Hemodialysis

Hemodialysis

Passage of patient's blood through artificial semi-permeable membrane to filter and excrete waste products (imitates kidneys)
- Can be in a hospital and outpatient
- We do this to help get rid of *WASTE - removal of
excess sodium and potassium

Vascular

_____ access is REQUIRED
- because it is blood - hemo
- AV fistula, AV graft, port (dialysis catheter)

Goal of Hemodialysis

Restore acid-base balance

Symptoms, GFR

Hemodialysis is based on ______, not on _____
--> Hyperkalemia, fluid overload, neuro, bleeding,
uremia - toxic products in urine
- Expect changes in BP - not uncommon for these patients to have HYPOTENSION

Who Needs Dialysis?

- Acid-base problems - OVERLOADS of fluids
- Electrolyte problems - Uremic Symptoms
- Intoxications

AV Fistula

- Surgical connection of artery and vein
- Commonly *radial artery and *cephalic vein
- Allow time
---> 4-6 weeks to MATURE
- Dual cannulation allows arterial blood to be
---> REMOVED, FILTERED, and RETURNED through
the vein
- Can fell a thrill (turbulent blood flow) as artery and
vein are pushing together
- Can hear a bruit* (swooshing)

AVF Management

- Assess CIRCULATION DISTAL to graft*
--> make sure we are getting perfusion DISTALLY
- CMS
- Assess for "bruit" (swooshing-sound) and feel a
"thrill" (vibration)
- Q4H
- NO BP, Venipuncture (IV FLUIDS OR BLOOD STICKS)
to fistula or graft and in affected limb
- RISK FOR DAMAGING the graft
- This fistula is only used for dialysis
- Encourage ROM - and to keep graft mature*
- Instruct the patient to avoid CARRYING HEAVY*
objects or LYING* on fistula

Dialysis Considerations

- May occur inpatient is HIGH risk
- Typically occurs in OUTPATIENT setting 3x a week
- for 3-5 HOURS each time
- Dialysis via diffusion, osmosis, and ultrafiltration
through semipermeable membrane
- Administration of anticoagulant + (heparinized
solution) ---> AS DIRECTED
- Monitor for bleeding

Dialysis Interventions

- Avoid Antibiotics and Antihypertensives
- Monitor Vital Signs
- Monitor bleeding

Avoidance of Antibiotics and Antihypertensives

- DO THIS PRIOR TO DIALYSIS
- Antihypertensives
--> we expect their BP to be LOW during dialysis
--> DO NOT give them anti-hypertensives (risk for
even LOWER BP)
- Antibiotics
--> They will get FILTERED OUT
--> Give them ABX after dialysis is OVER

Monitor Vital Signs

- Monitor BP
--> May go down a bit* expect HYPOTENSION
- Headache, changes in LOC, N/V
--> Things to watch out for
--> Put patients in Trendelenberg - LOWER THE
HOB*

LIFE, DIE, TRANSPLANT

Patients will have dialysis for ______, until they ______ or receive a _______

Dialysis Disequilibrium Syndrome

- Rapid DECREASE in fluid volume* and BUN levels*
- Changes in UREA*, can cause *CEREBRAL EDEMA*
- S/S Headache, N/V, restlessness, dec. LOC, Seizures
- Start with SLOW exchange and GRADUALLY
INCREASE to reduce risks

Dialysis Catheter

- Can go through the *Subclavian or the *Femoral
- Only used for Dialysis

Graft

We may use a _____ for someone who does NOT
have healthy arteries or veins*
---> still have to let it mature, this is a piece of
tubing

S/S of Dialysis Disequilibrium Syndrome

- Headache
- N/V
- Restlessness
- Dec. LOC
- Seizures
- R/F Cerebral Edema