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    Hemodialysi S: Ariane Jake C. Fernandez, RN, MSN

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    Micah Alexis Candelario
    Hemodialysis is the most common method of dialysis for patients with end-stage renal disease or acute kidney injury. It involves removing waste products and excess fluid from the blood through diffusion and osmosis using an external dialysis machine and artificial kidney called a dialyzer. Treatments usually last 3-4 hours and are done 3 times a week. Nursing management includes monitoring vitals, administering heparin to prevent clotting, assessing for complications, and caring for vascular access sites. The goals of hemodialysis are to remove toxins, correct electrolyte and fluid imbalances, and replace lost kidney functions until transplantation can be done.

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    Hemodialysi S: Ariane Jake C. Fernandez, RN, MSN

    Uploaded by

    Micah Alexis Candelario
    517 views37 pages
    Hemodialysis is the most common method of dialysis for patients with end-stage renal disease or acute kidney injury. It involves removing waste products and excess fluid from the blood through diffusion and osmosis using an external dialysis machine and artificial kidney called a dialyzer. Treatments usually last 3-4 hours and are done 3 times a week. Nursing management includes monitoring vitals, administering heparin to prevent clotting, assessing for complications, and caring for vascular access sites. The goals of hemodialysis are to remove toxins, correct electrolyte and fluid imbalances, and replace lost kidney functions until transplantation can be done.

    Original Title

    HEMODIALYSIS

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    Hemodialysis is the most common method of dialysis for patients with end-stage renal disease or acute kidney injury. It involves removing waste products and excess fluid from the blood through diffusion and osmosis using an external dialysis machine and artificial kidney called a dialyzer. Treatments usually last 3-4 hours and are done 3 times a week. Nursing management includes monitoring vitals, administering heparin to prevent clotting, assessing for complications, and caring for vascular access sites. The goals of hemodialysis are to remove toxins, correct electrolyte and fluid imbalances, and replace lost kidney functions until transplantation can be done.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    517 views37 pages

    Hemodialysi S: Ariane Jake C. Fernandez, RN, MSN

    Uploaded by

    Micah Alexis Candelario
    Hemodialysis is the most common method of dialysis for patients with end-stage renal disease or acute kidney injury. It involves removing waste products and excess fluid from the blood through diffusion and osmosis using an external dialysis machine and artificial kidney called a dialyzer. Treatments usually last 3-4 hours and are done 3 times a week. Nursing management includes monitoring vitals, administering heparin to prevent clotting, assessing for complications, and caring for vascular access sites. The goals of hemodialysis are to remove toxins, correct electrolyte and fluid imbalances, and replace lost kidney functions until transplantation can be done.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    HEMODIALYSI

    ARIANE JAKE C. FERNANDEZ, RN, MSN


    Treatment Options:

    1. Dialysis
    Hemodialysis
    Peritoneal Dialysis

    2. Renal Transplantation
    Dialysis

     From the Greek “dalusis” - dissolution, “dia”- through,


    and “lysis”- loosening.

     Dialysis is primarily ursed to provide an artificial


    replacement for lost kidney function in people with renal
    failure.

     Most patients begin dialysis when their kidneys have lost


    85% - 90% of their ability

     Dialysiswill continue for the rest of their lives/ until


    kidney transplant is done.
    The main functions of dialysis are to:

     Remove waste products such as BUN, Uric


    Acid, Excess electrolytes, Excess fluid
    from the blood to prevent build-up
     Treat patient with edema that does not
    respond to treatment
     Patient's with hyperkalemia, Hypertension
    and uremia
     It may also be used to remove certain
    medications or other toxins (poisoning or
    medication overdose) in the blood
    INDICATIONS
    Types of Dialysis:

     Hemodialysis

     Peritonieal Dialysis
    HEMODIALYSI
    S
    HEMODIALYSIS

     Most common and


    efficient method of
    dialysis
     Used for acute ill
    patient and require
    short term dialysis and
    for patients with ESRD
    who require long term,
    permanent therapy or
    until kidney transplant
    is done.
     The blood travels from the body to the
    machine through tubes inserted into a
    vein in your arm, leg, or neck through the
    artificial kidney called 'dialyzer” to
    excrete waste products and regulate
    electrolytes.

     Treatments are usually 3x a week for at


    least 3-4 hours per permanent treatment.
    Principles of Hemodialysis:
    1. DIFFUSION - toxins and waste in the blood
    tent to move from an area of higher
    concentration to and area of lover concentration.
    2. OSMOSIS - Excess water is removed by
    osmosis in which water moves from an area
    of lower concentration (dialysate bath) to an
    area of higher solute concentration (blood)
    3. ULTRAFILTRATION - water moving
    under higher pressure to an area of lower
    pressure. the force is necessary to remove
    fluid to achieve fluid balance.
    Equipment for Hemodialysis
    1. Hemodialysis machine

    Hemodialysis machine is required to


    pump the blood at requisite flow.
    The machine also monitors the flow
    parameters and the pressure in the circuit.
    The amount of ultrafiltration (removal
    of excess fluid from the body) can be
    programmed into the machine and current
    day machines will precisely remove the
    fluid to the last milliliter
    BLOODLINES
    Equipment for hemodialysis
    2. Dialyzer or the artificial Kidney

    Dialyzer acts as the semipermeiable membrane.


    Blood is pulled from the patient and carried into the
    filter.
    Once inside, the blood travels through many tiny
    tubules called hollow fibers.
    Water and solutes can pass acreoss the semi-
    permeable membrane between the blood and the fhuid
    that surrounds the follow fibers. Any fluid or solutes that
    enters the filter canister will be drained out as waste.
    Note: how the dialysis filter has structural similarities to the nephron unit. Blood
    arrives at the filter via the access tubing (afferent arterioles). Blood enters the
    small hollow fibers within the filter (glomerulos). Water and solutes diffuse across
    the semi-permeable membrane of the hollow fibers and collect in the canister
    (Bowman's capsule). Collected fluid (filtrate or effluent) is then removed via the
    drainage bag (collecting tubule). Blood that remains in the hollow fibers is
    returned to the patient via the return side of the filter) efferent arterial.
     Although they have similarities between
    nephron and dialyzer, they also have
    difference like some electrolytes and water
    are not reabsorbed.

     Any filtrate that enter the dialyzer will be


    removed via drainage tubule.

     This would only be controlled by adjusting the


    dialysis solution and ultrafiltration rate.
    NORMAL KIDNEYS Artificial Kidneys/ Dialyzer
     Urine formation x
     Excretion of waste
    products
     Regulation of electrolytes
     Regulation of Acid-base x
    balance
     Control of water balance
     Renal clearance
     Regulation of Red Blood x
    Cell
     Synthesis of Vitamin D to x
    active form
     Secretion of Prostaglandin x
     Auto regulation of Blood x
    pressure
    Equipment for Hemodialysis
    3.Dialysate bath is a solution that is
    composed of electrolytes, buffer such
    as lactate and acetate, and the most
    common is bicarbonate.
    Equipment for Hemodialysis

    5. Vascular Access which is allow blood to be removed,


    cleansed, adn returned to the patient's vascular system at
    rates between 200-800 ml/min
    Types of Vascular Access
    1. Subclavian, Internal Jugular, and Femoral Catheters - not permanent
    and is usually used for immediate hemodialysis. It is also used if the AV
    fistula or Graft are not yet matured.
    Types of Vascular Access

    2. Arteriovenous Fistula - it is a permanent site which is


    surgically done by anastomosing the artery to vein.
    Fistulas may need to be matured (6-8 weeks) before it can
    be used.
    Types of Vascular Access

    3. Arteriovenous Graft - subcutaneous interpositioning of


    a biologic, semibiologic orosynthetic graft.
    Nursing Management
    Before Hemodialysis

     There is an increase in BUN, creatinine, serum


    phosphorus, potassium, and low levels of hemoglobin,
    hct, Ca and Na (MUST HAVE lab exam)

     Weight and blood pressure (NOT on the site of AV


    fistula/graft) of the patient are taken. Dry weight also
    must be identified.
    Nursing Management

     Wash hands and use clean or sterile gloves (depends on


    the hospital protocols).

     Topical anesthetic is applied for needle insertion.


    Nursing Management
    During Hemodialysis

     Monitor VS especially closely monitore BP every 30


    minutes

     Administer of heparin to prevent blood clot. Coantact


    patient's bloodwith the dialysis membrane and the
    tubing leads to activition of the coagulation cascade.

     BT may be done as ordered


     Watch for complications during dialysis

    1. hypotension - may occur because fluis is removed. Nausea,


    vomiting, diaphorsis, tachycardia and dizziness are common signs of
    hypotenion
    2. Painful muscle cramping - rapic electrolyte excretion
    3. Exsanguination - dialysis needles are dislodge
    4. Dysrythmias - electrolyte and ph changes
    5. Air embolism
    6. Disequilibrium syndrome - results from cerebral fluid shifts of urea
    nitrogen in the blood rapidly. Nausea and vomiting, decreased LOC
    are the common symptoms.
    Assessment

     Assess access site for swelling or redness


     Check for audible bruit sign and palpable thrill in the AV
    fistula and graft.
     Assess client knowledge regarding hemodialysis
    Protect the Vascular
    Access
     Protect from damage
     Assess for patency
     Do not use extremity for BP taking or venipuncture
     Instruct to avoid tight dressing, restraints or jewwelty
    over vascular access
     Clean with soap and water
    After Hemodialysis

     Monitor VS expecially BP

     Weight patient

     Must obtain Lab examination and serum electrolytes (if


    ordered)
    Diet
    Goals:
    Maintain body weight (age, height, build)
    Maintain serum lab values within safe limits
    Comply with dietary regiment

    • Low sodium, Protein, Potassium, Phosphorus

    • High in Calcium
    Pharmacologic Treatment
     Protamine Sulfate - antidote for heparin
     Epogen/Synthetic erythropoietin
     Blood pressure medications
     Calcium supplements or multivitamins
     Phosphorus binders - to lower phosphorus levels in the
    blood
     Diuretics - to remove excess fluids
     Stool softeners or laxatives - to prevent or treat
    constipation, which can be caused by decreased fluid
    intake
     Ironsupplememt - to increase iron intake, which is
    important for production of red blood cells.

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