Angeles University Foundation

Angeles City, Philippines

A.Y. 2023-2024

FLIPPED CLASSROOM:
HEMODIALYSIS

SUBMITTED BY:
DELA PENA, Merson G.
GONZALES, Angel Allianah Blessie J.
MANALESE, Lei Ann Camille M.
ONG, Francine Joy G.
SUNGA, Alexis Joy C.
BSN 4-D / GROUP 16 / SUBGROUP B

SUBMITTED TO:
Diane Anne A. Lozano, RN

SEPTEMBER 2023
● DEFINITION OF HEMODIALYSIS
○ Hemodialysis is a medical procedure done in order to filter substances in the
blood such as waste, and extra water. It helps the body maintain a healthy
range of blood pressure and balance minerals like potassium, sodium, and
calcium, which is normally done otherwise by a healthy kidney. According to
the National Institute of Diabetes and Digestive and Kidney Diseases (2022),
hemodialysis is a treatment that can relieve the symptoms of a person with
kidney damage and prolong their life. However, it is a mere treatment, not a
cure to a failing kidney.

● MECHANISM
○ In order for the blood to go in and out of the body, a vascular access is needed,
it can be a fistula, a graft, or a catheter. The Dialysis Nurse places two needles
with tubing in the patient's access, one needle carries blood out of the body
and into the dialyzer, and the other one carries filtered blood from the dialyzer
and then into the body. The Dialysis Machine acts as a pump that forces the
blood out of the body and through the Dialyzer, which is the filter or
sometimes referred to as the “artificial kidney”. In the Dialyzer, the blood is
forced and filtered through many, very thin, hollow fibers where wastes and
extra salt and water are eliminated, with the help of a Dialysis solution called a
dialysate. The biological mechanisms involved in this process are diffusion,
osmosis, and ultrafiltration. After the blood is filtered, it is then returned to the
body through the needle, and into the vascular access. The whole process
usually takes around three to four hours each time.

● TYPES OF HEMODIALYSIS
○ In-center Dialysis: In-center dialysis refers to a type of renal replacement
therapy that takes place within a designated medical facility, usually a dialysis
clinic or a hospital. It is one of the methods used to treat end-stage renal
disease (ESRD) or chronic kidney failure. The term "in-center" indicates that
the dialysis sessions are performed at a designated medical facility, and
patients need to travel to the clinic for each treatment session. These sessions
 are usually scheduled three times a week, and each session typically lasts for
several hours.
○ Home Hemodialysis: Home hemodialysis is a type of renal (kidney)
replacement therapy that allows individuals with end-stage renal disease
(ESRD) or chronic kidney failure to perform hemodialysis treatments in the
comfort of their own homes, under the guidance of medical professionals.

● INDICATIONS
○ End-stage Renal Disease: Hemodialysis is commonly used for individuals
with end-stage renal disease, where the kidneys have lost nearly all their
function and are unable to effectively filter waste products and regulate fluid
balance.
○ Severe Chronic Kidney Disease: When kidney function drops significantly
(usually below 15% to 10%), hemodialysis might be necessary to maintain
proper electrolyte balance and remove waste products from the bloodstream.
○ Acute Kidney Injury: Hemodialysis may be required in cases of sudden and
severe kidney injury, such as those caused by infections, medications, toxins,
or surgical complications.
○ Severe Hyperkalemia: Hyperkalemia is the presence of excessively high
levels of potassium in the blood, and can be a life-threatening medical
condition. Hemodialysis is an effective method to rapidly lower potassium
levels in the blood. The dialysis machine filters the blood, removing excess
potassium and other waste products that the kidneys are unable to eliminate
properly.
○ Fluid Overload: In cases of severe fluid retention, where the kidneys are
unable to adequately remove excess fluids from the body, hemodialysis can
help restore proper fluid balance.
○ Uremia: Uremia refers to a condition where toxic waste products that are
normally excreted by the kidneys accumulate in the blood. Hemodialysis is
used to remove these waste products and alleviate symptoms like nausea,
vomiting, confusion, and fatigue.
● VASCULAR ACCESS FOR HEMODIALYSIS
○ Vascular access for hemodialysis is crucial for patients with kidney failure.
The choice of vascular access depends on the patient's individual
circumstances and the suitability of their veins.
○ There are three main types:
■ Arteriovenous Fistula (AVF): This is the preferred choice. It is
usually done in the arm by means of surgically connecting an artery
and a vein. Over time, the increased blood flow causes the vein to
enlarge, making it suitable for repeated needle insertions during
dialysis. AVFs are generally the most durable and have the lowest risk
of complications if they can be created successfully.
■ Arteriovenous Graft (AVG): If an AVF isn't possible due to small or
weak veins, a synthetic graft can be implanted to connect an artery and
a vein. Grafts are more prone to complications than AVFs.
■ Central Venous Catheter (CVC): CVCs are used when AVF or AVG
isn't an option. It's a tube inserted into a large vein, typically in the
neck, chest, or groin. CVCs carry a higher risk of infection and
complications.

● RISKS/COMPLICATIONS
○ Hemodialysis is a life-saving treatment for individuals with kidney failure, but
it does come with certain risks and potential complications. Here are some of
the primary risks associated with hemodialysis:
■ Infection: Infections can occur at the site of vascular access (e.g., AV
fistula, graft, or catheter) or in other parts of the body due to
compromised immunity. Strict infection control measures are essential.
■ Hemodynamic Instability: Rapid changes in fluid and electrolyte
levels during dialysis can lead to low blood pressure (hypotension),
which may cause dizziness, nausea, and in severe cases, loss of
consciousness.
■ Muscle Cramps: Sudden changes in fluid and electrolyte levels can
cause muscle cramps, which can be painful.
 ■ Arrhythmias: Electrolyte imbalances during dialysis can lead to
irregular heart rhythms (arrhythmias), which may require medical
intervention.
■ Hemorrhage: Bleeding can occur at the vascular access site,
especially if needles are inserted improperly or if the access site is
fragile.
■ Access Complications: Vascular access sites (AV fistulas, grafts,
catheters) can develop complications such as stenosis (narrowing),
thrombosis (clot formation), or infection.
■ Electrolyte Imbalances: Hemodialysis can lead to imbalances in
electrolytes like potassium, calcium, and phosphate, which can have
various adverse effects on the body.
■ Anemia: Frequent hemodialysis sessions can lead to a decrease in red
blood cell count, causing anemia. This may require additional
treatments like erythropoietin-stimulating agents.
■ Bone and Mineral Disorders: Chronic kidney disease and
hemodialysis can disrupt calcium and phosphate balance, leading to
bone and mineral disorders like renal osteodystrophy.
■ Cardiovascular Issues: Hemodialysis patients are at a higher risk of
developing problems due to fluid and electrolyte imbalances, which
can contribute to heart issues.
■ Amyloidosis: Over time, hemodialysis can lead to the buildup of a
protein called beta-2 microglobulin in the blood, which may lead to a
condition known as dialysis-related amyloidosis.
■ Psychological and Lifestyle Impact: The demands of hemodialysis
can have a significant impact on a person's mental health and lifestyle,
including diet restrictions and time spent at the dialysis center.
■ Dialysis Disequilibrium Syndrome: It can arise during or after
hemodialysis leading to symptoms such as dizziness, restlessness,
nausea, and vomiting due to rapid rapid removal of solutes from the
body.
○ It's important for healthcare providers and patients to work closely together to
manage and minimize these risks. Regular monitoring, adherence to treatment
 plans, and lifestyle modifications are crucial to improving the safety and
effectiveness of hemodialysis.

● NURSING RESPONSIBILITIES
○ Ensure that dialysis machines and equipment are functional and are set up
correctly.
Rationale: Proper medical equipment maintenance is essential for ensuring
patient safety and accurate readings. It is important to regularly check
functionality to prevent errors, malfunctions, and breakdowns.
○ Weigh the patient before and after dialysis to determine fluid loss and if dry
weight is achieved.
Rationale: The weight assessment will assist establish how much fluid must
be eliminated during hemodialysis for the patient to be restored to his dry
weight. The dry weight is the client's ideal weight before hemodialysis
treatments, without fluid accumulation.
○ Assess and document patient’s vitals before, during, and after dialysis
treatment.
Rationale: Determine whether the patient's blood pressure shows hypertension
or hypotension. Avoid taking the blood pressure of the client's arm with the
AVF or AVG for this might result in loss of access and clotting. Fever can be
an indication of infection. Patients; undergoing hemodialysis are prone to
developing dysrhythmias; this is why when monitoring the heart rate, observe
the rhythm.
○ Inspect the patency of the access site before, during, and after dialysis
treatment.
Rationale: Inspecting for bleeding, leaking or drainage, warmth, redness and
complaints of discomfort at the site if the patient has an AVF or AVG since
these are critical indicators of infection. Normally, palpating for a thrill, and
auscultating for a bruit can be assessed. If either is missing or hardly visible, it
could suggest an absence of access.
○ Examine lab findings for sodium, phosphorus, potassium, blood urea nitrogen,
and creatinine levels before and after dialysis treatment.
 Rationale: By comparing the pre-dialysis electrolyte readings to the
post-dialysis lab findings, you can establish the efficacy of the treatment.
○ Examine the patient's red blood cell (RBC) count, hemoglobin, and hematocrit
levels.
Rationale: Laboratory values for RBC count, hemoglobin, and hematocrit can
be lower than normal after dialysis.
○ Review the list of drugs of the patient, scheduled up to 4 hours before the
treatment and withhold sedating and antihypertensive medications.
Rationale: All antihypertensive medications should be held prior to
hemodialysis. Certain medications will pass through the dialysis equipment
yet give no benefit to the patient because these medications are water-soluble
vitamins and therefore should be withheld. Due to the increased prevalence of
arrhythmias during hemodialysis, antiarrhythmic medicines are usually used
as scheduled.
○ Watch out for signs of bleeding.
Rationale: Early identification and treatment can save a patient's life by
preventing life-threatening hemorrhage.
○ Monitor the patient for signs and symptoms of disorientation, decreased level
of consciousness, and headaches.
Rationale: These neurologic changes might be associated with disequilibrium
syndrome and must be reported immediately.
○ Conduct health teaching about the management and treatment of the patient’s
disease condition.
Rationale: Health teachings include the type of food and diet that the patient
eats, the level of activity needed, fluid restrictions and medications.
References:
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Azura Vascular Care. (n.d.). Arteriovenous Graft Facts. Retrieved from

https://www.azuravascularcare.com/infodialysisaccess/arteriovenous-graft-facts/

Hemodialysis. (2022a). National Institute of Diabetes and Digestive and Kidney

Diseases.https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure
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Healthline. (n.d.). Hemodialysis: Managing Common Side Effects. Healthline.

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https://www.mayoclinic.org/tests-procedures/hemodialysis/about/pac-20384824

Mnemonic Monday: AEIOU – Indications for Dialysis in Patients with Acute Kidney Injury.
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National Kidney Foundation. (2019, August 8). Choosing Dialysis: Which type is right for
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There%20are%203%20main%20types

Shepard, L. H. (2011). Preparing your patient for hemodialysis. Nursing Made Incredibly
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