HEMODIALYSIS A type of dialysis that uses a machine with an artificial filter to remove wastes and extra fluids from

the blood and balances electrolytes. y used when acute or total failure of Kidneys occurs 1. ESRD irreversible kidney failure 2. Prolonged diabetes mellitus 3. High BP 4. Kidey infection 5. Heart failure 6. Victims of drug or mushroom poisoning may also be recommended The Principle y Diffusion, Osmosis and ultrafiltration Diffusion- toxins and wastes in the blood are removed -higher concentration lower concentration Osmosis remove excess water, -higher solute concentration lower solute concentration Ultrafiltration- water moving under high pressure to an area of lower pressure. y Contaminated blood is led from body to dialysis machine. y Heparin is added to prevent blood clotting y The blood is driven through thin fibers in a dialisator. Their surface is made of semipermeable membrane y Waste products such as urea, creatinin, phosphorus and excess fluids are filtered out of bloodstream. They go across the membrane into the dialysis concentrate y purified blood returns to the bloodstream y Procedure is about 4 hours long and it has to be carried out about 3 times a week. y Hemodialysis is usually used for people with no working kidney. y Equipments y Dialysis Machine - pump blood and watch flow for safety -clean wastes from blood -watch your blood pressure and the rate of fluid removal from your body y Dialyzer - artificial kidney - The filter itself - containing thousands of tiny cellophane tubules that act as semipermeable membranes through which your blood is passed y Dialysis solution - The dialysate is a mixture of water and chemicals that are present in your blood. This fluid can be adjusted, based on your lab values, to give you the best filtering with fewer side effects. - Na, Ca, K, Bicarbonate, Mg - It draws toxins and excess water from the bloodstream y Needle -2 needles or specialized needles with 2 openings Vascular Access 1. Arteriovenous fistula- wrist ; at least 6 weeks to mature 2. Arteriovenous graft- arm , thigh or chest area; used in 2 weeks 3. Central Venous Catheter for immediate access for hemodialysis - use thin flexible tube placed into large vein (subclavian, jugular, femoral) Complication

1. 2. 3. 4. 5. 6.

Hypotension Muscle cramping Nausea and Vomiting Headache Chest pain and back pain Itching

NURSING INTERVENTIONS y y y y y y y Explain procedure to client Monitor hemodynamic status continuously Monitor acid-base balance Monitor electrolytes Insure sterility of system Maintain a closed system Discuss diet and restrictions on: a. Protein intake b. Sodium intake c. Potassium intake d. Fluid intake y y Reinforce adjustment to prescribed medications that may be affected by the process of hemodialysis Monitor for complications of dialysis related to: a. Arteriosclerotic cardiovascular disease b. Congestive heart failure c. Stroke d. Infection e. Gastric ulcers f. Hypertension g. Calcium deficiencies (bone problems such as aseptic necrosis of the hip joint) h. Anemia and fatigue i. Depression, sexual dysfunction, suicide risk

Care for vascular access

y y y

Wash the access with soap and warm water each day, and always before dialysis. Do not scratch the area or try to remove scabs. Check the area daily for signs of infection, including warmth and redness. Check that there is blood flow in the access daily. There should be a vibration (called a thrill) over the access. If this is absent or changes, notify your healthcare provider. Sometimes, flow monitoring is done during the dialysis treatment using ultrasound (sound waves). The flow monitoring measures the speed of blood flow during dialysis treatment. Take care to avoid traumatizing the arm where the access is located; do not wear tight clothes, jewelry, carry heavy items, or sleep on the arm. Do not allow anyone to take blood or measure blood pressure on this arm. Rotate needle sites on the access. Use gentle pressure to stop bleeding when the needle is removed. If bleeding occurs later, apply gentle pressure; call a healthcare provider if bleeding does not stop within 30 minutes or if bleeding is excessive.