The document outlines a lesson plan for teaching 1st year MSc nursing students about hemodialysis. The plan covers defining hemodialysis, its purpose and indications, access sites, how it works based on diffusion and osmosis principles, pre-procedure preparation, demonstrating the procedure, post-procedure care, and potential complications. Teaching methods include lectures, demonstrations, discussions, and assignments. The goal is for students to understand hemodialysis and be able to assist with the procedure.

1. SUBJECT: ADVANCE NURSING PROCEDURE
TOPIC: HEMODIALYSIS.
UNIT:
GROUP: 1st
YEAR M.Sc NURSING STUDENTS.
DATE AND TIME OF LECTURE :
VENUE: 1st
YEAR M.Sc NURSING CLASSROOM.
METHOD OF TEACHING: LECTURE CUM DEMONSTRATION.
TEACHING AIDS: Transparency-definition,purpose, indication Flip card-scientific principle.
Chart- site, how hemodialysis work.
Flash card-complication.
KNOWLEDGE ASSUMED: Students have previous knowledge about dialysis.

2. AIM:AT THE END OF CLASS THE STUDENTS WILL BE ABLE TO ASSISST FOR HEMODYALYSIS..
OBJECTIVE:THE STUDENTS WILL BE ABLE TO
 DEFINE DIALYSIS
 DEFINE HEMODIALYSIS..
 LIST PURPOSES OF HEMODIALYSIS.
 STATE INDICATION OF HEMODIALYSIS.
 LIST THE ACCESS SITE FOR HEMODIALYSIS.
 EXPLAIN THE SCIENTIFIC PRINCIPLE.
 ELABORATE ON HOW HEMODIALYSIS WORK
 DESCRIBE THE PREPREPARATION OF PROCEDURE.
 DEMONSTRATE THE PROCEDURE.
 ELABORATE ON POSTPREPARATION OF PROCEDURE.
 ENLIST COMPLICATIONS

3. CONTRIBUTORY
OBJECTIVE
TIME CONTENT Tg Lg ACTIVITY A V AIDS
INTRODUCTION
Students define
term dialysis
1min Dialysis is the movement of fluids and molecules across a semi
permeable membrane from one compartment to another.
Peritoneal dialysis and hemodialysis are the two type of dialysis.
Teacher ask, “what is the
definition of dialysis”. Student
responds and teacher appreciates.
Transparency
with
definition.
Students define
the term
hemodialysis.
1min Hemodialysis removes toxic wastes and other impurities from
blood of a patient. In hemodialysis blood is removed from
patient body through a surgically created access site pumped
through a filtration exit to remove toxins and then returned to
the body.
Teacher asks,” what is the
definition of hemodialysis”.
Student responds and teacher
appreciates.
Transparency
with
definition.
Students list
the purposes of
hemodialysis.
2min To extract toxic nitrogenous substance from the blood and to
remove excess water.
Teacher ask, what are the purpose
of hemodialysis? Student’s
responds and teacher appreciates.
Transparency
with purpose.
Students state
indication of
hemodialysis.
2min  ESRD
 Acutely ill patients who require short term dialysis.
Teacher ask s,” what are the
indication of hemodialysis?”.
Student responds.
Transparency
with
indication.
Student enlist
the
hemodialysis
acess site.
5min HEMODIALYSIS ACCESS SITE
Hemodialysis requires vascular site. The site and type of access
may vary, depending on the expected duration of dialysis, the
surgeon’s preference, and the patient’s condition.
Teacher elaborate on hemodialysis
site.
Chart with
site

4. Subclavian vein catheterization-using the seldinger technique,
the physician or surgeon inserts an introducer needle into the
subclavian vein. He then insert a guide wire through the
introducer needle and removes the needle. Using the guide wire,
he then threads a 5” to 12” (12-30cm)plastic or Teflon catheter
(with a Y hub) into the patient’s vein.
Femoral vein catheterization-using seldinger technique, the
physician or surgeon inserts an introducer needle into the left or
right femoral vein. He then insert a guide wire through the
introducer needle and removes the needle. Using the guide wire
he then threads a 5” to 12” plastic or Teflon catheter with a Y
hub or two catheters, one for inflow and other placed about
½”(1.3cm)distal to the first for outflow.
Arteriovenous or AV Fistula- An AV fistula requires advance
planning because a fistula takes a while after surgery to
develop—usually from two to six months. A properly formed
fistula is less likely than other kinds of vascular accesses to form
clots or become infected. Also, properly formed fistulas tend to
last years longer than any other kind of vascular access.A
surgeon creates an AV fistula by connecting an artery directly to
a vein, usually in the wrist or forearm. It is preferred that the
fistula be placed in the arm you use the least. Connecting the
artery to the vein causes more blood to flow into the vein. You
will be able to feel the vibration or pulse of the blood flowing
through your access. The vibration you feel is sometimes
referred to as the "buzz." This feeling is called a thrill. Your
healthcare professional will also listen for the blood flowing in
your access with a stethoscope. The "whoosh" sound that is
heard through the stethoscope is called a bruit (pronounced
brew-ee). You will become familiar with how to check your
access daily to make sure it is working properly. The high blood
flow from the artery through the vein helps the access grow
larger and stronger, making needle insertions for hemodialysis
treatments easier. The fistula takes some time to develop. You
will need to exercise the arm with the fistula to help it develop.
For the surgery, you'll be given a local anesthetic. In most cases,

5. the procedure can be performed on an outpatient basis. Although
it is the preferred access, small veins or other conditions could
make it difficult for some people to have a successful fistula.
Your surgeon may order a test (vessel mapping) to check the
size and quality of your veins and blood flow to determine the
best access for you. These and other problems with vascular
access can be corrected when determined in the early stages.
Your healthcare team will monitor your access regularly to help
you keep your access healthy and working properly.
Arteriovenous AV Graft- If you have small or weak veins that
won't develop properly into a fistula, you can have a vascular
access placed that connects an artery to a vein using a synthetic
tube, or graft, implanted under the skin in your arm. The graft is
usually a soft, man-made tube that connects to an artery on one
end and to a vein on the other end, allowing blood to flow
through it. The artificial graft material is used for needle
placement for blood access during hemodialysis. A graft does
not need as long to develop as a fistula does, so it can be used
sooner after placement, often within two to four weeks. The
thrill (vibration felt due to the high blood flow) can also be felt
in a graft, and the bruit ("whooshing" noise) can be heard with a
stethoscope if the graft is functioning properly. You will become
familiar with how to check your access daily to make sure it is
working properly. Compared with properly formed fistulas,
grafts tend to have more problems with clotting and infection
and need replacement sooner. However, a well-cared-for graft
can last several years.

6. Students
identify the
types of
dialyzer
3min TYPES OF DIALYZERS
THE HALLOW FIBRE DIALYZER-the most common type,
contains fine capillaries, with a semipermeable membrane
enclosed in a plastic cylinder. Blood flows through these
capillaries as the system pumps dialysate in the opposite
direction on the outside of the capillaries.
THE FLAT PLATE OR PARALLEL PLATE DIALYZER- has
two or more layers of semipermeable membrane,bound by a
semirigid structure. Blood ports are located at both ends,
between the membranes. Blood flow between the membranes,
and dialysate flow in the opposite direction along the outside of
the membrane.
THE COIL DIALYZER(no longer widely used) consist of one
or more semipermeable membrane tubes supported by mesh and
wrapped concentrically around a central core. Blood passes
through a coils as dialysate circulate at high speed around the
coils and meshwork.
Teacher explain about types of
dialyzer.
Transparency
with types.
Students states
the principles
on which
hemodialysis
work.
3min PRINCIPLES
Diffusion, osmosis, and ultra filtration are the principles on
which hemodialysis is based.
The toxins and wastes in the blood are removed by diffusion-
that is they move from an area of higher concentration in the
blood to an area of lower concentration in the dialysate. The
dialysate is a solution made up of all the important electrolytes
in their ideal extra cellular concentration.
Excess water is removed from the blood by osmosis, in which
water moves from an area of higher solute concentration (the
blood) to an area of lower solute concentration (the dialysate
bath).
In ultra filtration, water moves under high pressure to an area
of low pressure. This pressure is much more efficient than
osmosis at water removal and is accomplished by applying
Teacher explains about principles
on which hemodialysis work.then
ask the student to answer,
student responds and teacher
appretiates ask the student to sit
down.
Flip chart
with
principles.

7. negative pressure or a suctioning force to the dialysis
membrane.
Student
describe how
hemodialysis
work
4min HOW HEMODIALYSIS WORK.
 In hemodialysis, blood flow from the patient to an
external dialyzer(or the artificial kidney) through an
arterial access site. Inside the dialyzer, blood and
dialysate flow countercurrently, divided by a
semipermeable membrane. The composition of the
dialysate resembles normal extracellular fluid.
 The composition of the dialysate resembles normal
extracellular fluid.
 The blood contains an excess of specific solute and the
dialyate contains electrolyte that may be at abnormal
levels in the patient’s blood stream. The dialysate’s
electrolyte composition can be modified to raise or
lower electrolyte levels, depending on need.
 Excretory function and electrolyte homeostasis are
achieved by diffusion.
 Water crosses the membrane from the blood into the
dialysate by ultrafiltration. This process removes excess
water, waste product and other metabolites through
osmotic pressure and hydrostatic pressure.
 Cleaned of impurities and excess water, the blood
returns to the body through a venous site.
Teacher explain how dialysis
work. Ans then ask student.
Student respond and teacher
appretiates.
chart
Students
explain pre
procedure
preparation
2min PRE PROCEDURE PREPARATION
 Explain the procedure.
 Weigh the patient.
 Check vital signs, take blood pressure while siting and
standing.
 Provide comfortable position- supine or sitting in
recliner chair with feet elevated.
 Maintain sterility.
 Check whether the machine is working.
 Wash hands.
Teacher describes the pre
procedure preparation.
demonstration

8. Students list the
articles.
ARTICLES RATIONALE.
Dialysis machine For dialysis
Dialysate To filter blood
Two winged fistula needle For cannulation
Betadine To clean site
Spirit To clean site
10 ml syringe To flush
heparin To prevent clotting
Needle To aspirate
Gauze To clean
Tourniquet To apply pressure
Clean gloves To prevent infection
Adhesive tape To tape puncture site
Teacher explain articles and the
rationale.
models
Students
demonstrate the
procedure.
20min PROCEDURE
 Put mackintosh and towel under the av fistula site.
 Wash hands and dry it.
 Put clean gloves.
 Then flush the fistula needle using attached syringe
containing heparin flush solution,and set them aside.
 Clean the area with betadine and spirit 3 longotuidinal
stroke.
 Apply a tourniquet above the fistula to distend the vein
and facilitate venipuncture. Make sure you avoid
occluding the fistula.
 Perform venipuncture with a fistula needle.remove the
needle guard and squeeze the wing tips firmly together.
Insert the arterial needle at least 1”(2.5cm)above the
anastomosis, being careful not to puncture the fistula.
 Remove tourniquet and Flush the needle with heparin
flush solution to prevent clotting.clamp the arterial
needle tubing with a hemostat and secure the wing tip of
the needle to the skin with adhesive tape.
Teacher demonstrates the
procedure.
demonstration

9.  Perform another venipuncture with the venous needle a
few inches above the arterial needle. Flush the needle
with heparin. Clamp the venous needle tubing and
secure the wing tip of the venous needle.
 Remove the syringe from the end of arterial tubing,
uncap the arterial line from the hemodialysis machine
and connect the two line.tap the connection securely.
Repeat this with venous line.
 Release the hemostat and start hemodialysis.
 Blood flow rate 200-500ml/min and dialysate flow rate
300-900 ml/min.
 It takes 4 hours.
 After 4 hours wash hands. Turn the blood pump on the
hemodialysis machine to 50-100ml/min.
 Put the gloves and remove the tape from the connection
site of the arterial lines. Clamp the needle tubing with
the hemostat and disconnect the line. The blood in the
machine’s arterial line will continue to flow towards the
dialyzer, followed by a column of air. Just before the
blood reaches the point where the saline solution enters
the line, clamp the blood line with another hemostat.
 Unclamp the saline solution.
 After blood is retransfused, clamp the venous needle
tubing and the machine’s venous line with hemostats.
Turn off the blood pump.
 Remove the tape from the connection site of the venous
lines and disconnect the lines.
 Remove venipuncture needle, and apply pressure to the
site. Apply adhesive tape. Repeat the procedure on the
arterial line.
Students
elaborate on
post
preparation.
1min POST PROCEDURE
 Remove the mackintosh.
 Assess the patient’s weight and vitals sign.
 Assess for bleeding.
 DOCUMENTATION-time, day, hours of dialysis, any
Teacher explains on post
procedure preparation.
demonstration

10. complication.
Students list
complication
1min COMPLICATION
 Infection.
 Catheter clotting.
 Excessive removal of fluid during ultrafiltration can
cause hypovolemia and hypotension.
 Cardiac arrhythmias can occur during hemodialysis as a
result of electrolyte and ph changes in the blood.
 Thrombosis.
Teacher ask,” what are the
complication?”.students respond
and teacher appretiates.
Flash card
with
complication.
SUMMARY
Today we have learnt about the definition, purpose, indication,
access site ,how hemodialysis work,scientific principle,
preprocedure preparation, procedure, post procedure preparation
of hemodialysis.
RECAPITALATION
 List indication of hemodialysis
 What are the scientific principle.
CONCLUSION
I hope you have understood todays topic.
ASSIGNMENT
Read about Duocart biofiltration.

11. BIBLIOGRAPHY
 Langley, C. Nursing Procedure. Philadelphia: Lippincott
Williams & Wilkins
 Smeltzer, S. C. (2009). Brunner & Suddarth’s Textbook
Of Medical Surgical Nursing, New Delhi: Wolter
Kluwer (India) Pvt. Ltd.
 Crisp, J., & Taylor, C. (2008). Potter And Perry’s
Fundamentals Of Nursing. Australia: Elsevier
Publishers.

12. LESSON PLAN
ON
HEMODIALYSIS.
SUBMITTED TO: Ms.DEEPA.
SUBMITTED BY: Ms.NESSY