The document discusses hemodialysis, including its definition as a process that cleanses the blood of a person with kidney failure through diffusion and ultrafiltration. It describes the principle that waste is removed from the blood through a semi-permeable membrane, as well as the functions, access methods, dialysate bath, nursing interventions, equipment, procedure, complications, and teaching points for clients and families.

1. HEMODIALYSIS
11/14/2022
1
k.g.m.u
college
of
nursing

2.  INTRODUCTION
 DEFINTION
 PRINCIPLE
 FUNCTION
 ACCESS
 DIALYSATE BATH
 NURSING INTERVENTION
 ARTICLES
 PROCEDURE
 COMPLICATION
 CLIENT AND FAMILY TEACHING
11/14/2022
2
k.g.m.u
college
of
nursing

3. INTRODUCTION
Hemodialysis is an intermittent renal replacement
therapy involving the process of cleansing the clients
blood.
Haemodialysis is a process of purifying the blood of a
person whose kidneys are not working normally. This
type of dialysis achieves the extracorporeal removal of
waste products such as cretinin and urea and free water,
from the blood when the kidney are in a state of kidney
failure.
11/14/2022
3
k.g.m.u
college
of
nursing

4. DEFINITION
 Dialysis is an intermittent renal replacement therapy
involving process of cleansing the client’s blood.
 Dialysis is also used to control uremia and to
physical prepare the client to receive a transplanted
kidney ,it is necessary to keep the clients alive until
a suitable donor kidney is found ,dialysis may help
prevent uremia until the kidney begins functions
sufficiently .
11/14/2022
4
k.g.m.u
college
of
nursing

5. PRINCIPLE
 The semi permeable membrane is made up of a thin, porus,
cellophane
 The pore size of membrane allow to pass through such as
urea, creatinine, uric acid and water molecules
 The client blood flow through the dialyzer the movement of
substances occurs from the blood to the dialysate by the
principles of osmosis ,diffusion and ultrafiltration
 Ultrafiltration and diffusion are used to accomplish the goal
of dialysis .
 Ultra filtration refers to removal of fluid from the blood using
either osmotic or hydrostatic pressure to produce the
necessary gradient .
 Diffusion is the passage of particles (ions) from an area of
high concentration to an area of low concentration
11/14/2022
5
k.g.m.u
college
of
nursing

6. FUNCTIONS
 Cleanses the blood of accumulated waste
products
 Remove the byproducts of protein metabolism
such urea, creatinine and uric acid from the
blood
 Removes excess body fluids
 Maintains or restores the buffer system of the
body.
 Corrects electrolyte levels in body
11/14/2022
6
k.g.m.u
college
of
nursing

7. ACCESS FOR HEMODIALYSIS
Arterio venous graft
Arterio venous shunt
Percutaneous catheter
11/14/2022
7
k.g.m.u
college
of
nursing

8. DIALYSATE BATH
 A dialysate bath is composed of water and major
electrolyte
 The dialysate need not to be sterile because
bacteria and virus are too large to pass through
the pores of semi permeable membrane ;
however the dialysate must meet specific
standards and water is treated to ensure a safe
water supply.
11/14/2022
8
k.g.m.u
college
of
nursing

9. NURSING INTERVENTIONS
 Monitor vital signs before and after dialysis the
client’s temperature may elevate because of slight
warming of blood from the dialysis machine .
 Notify the PHCP about the excessive temperature
elevations because this could indicate sepsis ,
requiring blood cultures to be collected .
 Monitor laboratory values specifically BUN,
creatinine, and complete blood cells counts before
, during and after dialysis.
 Weight the client before and after the dialysis to
determine fluid loss ,note that the client will not
urinate or will urinate small amounts( maybe less
than 30ml).
11/14/2022
9
k.g.m.u
college
of
nursing

10. NURSING CARE OF CLIENT UNDERGOING
DIALYSIS
 Assessment/Analysis
 Urinary elimination: hourly output; characteristics (e.g.,
color, consistency, odor, amount)
 Vital signs
 Electrolyte status
 Neurologic status: attention span, weakness.
 Breath for ammonia odor
 Skin for color and uremic frost
 Complications: bleeding because of impaired platelet
function; infections associated with dialysis (e.g.,
pneumonia, infected vascular access site)
 Emotional status of client and significant others
11/14/2022
10
k.g.m.u
college
of
nursing

11.  Planning/Implementation
 Monitor vital signs, I&O
 Provide skin care
 Evaluate understanding of restricted diet.
11/14/2022
11
k.g.m.u
college
of
nursing

12.  Provide general care associated with dialysis
 Explain procedure and answer questions; assure that staff
member is available at all times
 Weigh before and after procedure
 Take vital signs before and after and every 15 minutes during
procedure; assess for hypotension and hemorrhage
 Use surgical asepsis to prepare site (e.g., abdomen or area of
fistula); if abdominal catheter is not in place for peritoneal
dialysis, have client void before catheter is inserted
 Check tubes for patency
 Provide back care to promote comfort; diversional activities to
help pass time during prolonged procedure
 Refer for nutrition counseling; stress importance of lifelong
dietary modifications. Monitor for electrolyte imbalances
particularly those associated with potassium and sodium.
11/14/2022
12
k.g.m.u
college
of
nursing

13.  Provide specific care associated with hemodialysis
 Monitor for patency of internal fistula between
treatments by palpating for thrill and auscultating for
bruit
 Monitor site for clotting; check clotting time; administer
heparin as prescribed
 Protect access device from trauma, manipulation, and
contamination (e.g., avoid taking blood pressure or blood
from arm with arteriovenous fistula, use sterile
technique).
11/14/2022
13
k.g.m.u
college
of
nursing

14.  Evaluation/Outcomes
 Maintains fluid and electrolyte balance
 Remains free from infection
 Adheres to dietary and fluid restrictions
 Verbalizes feelings
11/14/2022
14
k.g.m.u
college
of
nursing

15. ARTILCES
The hemodialysis machine pumps the patient's
blood and the dialysate through the dialyzer. The
newest dialysis machines on the market are
highly computerized and continuously monitor
an array of safety-critical parameters, including
blood and dialysate flow rates; dialysis solution
conductivity, temperature, and pH; and analysis
of the dialysate for evidence of blood leakage or
presence of air.
11/14/2022
15
k.g.m.u
college
of
nursing

16.  Water system
 An extensive water purification system is critical for
hemodialysis. Since dialysis patients are exposed to vast
quantities of water, which is mixed with dialysate
concentrate to form the dialysate, even trace mineral
contaminants or bacterial endotoxins can filter into the
patient's blood. Because the damaged kidneys cannot
perform their intended function of removing impurities, ions
introduced into the bloodstream via water can build up to
hazardous levels, causing numerous symptoms or death.
11/14/2022
16
k.g.m.u
college
of
nursing

17.  Dialyzer
 The dialyzer is the piece of equipment that actually
filters the blood. Almost all dialyzers in use today are of
the hollow-fiber variety. A cylindrical bundle of hollow
fibers, whose walls are composed of semi-permeable
membrane, is anchored at each end into potting
compound (a sort of glue). This assembly is then put into
a clear plastic cylindrical shell with four openings. One
opening or blood port at each end of the cylinder
communicates with each end of the bundle of hollow
fibers. This forms the "blood compartment" of the
dialyzer.
11/14/2022
17
k.g.m.u
college
of
nursing

18.  Dialyzer size and efficiency
 Dialyzers come in many different sizes. A larger
dialyzer with a larger membrane area (A) will
usually remove more solutes than a smaller
dialyzer, especially at high blood flow rates. This
also depends on the membrane permeability
coefficient K0 for the solute in question.
11/14/2022
18
k.g.m.u
college
of
nursing

19. 11/14/2022
19
k.g.m.u
college
of
nursing

20. PROCEDURE
 The needle used for Hemodialysis are large bore,
usually 14 to 16 gauge, and are inserted into the
fistula or graft to obtain vascular acess. One
needle is placed to pull blood from the
circulation to the HD machine, and other needle
is used to return the dialyzed blood to the
patient. the needle are attached via tubing to
dialysis lines.
If a patient has a catheter, the two blood lines are
attached to the two catheter lumens.
11/14/2022
20
k.g.m.u
college
of
nursing

21.  If a patient has a catheter, the two blood lines are
attached to the two catheter lumens. The needle
closer to the fistula {red catheter lumen}is used to
pull blood from the patient and send it to the
dialyzer with the assistance of a blood
pump.heparin is added to the blood as it flows into
the dialyzer because anytimeblood contact a foreign
substance, it has a tendency to clot. Blood is
returned from the dialyzrer to the patient through
the second needle {blue catheter lumen}
11/14/2022
21
k.g.m.u
college
of
nursing

22.  In addition tot the dialyser a dialysate delivery and
monitoring system is used.the system pups the dialysate
through the dialyser, counter current to the blood flow.
Dialysis is terminated by flushing the dialyser with saline
solution to return the blood in the extracorporeal circuit
back to the patient through the vascular access. Then the
needleare removed from the patient and from pressure is
applied to the veinpunture sites until the bleeding stops.
11/14/2022
22
k.g.m.u
college
of
nursing

23.  Before beginning treatment complete an
assessment that includes fluid status {weight, BP,
peripheral edema lung and heart sounds} condition
of vascular access, temperature and general skin
condition. The difference between the last post
dialysis weight and the present pre dialysis weight
determines the ultra filtration or the amount of
weight to be removed. While the patient is on
dialysis, take vital signs at least every 30 to 60
minutes because rapid BP changes may occur.
11/14/2022
23
k.g.m.u
college
of
nursing

24. COMPLICATIONS
 If the signs of complications occur the dialysis is
slowed or stopped ,depending on complications and
the PHCP is notified immediately .
 The nurse stays with the client and monitors the client
including vital signs ,while another nurse obtains
initial prescriptions from PHCP.
 If any signs of air embolism inform the doctor and turn the
clients on the trendelenburg’s position .
 Administer the oxygen if difficulty in breathing.
 Documents the events ,action taken and the clients response
11/14/2022
24
k.g.m.u
college
of
nursing

25. CLIENT AND FAMILY TEACHING
 The Client With Chronic Renal Failure Develop a
teaching plan based on the following:
 Follow the diet and fluid intake recommended by the
physician.
 Do not use salt substitutes (which often contain po
tassium) unless allowed by the physician.
 When doing laundry, use a mild laundry detergent.
 Use an extra rinse cycle to remove all detergent or add
1 tsp of vinegar per quart of water to the rinse cycle to
remove de tergent residue.
11/14/2022
25
k.g.m.u
college
of
nursing

26.  Take medications exactly as prescribed by the physician
 Do not use any nonprescription drug unless use is
approved by the physician.
 Keep a record of daily weight, and report any rapid
weight gain to the physician.
 Measure and record fluid intake and urine output.
 Take frequent rest periods; avoid heavy exercise
 Avoid exposure to those with any type of infection (e.g.
colds, sore throats, flu)
11/14/2022
26
k.g.m.u
college
of
nursing

27. 11/14/2022
k.g.m.u
college
of
nursing
27