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