Peritoneal Dialysis and Hemodialysis PDF

Hemo vs peritoneal Tenckhoff catheter is used in peritoneal dialysis. Hemodialysis: Blood is pumped from the arteriovenous fistula into a dialyzer. - lilinisin ang mixed na deox at oxygenated blood - Size 16 ang AV Fistula Needle na used in Hemodialysis In the dialyzer, waste products...

Hemo vs peritoneal Tenckhoff catheter is used in peritoneal dialysis. Hemodialysis: Blood is pumped from the arteriovenous fistula into a dialyzer. - lilinisin ang mixed na deox at oxygenated blood - Size 16 ang AV Fistula Needle na used in Hemodialysis In the dialyzer, waste products filter from the blood through an artificial membrane into a fluid called the dialysate. AV shot AV fistula 1. AV graft/shunt - Cannula is surgically placed in a large vein and large artery that approximate each other - Provides easy access to bloodstream - Prone to infections and clotting (prone sa clotting since mixed and deox at oxygenated blood) - Causes erosion of skin around the insertion site - 2–3 weeks 2. AV fistula - anastomosis of large artery and vein (fistula) - Purpose: to create one blood vessel for withdrawing and returning blood - Advantage: greater activity range than AV shunt - 2-3 months 3. Vein catheterization - Femoral or subclavian vein access is immediate - Catheters have two openings inside: 1. Red (arterial) opening to draw blood from the vein and out of the body into the dialysis pathway 2. Blue (venous) opening that allows cleaned blood to return to the body Tunneled vs Non–tunneled catheters 1. Non-Tunneled: used for emergencies and for short periods (up to 3 weeks) - deretso sa right atrium - mas delikado 2. Tunneled: - can be used for longer than 3 weeks - may tunnel under the skin - mas mahaba ang catheter - 2 ang incision Meet the Dialyzer (Your Artificial Kidney) - palaki ng number, palapad ang size Nursing Considerations: BEFORE: 1. Document the client’s weight (rationale: para alam ang huhugutin na fluids) 2. Obtain baseline VS (rationale: may chance na mag-hyper/mag-hypo) 3. Check medication hx (avoid hypertensives, sedatives, vasodilators) Rationale: Kapag may hypertensives, sedatives, vasodilators habang nagdadialysis, mas prone sa hypotension. DURING: 1. VS q30 minutes (q15 for 4-6 hours if abnormal) 2. Observe proper body alignment, allow frequent position changes (semi fowlers most appropriate position) 3. Monitor for nausea, vomiting (WOF for DDS/Dialysis Disequilibrium Syndrome) 4. Monitor for bleeding signs AFTER: (press nang matagal approximately 3-5 minutes, then i-tape) 1. Check the client’s weight (note any differences) 2. WOF bleeding and status of fistula 3. Assess for complications: - Blood related - Dialysate related - Patient related 1. Blood related: - Air in Blood Circuit - Air Embolism (pause then remove. bubble catcher etc.) - Blood Loss (d/t pag niremove, di pinepress. di mahigpit ang lock) - Access Recirculation (nagkakaroon ng stenosis, thrombosis) - Clotting - Poor BFR or blood flow rate (nangyayari pag di nagpapadialysis) - Needle Infiltration 2. Dialysate related - Dialysate Temperature - Hypothermia - Hyperthermia - Hemolysis - Crenation - Hypertonic dialysate  3. Patient related - Hypotension - Hypertension - Muscle Cramps - Headache - Nausea & Vomiting - Fever and/or chills - Fistula/Graft Infection, Thrombosis - Fistula Aneurysm, Pseudoaneurysm - Central Venous Catheter Infection - Catheter Thrombosis - Cardiac tamponade, pericarditis, pericardial effusion - Cardiac dysrhythmia - DDS (nahihilo, nasusuka) - First Use Syndrome (ethylene oxide. symptoms: neurologic changes) - Seizures - Angina - Anaphylaxis - Pruritus - Steal Syndrome (d/t constriction leading to hypoperfusion) - Cardiac Arrest - Dialysis Encephalopathy *Reverse osmosis (RO) water is used in Hemodialysis #2 add medications - crea, cbc #3 pwedeng nakaupo, pwedeng naka-semi fowlers blood lines: arterial (red), venous (blue) Twist tube, pull, babad sa acid concentrate #prefilled heparin syringe for clotting #3 Turn the machine on and perform safety checks: - machine safety - integrity of extracoporeal circuit (checking lang ng machine) Peritoneal Dialysis: using peritoneal membrane Four types: 1. Automated: can be used at home, reduces incidents of peritonitis 2. Intermittent:  - can be manual or automated - combines osmotic pressure with true dialysis 3. Continuous ambulatory PD - continuous na ambulatory na manual - most commonly used peritoneal dialysis - duration: 4 to 8 hours - portable type of dialysis 4. Continuous cycling PD (CCPD) - form of automated dialysis that uses an automated cycling machine Indications: 1. Px with Chronic Kidney Disease 2. Unstable patients who cannot tolerate anticoagulation 3. Patients with chronic infections, vascular access problems 4. Peritoneal dialysis is often the treatment of choice for older adults, because it offers more flexibility, if his or her status changes frequently. Contraindications: 1. Peritoneal adhesions 2. Extensive intra-abdominal surgery 3. Obesity 4. Recurrent episodes of peritonitis 5. Abdominal malignancies, ovarian cancers 6. Respiratory diseases, ruptured diverticulum NURSING CONSIDERATIONS BEFORE: 1. Allow the client to void before catheter insertion 2. Institute abdominal skin prep 3. Docu client’s WT and abdominal girth 4. Obtain baseline VS DURING: 1. Monitor electrolyte levels as prescribed 2. Obtain samples of return dialysate for culture 3. Monitor VS q30 minutes 4. Provide proper positioning for the dialysate to return from peritoneal cavity = semi fowler’s AFTER: 1. Compare client’s WT before and after 2. Monitor the dialysate remove (volume) - Volume: if greater than 500 mL or 1L is lost across 3 consecutive treatments = refer - Refer also if cloudy (cloudy = infection)  3. WOF for complications - Fluid overload - Excessive fluid loss - Pain + cloudy discharge - Severe pain in rectum/perineum d/t improper placement of catheter - Impaired breathing d/t increased pressure in diaphragm - Discomfort / pain: if dialysate is too acidic/too cold/introduced too quickly [ painitin muna bago i-connect sa patient(?) ]