Hemodialysis and Peritoneal Dialysis

What is Dialysis?

A life preserving process of replicating the function of the kidneys in that they restore acid-base balance filter out waste products, restores homeostasis and rids the body of excess fluid and electrolytes

What is Hemodialysis?

A technique in which an artificial kidney machine removes waste products from the blood

What are potential diagnoses are indications for hemodialysis?

Renal Insufficiency
AKI
CKD
Med/drug toxicity
Persistent Hyperkalemia
Pulmonary Edema
Hypervolemia w/o response to diuretics
Severe HTN

How would a client present a need for hemodialysis?

Fluid volume changes
Electrolyte/pH imbalances
FVO
neuro changes
Bleeding
Uremia (Cog impairment, pruritus, n/v)

What are preop procedures for hemodialysis?

Informed consent
Assess patency of long term device (AV fistula or graft) via distal pulse/circulation
Avoid BP, inj or IV into arm with access site
Elevate extremity to reduce swelling
Assess VS, BUN, Electrolytes, Hct, Weight
Hold meds until after dialysis

What are intraprocedure actions for hemodialysis?

Mx for complications like dialysis circuit clotting, air bubbles, dialysate temp (100) regulation of ultrafiltration, hypotension, cramping, vomitting, bleeding at site and contamination
Mx vs, coag studies
If bleeding give anticoag, have protamine sulfate to reverse heparin

What are post op procedures for hemodialysis?

Mx VS lab values. Decreased BP and lab changes are common post HD. Compare pre and post op weights for I/O's
Assess for complications (bleeding, muscle cramps, hypotension, clotting, headache)
Assess for disequilibrium syndrome (N/V, headache) or hypovolemia (hypotension, dizziness, tachycardia)

What client education are we providing for HD?

Alert nurse of concerns, check site and apply light pressure if bleeding, take meds/supps, well balanced meals, high in folate, increase protein intake w/ limits. No heavy objects on arm w/ access site, avoid sleepin on side w/ vascular acess, hand exercise avoid invasive procedures 4 to 6 hrs post dialysis

How should we know about clotting/infection of access site as a result of HD?

Anticoags and mx for hemorrhage
Immunosuppressive increases risk of infection
Older age is RA for dialysis hypotension and site complications

What are appropriate nursing actions for clotting/infection of an access site as a result of HD?

Aseptic technique
Avoid compression
Avoid venipuncture or BP on side w/ access site
Give anticoags
Assess graft side for thrill/distal pulses
Mx for redness, swelling, drainage or fever

What should we know about Disequilibrium syndrome as a result of HD?

Results from too rapid drop of BUN and circulating FL
Can cause cerebral edema and increased ICP
Early sxs N/V, LOC changes, seizures and agitation
Older age is RA for it due to rapid fluid/electrolyte changes

What nursing actions should we take for a pt w/ disequilibrium syndrome as a result of HD?

Slower dialysis rate for first timers or oler adults
give anticonvulsants/barbs if need be

What should we know about Anemia as a result of HD?

Blood loss and folate removal can cause anemia in addition to CKD causing decreased RBC production (erythropoietin)

What nursing actions should we take for a patient with Anemia as a result of HD?

Give Erythropoietin to stimulate rbc production
Mx Hgb and RBC, hypotension and tachycardia
Give blood products as needed

What infectious diseases are at an increased risk of occuring due to hemodialysi?

HIV
Hep B and C

What is peritoneal dialysis?

Instillation of dialysate solution into the peritoneal cavity, as it serves as a filtration membrane. This filters waste products, excess fluids and electrolytes into the dialysate from the blood.

What are indications for PD?

Unable to tolerate anticoag
Difficult vascular access
Chronic infections/unstable
chronic diseases (DM, HF, HTN)

What are pre op actions for PD?

Assess dry weight, VS, electrolytes, creatinine, BUN and BG
Assess pt ability to self perform by their LOC, past experience and understanding of procedure

What are intraprocedure actions for PD?

Mx VS, BG(dialysate has glucose), color and amount of fluid coming back, for sxs of infection (cloud/frothy/bloody and fever) or complications ( RD, abd pain, insufficent or troubled outflow), check site for leakage
Maintain surgical asepsis of cath insetion site and when assessing, lower bag than abdomen, reposition if flow is insufficient

What client education should we provide for a pt that does PD?

Home care of access site
Support groups
Follow instructions and take meds
take vits/mins with supplements of phosphorus, calcium, sodium and potassium
Older adults can't care for access site due to deficits
Provide moral support due to body image changes

What should we know about Peritonitis?

Maintain surgical asepsis
Mx for infection
Use sterile technique
Notify provider of concerns of infection