Hemodialysis Cleansing the blood of accumulated waste products Uses 1. Short term therapy in acutely ill clients 2.

. Long term use in clients with end-stage renal disease Hemodialysis requires five things: 1. Access to patients circulation (usually via fistula) 2. Access to a dialysis machine and dialyzer with a semipermeable membrane 3. The appropriate solution (dialysate bath) 4. Time: 12 hours each week, divided in 3 equal segments 5. Place: home (if feasible) or a dialysis center Three ways to access to clients circulation for dialysis:

Access Route Abbreviation forHemodialysis Arteriovenous Fistula AVF

Description A section of vein is directly sutured to an artery. It is usually placed in the nondominant arm, using the cephalic vein and radial artery Connection tube is clients own (autologous) saphenous vein, or made from polytetrafluoroethylene (PTFE)

Arteriovenous Graft

Central Venous Catheter

CVC

Catheter inserted by directly cannulating the vein. Usual CVC sites are: femoral, internal jugular, or subclavian veins

Procedure for hemodialysis 1. Patients circulation is accessed 2. Unless contraindicated, heparin is administered 3. Heparinized (heparin: natural clot preventer) blood flows through a semipermeable membrane in one direction 4. Dialysis solution surrounds the membranes and flows in the opposite direction 5. Dialysis solution is: a. Highly purified water b. Sodium, potassium, calcium, magnesium, chloride and dextrose c. Either bicarbonate or acetate, to maintain a proper pH 6. Via the process of diffusion, wastes are removed in the form of solutes (metabolic wastes, acidbase components and electrolytes) 7. Solute wastes can then be discarded or added to the blood 8. Ultrafiltration removes excess water from the blood 9. After cleansing, the blood returns to the client via the access Complications related to vascular access in Hemodialysis 1. Infection 2. Catheter clotting 3. Central venous thrombosis 4. Stenosis or thrombosis 5. Ischemia of the affected limb 6. Development of an aneurysm

Nursing interventions for Hemodialysis 1. Explain procedure to client 2. Monitor hemodynamic status continuously 3. Monitor acid-base balance 4. Monitor electrolytes 5. Insure sterility of system 6. Maintain a closed system 7. Discuss diet and restrictions on: a. Protein intake b. Sodium intake c. Potassium intake d. Fluid intake 8. Reinforce adjustment to prescribed medications that may be affected by the process of hemodialysis 9. 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