiseptic, and perform venipuncture.
- Collect the Sample: Fill the blood collection tube(s) to the appropriate level.
- Remove Tourniquet and Needle: Release the tourniquet before removing the needle. Apply pressure to the puncture site with a gauze pad to stop bleeding.
- Label the Sample: Immediately label the blood collection tube with the patient’s name, date of birth, date and time of collection, and your initials. Accuracy is paramount.
- Send to the Lab: Transport the sample to the laboratory promptly, following established protocols for handling and transport.
- Document: Document the procedure in the patient’s chart, including the date and time of collection, venipuncture site, any complications encountered, and the disposition of the sample.
Common Pitfalls and How to Avoid Them
- Incorrect Patient Identification: Always use two patient identifiers.
- Hemolysis: Avoid vigorous shaking of the blood collection tube, which can damage red blood cells and lead to inaccurate results. Handle the sample gently.
- Contamination: Ensure the venipuncture site is properly cleansed with antiseptic to prevent contamination of the sample.
- Insufficient Sample Volume: Fill the blood collection tube to the indicated level to ensure sufficient sample for analysis.
- Delayed Transport: Transport the sample to the laboratory promptly to prevent degradation and inaccurate results.
Impact of Medications on Creatinine Levels
Several medications can affect creatinine levels, including:
- ACE inhibitors and ARBs: Can increase creatinine levels, especially in patients with pre-existing kidney disease.
- NSAIDs: Can decrease blood flow to the kidneys, potentially increasing creatinine.
- Certain antibiotics (e.g., aminoglycosides): Can be nephrotoxic and elevate creatinine.
- Cimetidine: Can inhibit the secretion of creatinine.
The nurse should document all medications the patient is taking, so the physician can consider potential drug interactions when interpreting the results.
Table: Factors Affecting Creatinine Levels
| Factor | Effect on Creatinine | Mechanism |
|---|---|---|
| Kidney Disease | Increased | Reduced filtration of creatinine |
| Dehydration | Increased | Decreased blood flow to the kidneys |
| Muscle Mass | Increased | Higher creatinine production |
| Certain Medications | Increased or Decreased | Affecting renal function or creatinine metabolism |
| Diet | Increased | High protein intake can temporarily increase creatinine |
| Age | Decreased | Muscle mass tends to decrease with age, potentially lowering levels |
FAQs: Understanding Creatinine Levels
What does it mean if my creatinine level is high?
A high creatinine level usually indicates that the kidneys are not functioning properly and are not effectively filtering creatinine from the blood. This can be caused by a variety of factors, including kidney disease, dehydration, certain medications, and muscle breakdown. Further investigation is needed to determine the underlying cause.
What is a normal creatinine level?
Normal creatinine levels vary slightly depending on age, sex, and muscle mass. Generally, normal ranges are:
Men: 0.6 to 1.2 milligrams per deciliter (mg/dL)
Women: 0.5 to 1.1 mg/dL
These values can vary slightly depending on the laboratory performing the test.
What if my creatinine level is low?
Low creatinine levels are less common than high levels. They can be seen in individuals with low muscle mass, malnutrition, or severe liver disease. Pregnancy can also lower creatinine levels due to increased kidney filtration.
Can dehydration affect creatinine levels?
Yes, dehydration can significantly affect creatinine levels. When you’re dehydrated, your blood volume decreases, leading to reduced blood flow to the kidneys. This can cause creatinine levels to rise.
What is a creatinine clearance test?
A creatinine clearance test measures how well your kidneys are filtering creatinine from your blood. It involves collecting urine over a 24-hour period and drawing a blood sample. This test provides a more accurate assessment of kidney function than a single creatinine blood test.
How often should I have my creatinine level checked?
The frequency of creatinine level testing depends on your individual risk factors and medical history. If you have kidney disease, diabetes, high blood pressure, or other risk factors, your doctor may recommend regular testing.
Can diet affect creatinine levels?
Yes, diet can temporarily affect creatinine levels. A high protein diet can increase creatinine production, potentially leading to slightly elevated levels. However, this is usually not a cause for concern unless you have underlying kidney disease.
Are there any natural ways to lower creatinine levels?
While natural remedies may help support kidney health, they should not replace medical treatment. Staying hydrated, eating a healthy diet low in protein, and avoiding nephrotoxic substances can potentially help lower creatinine levels. Consult with your doctor before trying any natural remedies.
What is GFR and how does it relate to creatinine?
GFR stands for glomerular filtration rate, which measures how well your kidneys are filtering blood. GFR is often estimated using a formula that includes your creatinine level, age, sex, and race. GFR is a more comprehensive measure of kidney function than creatinine alone.
What happens if I have chronic kidney disease?
Chronic kidney disease (CKD) is a progressive condition in which the kidneys gradually lose their ability to function properly. If you have CKD, you’ll need regular monitoring of your creatinine levels and other kidney function tests. Treatment may include medication, diet changes, and lifestyle modifications.
What are the symptoms of high creatinine?
Elevated creatinine itself doesn’t always cause noticeable symptoms. Symptoms are usually related to the underlying kidney dysfunction, which can include fatigue, swelling (especially in the ankles and feet), changes in urination, nausea, and loss of appetite. It’s important to be evaluated by a physician.
Can exercise affect creatinine levels?
Intense exercise can temporarily increase creatinine levels due to muscle breakdown. However, this increase is usually transient and returns to normal after rest. If you have concerns about your creatinine levels, discuss your exercise routine with your doctor. When a creatinine level has been ordered follow-up may be required.