Access Route for Hemodialysis Arteriovenous Fistula

Abbreviation AVF

Description A section of vein is directly sutured to an artery. It is usually placed in the nondominant arm, using the cephalic vein and radial artery Connection tube is clients own (autologous) saphenous vein, or made from polytetrafluoroethylene (PTFE)

Arteriovenous Graft

Central Venous Catheter

CVC

Catheter inserted by directly cannulating the vein. Usual CVC sites are: femoral, internal jugular, or subclavian veins

Procedure for hemodialysis 1. Patients circulation is accessed 2. Unless contraindicated, heparin is administered 3. Heparinized (heparin: natural clot preventer) blood flows through a semipermeable membrane in one direction 4. Dialysis solution surrounds the membranes and flows in the opposite direction 5. Dialysis solution is: a. Highly purified water b. Sodium, potassium, calcium, magnesium, chloride and dextrose c. Either bicarbonate or acetate, to maintain a proper pH 6. Via the process of diffusion, wastes are removed in the form of solutes (metabolic wastes, acid-base components and electrolytes) 7. Solute wastes can then be discarded or added to the blood 8. Ultrafiltration removes excess water from the blood 9. After cleansing, the blood returns to the client via the access Complications related to vascular access in Hemodialysis 1. Infection 2. Catheter clotting 3. Central venous thrombosis 4. Stenosis or thrombosis 5. Ischemia of the affected limb 6. Development of an aneurysm Nursing interventions for Hemodialysis 1. Explain procedure to client 2. Monitor hemodynamic status continuously 3. Monitor acid-base balance 4. Monitor electrolytes 5. Insure sterility of system 6. Maintain a closed system

7. Discuss diet and restrictions on: a. Protein intake b. Sodium intake c. Potassium intake d. Fluid intake 8. Reinforce adjustment to prescribed medications that may be affected by the process of hemodialysis 9. Monitor for complications of dialysis related to: a. Arteriosclerotic cardiovascular disease b. Congestive heart failure c. Stroke d. Infection e. Gastric ulcers f. Hypertension g. Calcium deficiencies (bone problems such as aseptic necrosis of the hip joint) h. Anemia and fatigue i. Depression, sexual dysfunction, suicide risk

hemodialysis (also haemodialysis) is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies (the other two being renal transplant; peritoneal dialysis). Advantages
  

Low mortality rate Better control of blood pressure and abdominal cramps Less diet restriction

Better solute clearance effect for the daily hemodialysis: better tolerance and fewer complications with more frequent dialysis [17] [edit]Disadvantages
 

Restricts independence, as people undergoing this procedure cannot travel around because of supplies availability Requires more supplies such as high water quality and electricity Requires reliable technology like dialysis machines The procedure is complicated and requires that care givers have more knowledge Requires time to set up and clean dialysis machines, and expense with machines and associated staff[17]

   

Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease. The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis).

The process of doing peritoneal dialysis is called an exchange. You will usually complete 4 to 6 exchanges each day using the following steps: 1. Fill: Dialysis fluid enters your peritoneal cavity. 2. Dwell: While the fluid is in your peritoneal cavity, extra fluid and waste travel across the peritoneal membrane into the dialysis fluid. 3. Drain: After a few hours, the dialysis fluid is drained and replaced with new fluid. There are different types of peritoneal dialysis. Discuss these treatment methods with your doctor to decide which one might work best for you.
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Continuous ambulatory peritoneal dialysis (CAPD). During CAPD, the dialysate solution stays in your belly for about 4 to 6 hours. After this time, the solution is drained out of your belly. Your belly is then refilled with fresh solution. You need to change the solution about 4 times a day. This is the most commonly used form of peritoneal dialysis.

Continuous cycling peritoneal dialysis (CCPD). During CCPD, a machine automatically fills and drains the dialysate from your belly. This process takes about 10 to 12 hours, so you can perform CCPD at night while you sleep.

Peritoneal dialysis (per-ih-tuh-NEE-ul di-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can no longer do the job adequately. During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys, with the help of a fluid (dialysate) that flows into and out of the peritoneal space. Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling. You may be able to use fewer medications and eat a less restrictive diet than you can with hemodialysis. Peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity (or a reliable caregiver) and the ability to care for yourself at home.

The kidneys are responsible for filtering waste products from the blood.Dialysis is a procedure that is a substitute for many of the normal duties of the kidneys. The kidneys are two organs located on either side of the back of the abdominal cavity. Dialysis can allow individuals to live productive and useful lives, even though their kidneys no longer work adequately.