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HEMODIALYSIS OVERVIEW Haemodialysis is a procedure done to artificially cleanse the blood of a person when the kidney is already impaired

and loses its function in a form known as end stage renal failure to perform its vital functions mainly detoxifications of our blood and have it excreted by our body as waste products. It is the most common form of dialysis done for patients acutely ill and requires short term dialysis such as in cases of fluid retention, drug overdose, and other physiologic problems and in long term or permanent therapy for ESRD. Haemodialysis thought to prevent death for patient with ERSD but does not cure renal disease and does not compensate for the loss of endocrine and metabolic activities of the kidney. Every session of treatment has duration of 3 to fours. A dialyzer serves as a synthetic semi permeable membrane, replacing the renal glomeruli and tubules as the filter for the impaired kidneys. PRINCIPLES OF HEMODIALYSIS The main objectives of haemodialysis are to extract nitrogenous substances from the blood and to remove excess water. The principles behind hemodialysis are diffusion, osmosis, and ultrafiltration. The toxins and waste in the body is removed by diffusion in manner of from an area of higher concentration in the blood to an area of lower concentration in the dialysate. Excess water removed from the body by osmosis in which water moves from an area of higher solute concentration (the blood) to an area of lowere solute concentration (the dialysate bath). Ultrafiltration is defined as water moving under high pressure to an area of lower pressure. The body¶s buffer system is main tained using a dialysate bath made up of bicarbonate or acetate, which is metabolized to form bcarbonate. Anticoagulant heparin is administered to keep blood from clotting in the dialysis circuit. Cleanse blood is then returned to the body.

AND FEMORAL CATHETERS (central venous catheter) It is an access directly to the patients circulation for acute hemodialysis. The arterial segment of the fistula is used for arterial flow and the venous segment for reinfusion of the dialyzed blood. either side to side or end to side. COMPLICATIONS  Hypotension may occur during the treatment as fluid is removed. AV FISTULA A more permanent access created surgically by joining an artery to a vein.  Dysrhytmias may result from electrolyte and pH changes or from removal of anti arrhythmic medications during dialysis. It can only be used for only a short period of time when other types of vascular accsess is temporarily un usable. pneumothorax.  Painful muscle cramping may occur. it is achieve by inserting a double lumen or multi lumen catheter. thrombosis.  Exsanguination may occur if blood lines separate or dialysis needles are accidentally become dislodge. semibiologic. or synthetic graft material between an artery and vein. infection.  Air embolism is rare but can occur if air enters the vascular syatem . JUGULAR. Infection and thrombosis are the most common complications. Hematoma. INTERNAL. and in adequate blood flow are the common complications.VASCULAR ACCESS SUBCLAVIAN. GRAFT An arteriovenous graft that can be created subcutaneously interposing a biologic. usually late in the dialysis as fluid and electrolytes rapidly leave the extracellular space. The fistula takes 4 to 6 weeks to mature and can used for dialysis. Graft is created when when the patient vessel are not suitable for a fistula (patients w/ compromised vascular systems).

protein. Chest pain may occur in patients with anemia atherosclerotic heart disease  Dialysis disequilibrium results from cerebral fluid shifts. k.  Observe aseptic technique in caring for the vascular access to prevent infection. NURSING DIAGNOSES Risk for infection related to presence of accsess to circulatory system. Decreased cardiac output related to decreased circulatory volume. nausea and vomiting. and high in calcium  Fluid restriction since the kidney doesn¶t secrete excess fluid  Monitor vital signs  Assess for fluid retention  Assess for venous site for redness and swelling  Check for audible sign and palpable thrill in the AV fistula and graft PHARMACOLOGIC TREATMENT Protamine sulphate ± antidote for heparin Epogen ± a synthetic erythropoietin Blood Pressure medications Calcium supplements and multivitamins Phosphorus binders ± to lower phosphorus levels in the blood Diuretics ± to remove excess body fluids . Altered nutrition less than body requirements related to intake restriction NURSING MANAGEMENT  Have the patient lie on bed after haemodialysis to prevent hypotension.  Monitor body weight to assess for any fluid retention. light-headedness and dizziness. fat. restlessness. Anxiety related to presence of chronic condition. decreased LOC and seizures.  Offer psychologically family support  Dietary low in Sa. Signs and symptoms include headache.

phosphorus ± to evaluate level in the blood and serve as basis for efficacy of hemodialysis. PERITONEAL DIALYSIS OVERVIEW .Stool softeners and laxatives ± to prevent and treat constipation. hgb count BUN. Iron supplements ± to increase iron intake which is important for production of red blood cell. which can be caused by decreased fluid intake. serum potassium. creatinine. hct. LABORATORY EXAMINATION CBC ± to evaluate RBC.

Your health care team will show you how to keep your catheter bacteria-free to avoid peritonitis.uses the same type of machine as CCPD. you begin one exchange with a dwell time that lasts the entire day. Preventing Problems Infection is the most common problem for people on PD. In the morning. You don¶t need a machine for CAPD.The goal of peritoneal dialysis are to remove toxic substance and metabolic waste and to re-establish normal fluid and electrolyte balance. Your doctor will prescribe the number of exchanges you¶ll need. Peritoneal dialysis maybe the treatment of choice for patients with renal failure who are unable to unwilling to undergo hemodialysis and kidney transplantation. This requires assistance and is usually done at a hospital or center. which now contains wastes. which is an infection of the peritoneum. typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while you sleep. you¶ll drain the solution. all you need is gravity to fill and empty your abdomen. Type of Peritoneal Dialysis y Continuous Ambulatory Peritoneal Dialysis (CAPD) If you choose CAPD. y Nocturnal Intermittent. Improved catheter designs protect against the spread of . at risk for the adverse effects of systemic heparin. y Continuous Cycler-Assisted Peritoneal Dialysis (CCPD) CCPD uses an automated cycler to perform three to five exchanges during the night while you sleep. It often takes longer than CCPD. into the bag. You then repeat the cycle with a fresh bag of solution. you¶ll drain a fresh bag of dialysis solution into your abdomen. The more likely to be the candidate for peritoneal dialysis are those diadetic and have cardiovascular disease patients. Patients who are susceptible to the rapid F/E and metabolic changes that occur during hemodialysis experiences fewere of these condition with the slower rate of peritoneal dialysis. After 4 to 6 or more hours of dwell time.

Remove excesses body fluid. Establish electrolyte balance. Here are some signs to watch for:Fever Nausea or vomiting Redness or pain around the catheter unusual color or cloudiness in used dialysis solution a catheter cuff that has been pushed out. but here are some general rules:Store supplies in a cool. Find a clean. Control severe. clean. dry place. Wear a surgical mask when performing exchanges. Keep a close watch for any signs of infection and report them so they can be treated promptly. Purposes of Peritoneal dialysis y y y y y y Aid in the removal of toxic substances and metabolic wastes. Severe fluid overload in pediatric cardiac patients To remove toxic and metabolic wastes.bacteria. but peritonitis is still a common problem that sometimes makes continuing PD impossible. Assist in regulating the fluid balance of the body. Clean the exit site with antiseptic every day. intractable heart elimination of water and sodium. Wash your hands every time you need to handle your catheter. well-lit space to perform your exchanges. dry. Control blood pressure. failure when diuretics no longer promote Indication for Peritoneal Dialysis y y y Acute renal failure. Contraindication for Peritoneal Dialysis y y y y Abdominal wound or infection Peritonitis Abdominal disease Fecal fistula or colostomy . Inspect each bag of solution for signs of contamination before you use it. You should follow your health care team¶s instructions carefully.

y b. abdominal pain y or discomfort.Use sterile drapes to prevent contamination y h.Elevate head of bed. Monitor for malaise. Monitor signs of infection. Obtain Weight. Monitor VS. Assess the catheter site dressing for wetness or y bleeding. Complication: y y y y y Peritonitis Bleeding Leakage Metabolic disturbances Cardio. y c. y b. . encourage deep breathing y exercises y . INTERVENTIONS DURING TREATMENT y a. y Respiratory Distress: y .Change the dressings frequently. Monitor for respiratory distress. Monitor VS. Elevate head of bed at intervals.Prevent air from entering peritoneum by keeping y drip chamber of tubing three quarters full of fluid. Monitor for hypotension and hypertension y f. Turn the client from side to side if the outflow is y slow to start. Monitor dwell time to extend beyond the y physician¶s order because this increases risk of y hyperglycemia.y y Gastric or diaphragmatic hernia Extensive adhesions from previous surgery. vomiting.Turn patient side to side y .Encourage patient to move about if ambulatory y d.Reduce the volume administered y Abdominal Pain: y . y . Monitor signs of pulmonary edema. nausea.Slow inflow rate y . y Leaks: y . Have the client void. y g. y i. y e. y c.respiratory problem INTERVENTIONS BEFORE TREATMENT y a. being careful not to y dislodge the catheter y . is possible.

Monitor outflow for color and clarity. and at the end of the treatment .y y y y y y y y y y y y y y y y y j.Fluid balance . of exchanges . m.Assessment of VS and patient¶s condition y . Keep accurate records: .Exact time of beginning and end of each exchange . which should be continuous stream after the clamp is opened. k. Monitor outflow. the difference is equal to the amount absorbed or retained by the client during dialysis and should be counted as intake. Monitor intake and output accurately. throughout. l. If outflow is less than the inflow.No.Medications added to dialyzing solution .Level of responsiveness at beginning.Pre and Post dialysis weight plus daily weight .Amount of solution infused and recovered .