This document outlines guidelines for providing hemodialysis treatment, including: only using the access arm for dialysis and applying direct pressure for bleeding; using catheters only for dialysis unless otherwise ordered; postponing routine meds before/after dialysis unless ordered; avoiding IM meds/IVs for 3 hours after; weighing patients daily and prohibiting access arm procedures; and observing patients during and after treatment for adverse reactions.

1. Hemodialysis
Hemodialysis is provided according to physician orders by
contract staff that follow their agency policy
 The access arm is not used as a site for arterial blood gas
sampling nor is it utilized for BP’s, IV’s, or other venipunctures
or tourniquet
 In the event that accidental venipuncture of the fistula/graft
occurs, direct pressure is applied for ten minutes or until
bleeding stops
 Continue to observe for signs of bleeding
 Hemodialysis catheters are used for dialysis only unless the
protocol for difficult IV starts has been followed and the
attending physician gives the order to utilize the line

2. Hemodialysis (continued)
 If the Hemodialysis catheter is needed for IV infusion follow the
CVC policy and physician orders for Utilization of Hemodialysis
Catheters for Intermittent Intravenous Infusion
 Routine medications are postponed prior to dialysis and
resumed following dialysis unless specifically ordered by the
nephrologist
 Due to risk of hemorrhage, no IM medications are administered
or IV initiated for three hours following dialysis
 If venipuncture is performed within three hours of termination
of dialysis, direct pressure is applied for five minutes or until
bleeding stops
 Apply pressure dressing for one hour to prevent further
bleeding

3. Hemodialysis (continued)
 All medications listed with the physician’s dialysis
order, (for example, Epogen), are administered by the
contract nursing staff in accordance with their agency
policy
 Hemodialysis is provided in the designated dialysis
treatment room; however, hemodialysis may be
provided at the bedside if the patient’s condition
warrants
 Patients that are isolated or who have
Hepatitis B undergo hemodialysis in their
room with appropriate precautions
maintained

4. Hemodialysis (continued)
 Nurse to nurse report occurs prior to and following
hemodialysis
 In the event that a patient becomes unresponsive, or at
the discretion of the contract dialysis nurse, becomes in
need of emergent care, the dialysis nurse dials 5555 or
pushes the code button and reports a “Code Blue”
 In addition to the administrative supervisor and the ER
staff, the primary nurse reports to the treatment area
 In the event that the patient is a DNR, the dialysis nurse
first notifies the physician, and then the primary nurse to
determine the best course of action

5. Hemodialysis (continued)
 All dialysis patients are weighed daily and have a sign
posted at bedside prohibiting needle sticks and BP’s in the
access arm
 Pertinent aspects of the patient’s condition are assessed
before, during, and following hemodialysis
 These include, but are not limited to cardiovascular, vital
signs, respiratory, pharmacological, and coagulation
status
 Patients are observed for signs of adverse
reactions, including:
hypovolemia, hemorrhage, disequilibrium
syndrome, electrolyte imbalance, and air embolism