use artificial kidney to remove waste products and excess water from the patient’s blood Three primary methods are used to gain access to the blood Nursing Management of Hemodialysis

1. Medical Surgical Nursing
HEMODIALYSIS
‫الصحت‬ ‫معهد‬‫العالي‬
‫المادة‬ ‫مدرس‬
‫م‬.‫إختصاص‬ ‫جامعي‬
‫الوهاب‬ ‫عبد‬ ‫نزار‬ ‫صـالح‬
‫تمـريض‬ ‫علــوم‬ ‫ماجـستير‬
MSN. Salah Nazar Abdulwahhab
www.slideshare.net
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2. Definition of Hemodialysis
Hemodialysis: use artificial kidney to remove waste products and excess water from the patient’s
blood.
During the dialysis procedure
- Dialyzing solution flow in opposite directions through the dialyzer across an enclosed
semipermeable membrane
- The dialysate contains electrolytes and water
- The patient’s blood contain metabolic waste products, excess water and electrolytes
- The waste products in blood move into the dialysate by diffusion through the membrane
because of the difference in their concentrations
- Cleansed blood is returned back into the patient’s body through another tube
- A hemodialysis takes 3 to 4 hours and done three or four times a week
- Hemodialysis is done at a hemodialysis center
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4. Types of HD Vascular Access
Three primary methods are used to gain access to the blood
1- Central Venous Catheter
2- Arteriovenous (AV) fistula
3- Arteriovenous (AV) graft
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5. 1- Central Venous Catheter (CV Line)
1- Central Venous Catheter
plastic catheter with two or three ports is placed in the subclavian vein, the jugular vein, or the
femoral vein for temporary access to allow large flows of blood withdrawn from the first lumen
- Used for clients who need rapid access for immediate dialysis like
A- Clients who are likely to recover from ARF
B- Client with end-stage renal failure
C- Clients waiting for other sites to mature
The blood goes into the dialysis circuit, and is returned to the body via the second lumen
There are Two types of (CV Line)
A- Non-tunneled
B- Tunneled
- popular for clients because it doesn’t involve needles for each treatment
- cannot be used long term due to the risk of infection
Complications of CV Line
1- Venous Stenosis
2- Infections
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6. Central Venous Catheter
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7. 2- Arteriovenous (AV) fistula
Arteriovenous (AV) fistula: surgical intervention done by surgeon include links an artery to a vein under the
skin of the arm.
- (AV) fistula the best choice
- Fistula is less prone to infections and blood clots
- Blood flows is very high through at fistula site, can be felt by placing a finger over a mature fistula (thrill)
- Not placed in a cephalic or basilic vein, because may need grafts or fistulas in the future
- Take approximately 4-6 weeks to mature
- During treatment, 2 needles are inserted, one to draw blood out of the body and the other to return blood to
the body
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8. Advantages of Arteriovenous Fistula
more effective dialysis treatment
1- Decreased infection rate
2- Decreased incidence of thrombosis
3- Increased blood flow rates
Complications of an AV Fistula
1- Vascular access steal syndrome (high flow rate lead to poor rest of the limb)
2- Cool extremities of the limb
3- Cramping pains
4- Possible tissue damage
5- Aneurysm: (bulging in the wall of the vein) result from weakened in the vessel wall by
repeated insertion of needles over time
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9. 3- Arteriovenous (AV) graft
Arteriovenous (AV) graft: like a fistula, except an artificial vessel is used to join the artery and the vein
- Grafts are used when client’s own vasculature does not permit a fistula
- AV graft will mature much faster than an AV fistula
- AV graft could be ready to use within days after formation
Complications of Arteriovenous Graft
1- High risk for narrowing
2- Clotting or thrombosis may occur
3- Greater risk of infection
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10. Complication of Hemodialysis
1. Air embolism
2. Thrombosis
3. Dizziness
4. Diaphoresis
5. Tachycardia
6. Hypotension
7. Dysrhythmias
8. Bleeding
9. Shortness of breath
10. Nausea and vomiting
11. Painful muscle cramping
12. Decreased level of consciousness
13. Fatigue
14. Seizures
15. Headache
16. Chest pain
17. Restlessness
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11. Nursing Management of Hemodialysis
1 . Before dialysis
2 . During dialysis
3 . After dialysis
1 . Before Dialysis
A. Check the weight
Present weight – dry weight = Target weight
B. Check the Vital signs
1. BP – standing, sitting
2. Cardiac rate and rhythm
3. Respiratory rate
4. Temperature
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2- During Dialysis
1- Promote patient comfort
2- Monitor alarms of the machine
3- Monitor vital signs (in B.P. avoid take on access arm)
4- Monitor Laboratory studies
5- Monitor for complications
(Infection, Bleeding, Hypertension/ hypotension, fatigue, chest pains, leg cramps, nausea and headaches)
6- Monitor any chills or fever
7- Monitor the site of access
8- Observe site for any blood leaks
9- Medications as prescribed (Heparin, Imferon, erythropoietin)
3- After Dialysis
1- On removal of fistula needle apply pressure dressing using sterile gauze and wait until the puncture site clotted.
2- Tape with pressure dressing and instruct pt. to remove it (4 to 5 Hours) later to prevent possible bleeding.
3- Ask your patient to rest at least 15 minutes to prevent postural hypotension after dialysis.
4- Reinforce diet and fluid requirements of patient on dialysis.
5- Remind their about next schedule dialysis.
6- Weigh patient before leave the center.
7- Monitor vital signs
8- Recording and Reporting