DIALYSIS

Dialysis
- Removal by artificial means of
metabolic wastes, excess electrolytes,
and excess fluid from clients with renal
failure using the principles of diffusion
and osmosis.

Purposes of Dialysis:
1.

2.

3.

4.

Remove the end products of protein

metabolism from the blood.
Maintain safe levels of electrolytes
Correct acidosis and replenish blood
bicarbonate system
Remove excess fluid from the blood.

HEMODIALYSIS
- Shunting of blood from the clients
vascular system through an artificial
dialyzing system, and return of dialyzed
blood to the clients circulation

TATAGAL PA BA AKO?

ACCESS ROUTES:
a. External AV shunt
One cannula inserted into an artery and
the other into a vein; both are brought
out to the skin surface and connected by
a U-shaped shunt
Nursing Care:
1. Auscultate for a bruit and palpate for a
thrill to ensure patency

2. Assess for clotting (color change of

blood, absence f pulsation in the tubing)
3. Change sterile dressing over shunt daily.
4. AVOID performing venipuncture,
administering IV infusions, giving
injections, or taking a BP with a cuff on
the shunt arm.

b. AV Fistula

Internal anastomosis of an artery to an

adjacent vein in sideways position; fistula
is accessed for hemodialysis by
venipuncture; It takes 4-6 weeks to be
ready for use

Nursing Care for AV Fistula:

1. Auscultate for a bruit and palpate for a
thrill to ensure patency.
2. Report bleeding, skin discoloration,
drainage and pain.
3. AVOID restrictive clothing/ dressing
over the site.
4. AVOID administration of IV infusions,
giving injections, or taking BP with a
cuff on the fistula extremity

b. Femoral/ Subclavian Cannulation

Insertion of a catheter into one of these

large veins for easy access to the
circulation; Procedure is similar to
insertion of a CVP line
Nursing Care:
1. Palpate peripheral pulses in cannulized
extremity

2. Observe for bleeding/ hematoma

formation
3. Position catheter properly to avoid
dislodgement during dialysis

Nursing Care: BEFORE & DURING

DIALYSIS
1. Have the client void.
2. Chart clients weight
3. Assess vital signs before and every 30
minutes during the procedure
4. Withhold antihypertensive, sedative and
vasodilators unless ordered otherwise.

5. Ensure bed rest with frequent position

changes for comfort.
6. Inform client that headache and nausea
may occur.
7. Monitor closely for signs of bleeding
since blood has been heparinized for the
procedure

Nursing Care: POST DIALYSIS

1. Chart the clients weight
2. Assess for complications
a. Hypovolemic Shock
b. Bleeding
c. Dialysis Disequilibrium Syndrome
- nausea, vomiting, elevated BP,
disorientation, leg cramps, seizures,
and peripheral paresthesias

d. Air embolism
e. Infections
f. AIDS
g. LVH
h. Bone problems

Key Nursing Diagnosis

1. Risk for infection related to regular
exposure of the clients blood to the
external environment
2. Impaired gas exchange related to
altered blood flow during dialysis
3. Risk for deficient fluid volume related
to rapid fluid removal and electrolyte
changes during dialysis

PERITONEAL DIALYSIS
Introduction of a specially prepared
dialysate solution into the abdominal cavity,
where the peritoneum acts as a
semipermeable membrane between the
dialysate and blood in the abdominal vessels

Nursing Care:
1. Chart the clients weight.
2. Assess vital signs before, every 15
minutes during first exchange, and every
hour thereafter.
3. Assemble specially prepared dialysate
solution
4. Have a client void
5. Inflow: allow dialysate to flow
unrestricted (10-20 minutes)

6. DWELL: Allow the fluid to remain in the

peritoneal cavity for prescribed period (30-45
minutes)
7. DRAIN: Unclamp outflow tube and allow to
flow by gravity
8. Observe characteristics of the solution:
CLEAR PALE YELLOW normal
CLOUDY infection, peritonitis
BROWNISH bowel perforation
BLOODY common initially but abnormal
if continuous

9. Assess for complications

a. Peritonitis
b. Respiratory difficulty
c. Protein loss
d. Hypovolemia

Key Nursing Diagnoses

1. Risk for infection related to catheter
insertion into the peritoneum
2. Deficient knowledge to unfamiliarity
with peritoneal dialysis
3. Risk for deficient fluid volume related
to excessive fluid removal during the
procedure.