HEMODIALYSIS

Is the most common form of dialysis use. Is used for patients who are acutely ill and require short term dialysis and for patients with ESRD who require long-term or permanent therapy. Usually done 3 times a week for 3-4 hours treatment. Objectives: Extract toxic nitrogenous substances from the blood Remove excess water

Principles:

DIFFUSION toxins and wastes are removed from an area of higher concentration in the blood to an area of lower concentration in the dialysate. OSMOSIS is used to remove the excess water, in which water moves from an area of higher solute concentration (the blood) to an area of lower solute concentration (the dialysate). ULTRAFILTRATION water moves under high pressure to an area of lower pressure.

DIALYSATE - is a solution made up of all the important electrolytes in their ideal extracellular concentrations. Is usually made up of bicarbonate or acetate. DIALYZER are hollow fiber devices containing thousands of tiny cellophane tubules that act as semi-permeable membrane. Heparin is administered to keep the blood from clotting in the dialysis circuit. VASCULAR ACCESS
1. Vascular Access Device- is done by inserting a double-lumen large bore catheter

into the subclavian, internal jugular, or femoral vein and can only be used for no longer than 3 weeks while a double-lumen cuffed catheter is inserted into the internal jugular vein of patients requiring a central venous catheter for dialysis and may be used for long-term access .Some of the risks involved in this procedure are: Hematoma

Pneumothorax Infection Thrombosis of the subclavian vein Inadequate flow

2. Arteriovenous Fistula is created surgically by joining an artery to a vein, either

side-to-side or end-to-side and is the preferred method of permanent access. The fistula should be allowed at least 14 days to mature. Patients are encouraged to do exercises to increase the size of these vessels.
3. Arteriovenous Graft can be created by subcutaneously interposing a biologic,

semibiologic, or synthetic graft material between an artery and a vein. Candidates for this type of access are patients whose vessels are not suitable for the creation of a fistula. Infection and thrombosis are the most common complications of arteriovenous grafts. Complications:
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Disturbances of lipid metabolism Gastric ulcers and other GI problems Disturbed calcium metabolism Fluid overload Hypotension Painful muscle cramping Exsanguination Dysrythmias Air Embolism Chest pain Dialysis disequilibrium

Nursing Management

Pharmacologic Therapy Nutritional and Fluid Therapy - Restriction of dietary protein (with high caloric value) - Fluid restriction (an amount equal to the daily urine output plus 500ml/day) - Sodium restriction

Meeting Pyschosocial Needs - Suicide precaution

Promoting Home and Community-Based Care