Hemodialysis procedure

• Hemodialysis replicates kidney function using a closed system outside the body.
• The process eliminates waste, excess water and corrects electrolyte abnormalities, restoring the acid-base buffer system.

Hemodialysis Requirements

• Successful hemodialysis needs client circulation access.
• Semi-permeable membrane (dialysis machine) is required.
• Hemodialysis solution consists of highly purified water, electrolytes, and dextrose.

Access Sites for Hemodialysis

• Central Venous double lumen catheters are for temporary acute situations.
• Arteriovenous fistulas involve surgically connecting the radial artery to the cephalic vein to create a large access point under the skin.
• Arteriovenous grafts use a synthetic graft if the peripheral vascular system is not intact or fragile.

Standard Dialysis Procedure (~4 hours)

• Begins with securing access to the client's circulation.
• Heparin is administered to prevent clotting at the access site.
• Heparinized blood flows in one direction through a semipermeable membrane.
• Dialysis solution flows in the opposite direction.
• Diffusion removes wastes and corrects electrolytes.
• Ultrafiltration removes excess water from the blood.
• Filtered blood returns to the client.

Nursing Interventions during Hemodialysis

• Administer anticoagulants and monitor for bleeding.
• Frequent monitoring of vital signs is essential, as hypotension may occur due to excessive fluid removal.
• Antihypertensives should be withheld before hemodialysis to avoid potential hypotension.
• Blood pressure should be checked on the arm without a fistula or graft.
• Provide appropriate nutrition, considering the patient can eat before or during dialysis.

Assessment Findings of Suspected Air Embolism

• Monitor for tachypnea, chest pain, anxiety, and changes in sensorium.
• Watch for hypotension and reduced O2 saturation (O2Sat).

Nursing Interventions for Suspected Air Embolism

• Immediately clamp the access tubing to prevent further air entry.
• Reposition the client to a left-side Trendelenburg position to help trap the air in the right atrium.
• Administer high-flow oxygen.
• Immediately notify the Healthcare Provider (HCP) as it is a medical emergency.

Suspected Disequilibrium Syndrome Information

• Occurs as a result of rapid changes in the composition of extracellular fluid.
• Solutes are removed from the blood more quickly than from the cerebrospinal fluid and brain, leading to an imbalance between extracellular and intracellular fluid.
• Often observed in new clients initiating hemodialysis sessions.

Clinical Manifestations of Disequilibrium Syndrome

• Symptoms include nausea, vomiting, and headache.
• Restlessness and agitation can occur.
• In severe cases, may manifest as confusion, seizure, and potentially death.

Nursing Interventions for Disequilibrium Syndrome

• Reduce or stop dialysis.
• Immediately notify the Health Care Provider (HCP).
• Lessen environmental stimuli to provide a calm atmosphere.
• High osmolar substitutes, such as IV hypertonic saline or IV mannitol, may be administered.
• Shorter dialysis periods at reduced flow rates may be prepared to prevent recurrence.