MANAGEMENT OF EXTRACORPOREAL PASSAGE OF THE PATIENTS BLOOD THROUGH A DIALYZER

Purpose
As a treatment, it extracts and removes excess electrolytes, fluids, and toxic nitrogenous substances from the blood Always intermittent; treatments usually occur three times a week for at least 3-4 hours

Indications

Blood urea nitrogen >90 mg/dL Serum creatinine of 9 mg/dL Hyperkalemia Drug toxicity Intravascular and extravascular fluid overload Metabolic acidosis Uremia (e.g. pericarditis, GI bleeding) Changes in mentation Contraindications to other forms of dialysis

Contraindications
Hemodynamic instability Inability to anticoagulate Lack of access to circulation

Procedure for Hemodialysis 1. Patients circulation is accessed

2. Anchor connections and tubings securely 3. Unless contraindicated, heparin is administered 4. Heparinized (heparin: natural clot preventer) blood flows through a dialyzer in one direction 5. Dialysis solution (dialysate) surrounds the membranes and flows in the opposite direction 6. Dialysate is: a. Highly purified water b. Sodium, potassium, calcium, magnesium, chloride and dextrose c. Either bicarbonate or acetate, to maintain a proper pH 7. Via the process of diffusion, wastes are removed in the form of solutes (metabolic wastes, acid-base components and electrolytes) 8. Ultrafiltration removes excess water from the blood 9. After cleansing, the blood returns to the client via the access 10. After 3-4 hours, discontinue hemodialysis according to protocol.

Procedure Equipment

Hemodialyzer
artificial kidney
Blood from patient flows through hollow

fiber: wastes are removed with excess water Toxins move between dialysate and blood to achieve equilibrium Excess fluid, urea, and other wastes move into the dialysate Cleansed blood is returned to the patient

Principles of Hemodialysis
DIFFUSION OSMOSIS ULTRAFILTRATION

Vascular access
Temporary acute access Double-lumen venous catheter Subclavian and femoral veins Permanent vascular access A-V fistula A-V graft

Vascular Access Care

Check for redness, localized swelling or pustules, localized bulging Report coldness, numbness, weakness or pain in the site is experienced Clean the skin with soap and water For catheter, make sure the dressing is intact, clean and dry, clamps are closed, and caps are secured Avoid using access arm for blood draws

Vascular Access Care

Avoid activities that could block or slow the blood flow within your access such as:

BP taking on the access extremity Carrying heavy objects on the access arm Sleeping on access arm Sleeping with access arm bent Placing excessive pressure on your access after needle removal following dialysis Wearing tight fitting clothing

Nursing Responsibilities

Predialysis Care
Review blood chemistries before treatment Assess vital signs including orthostatic BP,

apical pulse, RR, and lung sounds Record weight Assess vascular site for palpable pulsation or vibration and an audible bruit and for inflammation Alert all personnel to avoid using the extremity with the vascular access site for BP or venipuncture

Nursing Responsibilities

During Dialysis Care

Assess and document vital signs and

vascular access site condition Monitor BUN, serum creatinine, serum electrolyte, and hematocrit levels between dialysis treatment Assess patients for bleeding at the access site or elsewhere Administer heparin, according to protocol

Nursing Responsibilities

Postdialysis Care
Continue monitoring of vital signs
Compare postdialysis vital signs and blood

chemistries with predialysis values Assess for headache, nausea and vomiting, muscle cramps, or seizure activity Provide catheter or fistula care according to protocol

Thank you for listening! -THE END-