kidney replacement therapies: Hemodialysis

what are the two types of dialysis

hemodialysis and peritoneal dialysis

hemodialysis

what it is

indications

mechanism

• cleaning the blood, filtering it out bc the kidneys wont

• CKD, where the GFR is below 15, potassium imbalance, uremia, acidosis

• works by osmosis or diffusion. the dialysate has a osmolarity that pulls toxins into it. dialysate goes in one way, blood flows in the other way. toxins leave the blood into the dialysate

complications of hemodialysis

clotting - it is an invasive procedure

hypotension

dialysis disequilibrium syndrome (seizures or coma)

dialysate sensitivity

what types of vascular access is given for hemodialysis

why one over the other

AV fistula

AV graft

Fistula is preferred but a graft can be given if the fistula is to hard, people don’t have good veins

fistula vs graft and when one would be used over the other

fistula is preferred - it is a surgical fusion of arteries and veins

graft is the second one - it is a synthetic connection using a tube. no fusion of bodily vessels. use if patient is not eligible for fistula surgery

what assesment finding means a graft/fistula is patent

how often to check?

bruit/thrill

every 4 hours

complications of a vascular access

thrombus formation

aneurysm

steal syndrome- ischemia in areas below fistula due to decreased blood flow

contraindications for HD

hemodynamic instability

vascular disease

bleeding disorders

diabetes

complications of hemodialysis

cramps

blood loss

hepatitis

disequilibrium syndrome

headache

itching

infection

nursing considerations for hemodialysis

aseptic technique

give heparin before

no invasive procedures for 6 hours after

how many HD sessions

3 four hour sessions

what does HD also filter out

water, Na, K and protein

hemodialysis diet

protein: 1.5 g/kg/day

na: 2-4 g/day

K: 70 day

phosphorus: 700 mg/day

peritoneal dialysis

indications

mechanism

procedure

• dialysis through the stomach peritonium

• if patient wants to do at home.

• osmosis filters out toxins from blood into dialysate

• dialysis tube placed through the stomach. four steps

  • inflow

  • dwell

  • drain

types of peritoneal dialysis

continuous ambulatory dialysis

multiple bag continuous ambulatory dialysis

automated peritoneal dialysis

intermittent peritoneal dialysis

continuous cycle peritoneal dialysis

complications of peritoneal dialysis

peritonitis

pain

exit site infections

tunnel infections

bleeding or bowel or bladder perforation

hyperglycemia

protein loss

hernias

weight gain

respiratory distress

peritonitis symptoms

board like abdomen and rigidity

increased heart rate and BP

dehydration pain and no bowel sounds

nursing education and nursing considerations for those on peritoneal dialysis

lay patient in low fowlers

watch for infection

monitor vital signs every 15-30 min

monitor for peritonitis

nursing education and nursing consideration for those on hemodialysis

cloudy outflow - peritonitis

brown/red outflow - bowel perforation

yellow outflow - bladder perforation

PD exchanges per day, dwell time, and drain time

depends on the type of peritoneal dialysis

• continuous ambulatory means: 24 hrs a day

• continuous cycling is 24hr a day but dialysis only during sleep

• automated - is patient specific

dwell time is 30 min to one hour

drain time is 15 min

peritoneal dialysis contraindications

peritoneal adhesions, fibrosis, inflammatory GI disease, obesity, ascites, recent GI surgery

peritoneal dialysis diet

protein - 1.5 g/kg/day

potassium - per patient

sodium - per patient

phosphorus: 800 mg/day