HEMODIALYSIS RULES

DW
EDTNA/ERCA guidelines say that by consensus the IDWG should be no more than 4% of patients dry
weight or between 1.5-2.0kg. In life threatening fluid overload the safest way to remove large volumes
of fluid is using iso uf as above but no more than 1000ml over half an hour with very close monitoring
fluid removal depend on the dry weight we set and remove the fluid during each dialysis session to a
maximum of 10 ml/kg/hr
No more than 1 l/h for and average person/Safe rule of thumb: 10 ml/kg/hour
Folic Acid
15 mg/weekly folic acid (5mg after each dialysis procedure) is required to suplement its deficit or to
treat hyperhomocysteinemia
5 and up to 10 mg/day should be sufficient to treat the deficiency
Zinc
Administration of zinc improved appetite loss, dry mouth, nausea, and hypogeusia
Zn lowers prolactine - testosterone goes up - improved sexual function, muscle mass and nutritional
state
The dose that was used is 100 mg
Heparin
Management of patients Pre & Post OP/ Very high risk of bleeding
Heparin free dialysis should be initiated. Regular saline flushes: 100mls every 40-60 mins should be
implemented; this extra fluid should be calculated in the overall Ultrafiltration value. Or Rinse dialyzer
with 5000 IU to 20000 IU of heparin, flush system with 1L to 2L saline
Management of patients with Acute renal failure
Heparin free dialysis should be initiated after central venous catheter insertion. Minimal heparin should
then be administrated.
Protocol for administration of heparin by nurses during haemodialysis for patients with a low risk of
bleeding.
Bolus injection Dosage 30-50 iu/Kg, Continuous infusion 800- 1500 iu/HR.
Example:
Patient weight is 70Kg and has 3 hours dialysis receives:
Bolus = 30 X 70Kg = 2100 IU
Infusion = 1500 X 3hr = 4500 IU
Protocol for administration of heparin by nurses during haemodialysis for patients with a high risk of
bleeding.
E.g.: Patients receiving warfarin, low platelets
Bolus injection dosage 10-25 IU/Kg, Continuous infusion 10-22 IU/Kg/hr
Example:
Patient weight is 70Kg and has 3 hours dialysis receives:
Bolus = 10 X 70Kg = 700 IU
Infusion = 10 X 70Kg X 3hrs = 2100 IU