Hemodialysis involves removing waste and excess fluid from the blood of patients with kidney failure. It is done 3 times a week, with each session lasting 2-4 hours. Blood passes through a dialyzer containing semipermeable membranes where waste diffuses out of the blood into the dialysate solution. Ultrafiltration also removes fluid. Vascular access via fistula or graft is required. Nursing responsibilities include monitoring for hypotension and ensuring proper access care and dietary education. Peritoneal dialysis uses the peritoneal membrane and involves exchanging dialysate fluid in the abdomen via catheter.

1. Dialysis
Mr Sushil Sudarshan Humane
MSN Rn

2. Introduction
• Dialysis is the procedure used to correct fluid and
electrolyte imbalances and to remove waste
products in renal failure.
• waste removal and fluid removal.
• Do Not Do not correct the endocrine functions of
the kidney. Hence , dialysis is not a cure for kidney
failure.

6. Hemodialysis
• How long does hemodialysis take?
• Hemodialysis usually is done three times a week.
• Each treatment lasts from 2 to 4 hours.
• During treatment, patient can read, write, sleep, talk, or watch TV.

7. Hemodialysis
• Dialyzer are hollow-fiber artificial kidneys that contain thousands
of tiny tubules that act as semipermeable membranes.
• The blood flows through the tubules, while a solution (the
dialysate) circulates around the tubules.
• The exchange of wastes from the blood to the dialysate occurs
through the semipermeable membrane of the tubules
• The blood flows in one direction and the dialysate flows in
the opposite.

9. hemodialysis
• Diffusion- movement of solutes from
an area of greater concentration to an
area of lower concentration.
• In renal failure urea, creatinine, uric
acid, and electrolytes( Potassium,
phosphate), move from the blood to
the dialysate with the net effect of
lowering their concentration in the
blood.
• But WBC’s, RBC’s and other contents
within the blood are too large to
diffuse across the membrane.

10. Hemodialysis
• The movement of fluid from an area of lesser to an area of greater
concentration of solutes.
• Glucose is added to the dialyzing solution and creates an osmotic
gradient across the membrane to remove excess fluid from the blood.

11. Hemodialysis
• Ultra filtration is defined as water
moving under high pressure to an
area of lower pressure. This process is
much more efficient at water removal
than osmosis.
• Ultra filtration is accomplished by
applying negative pressure or a
suctioning force to the dialysis
membrane.

12. Hemodialysis
• Access to the patient’s
vascular system must be
established to allow blood to
be removed, cleansed, and
returned to the patient’s
vascular system .
• Several types of access are
available.
• Fistula
• Graft

13. Hemodialysis
• FISTULA A more permanent access.
• Created surgically (usually in the
forearm) by joining an artery to a
vein, either side to side or end to
side.
• The arterial segment of the fistula is
used for arterial flow and the venous
segment for reinfusion of the dialyzed
blood.

14. Hemodialysis
• The fistula takes 4 to 6 weeks to mature
before it is ready for use. This gives time
for healing and for the venous segment
of the fistula to dilate .
• The patient is encouraged to perform
exercises to increase the size of these
vessels (i.e, squeezing a rubber ball for
forearm fistulas).

15. Hemodialysis
• An arteriovenous graft can be created by
subcutaneously inserting a biologic, semi
biologic, or synthetic graft material
between an artery and vein . Indications:
• When the patient’s vessels are not
suitable for a fistula.
• Grafts are usually placed in the forearm,
upper arm, or upper thigh.

16. Peritoneal dialysis
• Peritoneal membrane , serves as the
semi permeable membrane for
dialysis.
• It involves repeated cycle of instilling
dialyzing solution into the peritoneal
cavity through a catheter into it.

17. Peritoneal dialysis
• CAPD - which stands for Continuous
Ambulatory Peritoneal Dialysis - happens
throughout the day, at home or at work,
while the person goes about his or her daily
life.
• Between 1.5 and 3 litres of fluid is run each
time for four times a day, exchanging for the
fluid from the previous exchange.
• Patient doesn’t need a machine for CAPD; all
he/she needs is gravity to fill and empty the
abdomen.

18. Peritoneal Dialysis
• PD - Automated Peritoneal
Dialysis - in which the
dialysate solution is changed
by a machine, at night, while
you are asleep.
• The machine will exchange
8-12 litres over 8-10 hours

19. Complications
HEMODIALYSIS
• Hypotension
• Muscles cramps
• Clot formation
• Septicemia
• Hepatitis
• Disequilibrium syndrome
PERITONEAL DIALYSIS
• Exit site infection,
• peritonotis,
• abdominal pain
• Hernia
• Lowback pain
• Protein loss
• Atelactasis and pneumonia

20. Nursing responsibility
• Informed Consent
• Explanation
• Ask the patient to void.
• Check Wt., vitals ( BP ) at the beginning and at least every 30 minutes.
• Check for cannula and fistula for patency and palpate for the thrill and auscultation of bruits.
• Withhold antihypertensive on the day of HD.
• Assurance

21. Nursing responsibility
• Regular observation of complications.
• Check and record vitals X15 minutes.
• Serve foods as patient’s interest ( not for hypotensive prone patients)
• Each treatment lasts from 2 to 4 hours. During treatment, Pt. is allowed to read,
write, sleep, talk, or watch TV.
• Back care and divertional therapy
• Inform to Dr. if complications.

22. Nursing responsibility
• Check and record vital signs, Wt. after HD and total UF.
• Record the condition of the patient.
• Medications as ordered( if)
• Explain about the care necessary after HD.
• Inform the family and patient of date for next dialysis.
• Send the patient home or ward.

23. Nursing responsibility
• Make sure that nurses or Dr check the access before and after each treatment.
• Use the access site only for dialysis.
• Keep access clean at all the time.
• Do not let anyone put a BP cuff on access arm.
• Do not wear jewellory or tight clothes over access site.
• Do not sleep with your access arm under head or body.
• Do not lift heavy objects or put pressure on access arm.

24. Nursing responsibility
• Care of vascular access.
• Detection of complications.
• Diet : Tell the patient
• to eat animal proteins such as meat and chicken.
• to Avoid too much potassium diet.
• to limit fluid intake
• to avoid excess salt.
• to limit foods contain the mineral phosphorus such as milk, cheese, nuts, etc.

25. Thank you