DIALYSIS

 General Information:  1. Removal by artificial means of metabolic wastes, excess

electrolytes, and excess fluid from clients with renal failure.
 2. Principles
 A. diffusion – movement of particles from an area of high

concentration to one of semipermeable membrane
 B. osmosis - movement of water through a semipermeable membrane

from an area of lesser concentration of particles to one greater concentration.

replacing the renal glomeruli and tubules as the filters  Contain thousand of tiny cellophane tubules that act as semipermeable membranes. allergic or adverse reaction . semipermeable membrane.hypersensitive.  Biocompatibility. NSS  Hemodialysis catheter/needle  Tourniquet  Dialysate  A solution composed of all the important electrolytes  Dialyzer or artificial kidney  Serves as synthetic.Equiptments:  Blood line.

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and return of dialyzed blood to the client’s circulation.  2.Hemodialysis  1. Dialysis coil acts as the semipermeable membrane. . Shunting of blood from the client’s vascular system through an artificial dialyzing system. the dialysate is a specially prepared solution.

1. internal jugular and femoral catheters Immediate access for acute hemodialysis Risks: hematoma. thrombosis Be used for several weeks . infection. Subclavian.

Fistula  More permanent access  Surgically inserted usually in the forearm by joining (anastomosis) an artery to a vein (either side to side or end to end)  It takes 4-6 weeks to mature before it is ready for use.2.  Squeezing of rubber ball (increase size of the vessels) .

often within 2 or 3 weeks. implanted under the skin between an artery and vein. Indicated for small veins that won’t develop properly into a fistula A graft doesn’t need to develop as a fistula does.3. Risks: infection. Graft Arteriovenous graft using a synthetic tube or graft. so it can be used sooner after placement. thrombosis .

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Nursing Care:  Auscultate for a bruit and palpate for a thrill to ensure patency.  Assess for clotting ( color change of blood. absence of pulsations in tubing>. .  Avoid performing venipuncture. giving injections.  Change sterile dressing over shunt daily. or taking a blood pressure with a cuff on the shunt arm.

 Position catheter properly to avoid dislodgement during dialysis. ( subclavian cannulation) .  Avoid restrictive clothing/ dressing over site. Report bleeding. drainage and pain. skin discoloration.

assess vital signs before and every 30 minutes during     procedure. have client void dialysis:  2. inform client that headache and nausea may occur. Ensure bed rest with frequent position changes for comfort. 7. 6. withhold antihypertensive.Nursing care before and during  1. monitor closely for signs of bleeding since blood has been haparinized for procedures. sedatives and vasodilators to prevent hypotensive episode ( unless ordered otherwise. 4. chart client’s weight  3. 5. .

 Dialysis disequilibrium syndrome ( urea is removed more rapidly from the blood than from the brain) assess for nausea . chart client’s weight. vomiting. disorientation. Assess for complications:  Hypovolemic shock may occur as a result of rapid removal or ultrafiltration of fluid from the intravascular compartment. leg cramps and peripheral paresthesias.Nursing care : postdialysis  1. .  2.

2.Hemodialysis Complication: 1. 7. 4. 6.  A transient osmotic gradient that promotes water movement into the cells  Gradual dialysis 150-250 mL/min . Hypotension Bleeding Infection (local or systemic) Painful muscle cramping Dysrhythmias Air embolism Chest pain Dialysis disequilibrium Syndrome  Neurologic signs. during or following shortly after intermittent hemodialysis. attributed to cerebral edema. 8. 3. 5.

Peritoneal Dialysis  Introduction of a specially prepared dialysate solution into the abdominal cavity. CHF and pulmonary edema)  Older patients  Side effects of heparin .  Treatment of choice who are unable or unwilling to hemodialysis and kidney transplantation  Indicated for patients who are susceptible to rapid F/E and metabolic changes caused by hemodialysis  Waste Products are cleared in 36-48 hours  Preferred treatment for:  DM or cardiovascular disease (HPN. where the peritoneum acts as a semipermeable membrane between the dialysate and blood in the abdominal vessels.

Diffusion and osmosis  Waste products move from an area of higher concentration (peritoneal blood supply) to an area of lower concentration (peritoneal cavity) across the semipermeable membrane (peritoneum). serves as the semipermeable membrane. .a serous membrane that covers the abdominal organs and lines the abdominal wall. Ultrafiltration  Water removal occurs through an osmotic gradient created by adding dextrose to the dialysate.Principles of PR Peritoneum.

heating pad Dialysate is warmed to prevent discomfort and dilate vessels to increase urea clearance Flow Sheet Heparin to prevent blood clot to the catheter Antibiotics.25% Heating cabinet.Equiptments/ preparation Rigid stylet catheter is inserted 3-5 cm below the umbilicus Dialysate. 2.500 mL to 3000 mL Dextrose solutions of 1. insulin and KCL may be added .5%. incubator. and 4.5%.

Performing the exchange 1. Dwell  Time allows for diffusion and osmosis to occur  5-10 minutes (diffusion creatinine and urea) 3. Drainage  10-30 minutes  Drainage should be colorless or straw-colored and should not be cloudy  Bloody drainage is normal during the first few exchange . Infusion  5-10 minutes  2 liters of dialysate solution 2.

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Approaches of PD .

 Continuous ambulatory Peritoneal Dialysis  A continuous type of peritoneal dialysis performed at home by the client or significant others.  Following infusion of the dialysate into the peritoneal cavity.  Dialysate is delivered from flexible plastic containers through a permanent peritoneal catheter. the bag is folded and tucked away during the dwell period. .

Leakage  Occur usually after the catheter is inserted  It stops for several days allowing the site to heal . staphylococcus aureus  Cloudy dialysate drainage.PD Complications 1. diffuse abdominal pain. and tenderness 2. Peritonitis  Most common and serious complication  Caused by: staphylococcus epidermidis.

through the opening of the fallopian tubes.3. Bleeding  Common during the first few exchanges  Common in young menstruating women  Hypertonic fluid pulls blood from the uterus. and into the peritoneal cavity 4. Long term complications  Abdominal hernias  Hemorrhoids .

Nursing Care :  chart client’s weight. every 15 minutes during first exchange. Have client void. Assemble specially prepared dialysate solution with added medications. .        and every hour thereafter.  Assess vital signs before. Inflow: allow dialysate to flow unrestricted into peritoneal cavity ( 10 -20 minutes) Dwell : allow fluid to remain I nperitoneal cavity for prescribed period ( 30 -45 minutes) Drain: unclamped outflow tube and allow to flow by gravity. Warm dialysate solution to body temperature. Assist physician with trocar insertion.

clear pale yellow: normal  B. brownish : bowel perforation  D. bloody : common during first few exchanges.  Monitor total I & O and maintain records . peritonitis  C. cloudy : infection. abnormal if continues. Observe characteristics of dialysate outflow:  A.

 B. Assess for complications:  A. assess for signs and symptoms of atelectasis.  Protein loss : most serum proteins pass through the peritoneal membrane and are lost in the dialysate fluid. respiratory difficulty: may occur from upward displacement of diaphram due to increased pressure in the peritoneal cavity. Peritonitis resulting from contamination of solution or tubings during exchange. monitor serum protein levels closely. pneumonia and bronchitis. .

Skin and mucous membranes free from ecchymoses/ bleeding: improved laboratory values ( CBC. Client verbalizes increased tolerance for activities. adequate urinary output with specific gravity/ laboratory      studies within client’s normal range. Vital signs within normal range. clotting factors) no signs of bleeding. client identify measures to prevent/ reduce the risk of infections. Client identifies ways to compensate for cognitive impairment. absence of edema. Stable weight gain. stable weight. demontrates improved problem solving skills. . Platelet. pulmonary congestion.Evaluation :  1.

Risk for infection 3. Fluid volume excess 7. Impaired skin integrity . Risk for injury 5. Altered urinary elimination 6.Nursing Diagnosis 1. Altered nutrition: less than body requirements 4. Altered tissue perfusion: renal 2.