Hemodialysis

What are the two common choices for permanent vascular access?

-AV fistula -AV graft

What is the general selection criteria for HD?

-Irreversible kidney failure when other therapies are unacceptable or ineffective -Absence of illnesses that would seriously complicate HD -Expectation of rehabilitation -The patient's acceptance of the regimen

What are the types of subclavian dialysis catheters?

-Mahurkar catheter -PermCath Catheter

What is a subclavian dialysis catheter?

-a radiopaque tube that can be used for hemodialysis -Y-shaped tubing allows arterial outflow and venous return through a single catheter

What does the survival rate of a patient on HD depend on?

-age -cause of kidney failure -presence of other diseases (CAD, HTN, DM)

What medications should be given after HD treatment?

-antibiotics -vasoactive drugs

What happens during hemodialysis?

-blood and dialysate run in different directions -toxins are diffused into the dialysate, leaving the patient's blood free from toxins/at least reduced toxins

What are the four parts of the dialyzer?

-blood compartment -dialysate compartment -semipermeable membrane -enclosed support structure

Why should vasoactive medications be given after HD treatment?

-cause hypotension during HD

What can the change in urea level cause?

-cerebral edema -increased intracranial pressure

What are some of the alarms on a HD machine?

-change in dialysate temperature -air in blood tubing -blood leak in dialysate compartment -changes in pressure of either compartment -changes in composition of the blood/dialysate

What type of procedure is involved in hemodialysis?

-complex -specially trained registered nurse required

What are complications of hemodialysis?

-dialysis disequilibrium syndrome -infectious disease

Why should antibiotic be given after HD treatment?

-dialyzable -can be partially removed from blood during dialysis

What does a HD system include?

-dialyzer -dialysate -vascular access routes -HD machine

What are possible complications of hemodialysis?

-disequilibrium syndrome -muscle cramps -hemorrhage -air embolus -hemodynamic changes (hypotension, anemia) -cardiac dysrhythmias -infection

Where is an AV graft located?

-forearm -upper arm -inner thigh

What neurological symptoms can result from dialysis equilibrium syndrome?

-headache -nausea/vomiting -restlessness -decreased LOC -seizures -coma -death

What are the two most serious blood-transmitted infections from long-term HD?

-hepatitis (B/C) -HIV

Where can the patient go for HD treatment?

-hospital-based center (recently started TX/have complicated conditions requiring supervision) -community/freestanding HD center -outpatient center/in-home HD

What are common problems postdialysis and should be closely monitored for?

-hypotension -headache -nausea/vomiting -malaise/dizziness -muscle cramps/bleeding

Where may hemodialysis be preformed?

-in-patient procedure on critically ill patients -out-patient for more stable patients

What is the rationale for warming the dialysate?

-increase the diffusion rate -prevent hypothermia

What are reasons a patient can not participate in in-home HD?

-lack skilled partner to assist with therapy/manage dialysis machine -find use of in-home dialysis too stressful -water systems must be installed in home to provide safe, clean water supply

What are the advantages of in-home HD?

-least disruptive -allows patient to adapt regimen around their lifestyle

What is a Mahurkar catheter?

-made of polyurethane -used for short-term access

What is a PermCath catheter?

-made of silicone -used for long-term access

What are the advantages of hemodialysis?

-more efficient clearance -short time needed for treatment

What are the types of vascular access for HD?

-permanent -temporary

What vessels are used to form an AV fistula?

-radial/brachial artery and a cephalic vein of nondominant arm

Why are berry aneurysms dangerous?

-they are susceptible to rupture -often lead to fatal bleeding within the brain

What complications can occur with vascular access?

-thrombosis (most frequent) -stenosis -infections -aneurysms -ischemia -heart failure

What do you have to do to access the AV fistula?

-two needles are used -one toward venous blood flow (clean blood is returned to the body) -other toward arterial blood flow (blood comes out to be cleaned)

What are the nursing implications in hemodialysis?

-vascular access care -restrict diet

What type of access is used in hemodialysis?

-vascular route

How long does it take for an AV graft to mature?

1-2 weeks

What is the dialysate warmed up to during HD?

100° F (37.8° C)

How long does it take for an AV fistula to mature?

2-4 months or longer

What is an AV fistula?

an internal anastomosis of an artery to a vein

What is given during hemodialysis to prevent clotting?

anticoagulants

What could happen if the alarm is not answered on the HD machine?

could cause a life-threatening complication

What is dialysate?

dialyzing solution

What is dialysate?

dialyzing solution that mimics human plasma

Where is an AV fistula located?

forearm

What is contraindicated in hemodialysis?

hemodynamically instability

What type of anticoagulant is given during hemodialysis?

heparin

What is hemodialysis?

most common renal replacement therapy used in ESKD and kidney failure

What is diffusion?

movement of molecules from an area of higher concentration to an area of lower concentration

What is of utmost importance with vascular access?

prevention of infection

What is the antidote for heparin?

protamine sulfate

What causes dialysis disequilibrium syndrome?

rapid decrease in fluid volume and BUN levels during HD

What are berry aneurysms?

small, berry-shaped outpouchings of the main arteries that supply the brain

How is dialysis disequilibrium syndrome prevented?

starting HD for short periods with low blood flows so that rapid chagnes in plasma composition are avoided

When HD is expected to be used for several weeks what type of catheter is used?

subclavian dialysis catheter

What is an AV graft?

synthetic vessel tubing tunneled beneath the skin, connecting an artery to a vein

What is the dialyzer also known as?

the artificial kidney

How are the vessels selected for vascular access?

they need to maintain an infusion of 250-300ml/min for 3-4 hours