Care of Hemodialysis and peritoneal dialysis patients

Jaisha

Nursing Supervisor, Kauvery Hospital, Hosur, Tamil Nadu

Introduction

Dialysis is a procedure for cleaning and filtering the blood substitute for kidney function when the kidneys cannot remove the nitrogenous waste products and maintain adequate fluid, electrolyte and acid base balance.

Indication

  • Acute renal failure
  • Chronic renal failure
  • Poisoning
  • Severe metabolic acidosis
  • Hyperkalemia
  • Fluid overload or acute pulmonary edema

Types

  • Hemodialysis ( through the machine)
  • Peritoneal dialysis (through the peritoneal cavity )

Hemodialysis

Hemodialysis, also known as “hemo,” is a life-saving treatment for kidney failure that utilizes a machine to filter wastes and excess fluid from the blood when the kidneys are unable to do so effectively.

Access

  • Central venous catheter
  • Intrajugular catheter
  • Tunneled catheter.
  • Femoral catheter.
  • Subclavian catheter.
  • Arteriovenous fistula.
  • Arteriovenous graft.

Complications

  • Hypotension
  • Muscle cramps
  • Itching
  • Sleep problems
  • Anemia
  • Bone disease
  • Hypertension
  • Access site complication
  • Air embolism
  • Amyloidosis

Predialysis care

Assessment

  1. Weight: Determines amount of fluid to be removed during dialysis.
  2. Vital signs: BP for hypo and hypertension, temperature for sepsis, respiration for fluid overload.
  3. Potassium level: Determines potassium level in dialysate, this is done monthly if patient is symptomatic.
  4. Anticoagulation status.
  5. Hold the antihypertensive drugs, especially if systolic pressure is below 100 as per
  6. History of head ache, vomiting, diarrhea, fever, bleeding, any fall or any other signs and symptoms that a patient experienced since last dialysis.
  7. Assess the neurological status like speech and mental status.
  8. Check the condition and patency of vascular access.
  9. Check the catheter exit site for sign of infection.

Continuous ambulatory Intra-dialysis monitoring

  • Monitor vital signs.
  • Monitor for complications like hypotension, muscle cramps, nausea, vomiting, itching, head ache and chills.
  • Less commonly disequilibrium syndrome, arrhythmia, cardiac tamponade, seizure, air embolism and cardiac arrest.
  • Monitor access site for any oozing, dislocation of catheter or needles and machine parameters.
  • Discuss about diet and its restrictions.
  • Discuss about medications and vaccination status.

Post dialysis care

  • Monitor for vitals and report for hypotension and hypertension.
  • Watch for bleeding.
  • Check the weight and compare it with pre dialysis weight.
  • Check the access site for bruit, hematoma, swelling and catheter dressing.
  • Fix the dry weight.
  • Watch for other complications like muscle cramps, itching and breathing difficulty.
  • Mental status.

Peritoneal dialysis

It is a treatment for kidney failure that filters your blood using the lining of your abdomen.

Types of PD

  • Peritoneal dialysis (CAPD): Performing dialysis several times a day.
  • Automated peritoneal dialysis: A machine helps to filter your blood during the night while you sleep.
  • It can be done at home with cautious about clean environment.

Indications

  • Arteriovenous access failure.
  • Intolerance to hemodialysis.
  • Congestive heart failure.
  • Children aged 0-5years with end stage renal disease.

 

Complication

Infectious complication

  • Peritonitis
  • Exit site or tunnel infections.

Noninfectious complications

  • Impaired flow
  • Leak.
  • Pain (during infusion or drainage).

Related to increased intra-abdominal pressure

  • Back pain
  • Hernia
  • Hydrothorax.

Metabolic

  • Hypokalemia.
  • Metabolic syndrome.
  • Weight gain.

Care of patients on peritoneal dialysis

Infection prevention

  • Exit site care.
  • Catheter care.
  • Dialysate care.
  • Sterile technique.
  • Dressing.

Monitoring and assessment

  • Vital signs
  • Dialysis fluid
  • Fluid and electrolyte balance.
  • Weight.

Patient education

  • Self-care techniques.
  • Diet and modifications.
  • Complications
  • Emotional support.
  • Medications.
  • Exercise.

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