HEMODIALYSIS

INTRODUCTION:

The kidney is responsible for filtering waste product from blood. Dialysis is a procedure that is
substitute of many of the normal function of the kidney.

 It can allow the individual to live useful and productive life even though their kidney is
no longer work adequately.

 It maintains fluid and electrolyte balance of the body and remove waste products.

DEFINITION: -

“Dialysis is a procedure in which the waste product from the body filtered out through a
dialyzer when the kidney is not able to filter out the waste product”.

Uses:
1. Short term therapy in acutely ill clients
2. Long term use in clients with end-stage renal disease

Equipment: -
1. Access patient’s circulation (usually via fistula)
2. Access a dialysis machine and dialyzer with a semipermeable membrane
3. The appropriate solution (dialysate bath)
4. Time: 12 hours each week, divided in 3 equal segments
5. Place: home (if feasible) or a dialysis center

Three ways to access to client’s circulation for dialysis:

Access Route for Abbreviation Description

Hemodialysis
Arteriovenous AVF A section of vein is directly
Fistula sutured to an artery. It is
usually placed in the non-
dominant arm, using the
cephalic vein and radial
artery
Arteriovenous Connection tube is client’s
Graft own (autologous) saphenous
vein, or made from
polytetrafluoroethylene
 (PTFE)
Central Venous CVC Catheter inserted by directly
Catheter cannulating the vein. Usual
CVC sites are: femoral,
internal jugular, or subclavian
veins

Procedure for hemodialysis: -

1. Patient’s circulation is accessed
2. Unless contraindicated, heparin is administered
3. Heparinized (heparin: natural clot preventer) blood flows through a semipermeable
membrane in one direction
4. Dialysis solution surrounds the membranes and flows in the opposite direction
5. Dialysis solution is
a. Highly purified water
b. Sodium, potassium, calcium, magnesium, chloride and dextrose
c. Either bicarbonate or acetate, to maintain a proper pH
6. Via the process of diffusion, wastes are removed in the form of solutes (metabolic wastes,
acid-base components and electrolytes)
7. Solute wastes can then be discarded or added to the blood
8. Ultrafiltration removes excess water from the blood
9. After cleansing, the blood returns to the client via the access

Complications related to vascular access in Hemodialysis

1. Infection
2. Catheter clotting
3. Central venous thrombosis
4. Stenosis or thrombosis
5. Ischemia of the affected limb
6. Development of an aneurysm

Nursing interventions for Hemodialysis:

1. Explain procedure to client
2. Monitor hemodynamic status continuously
3. Monitor acid-base balance
4. Monitor electrolytes
5. Insure sterility of system
6. Maintain a closed system
7. Discuss diet and restrictions on:
a. Protein intake
b. Sodium intake
c. Potassium intake
d. Fluid intake
8. Reinforce adjustment to prescribed medications that may be affected by the process of
hemodialysis
9. Monitor for complications of dialysis related to:
a. Arteriosclerotic cardiovascular disease
b. Congestive heart failure
c. Stroke
d. Infection
e. Gastric ulcers
f. Hypertension
g. Calcium deficiencies (bone problems such as aseptic necrosis of the hip joint)
h.  Anemia and fatigue
i. Depression, sexual dysfunction, suicide risk

SIGNATURE OF THE TEACHER SIGNATURE OF THE STUDENT

SUBMITTED TO SUBMITTED BY

MRS.P.LAXMI BAI PRATIMA TOPNO

LECTURER (MSN) M.SC.(N)1ST YEAR

CON,BERHAMPUR CON,BERHAMPUR

SUBMITTED ON