Hemodialysis and Peritoneal Dialysis
Hemodialysis
Hemodialysis is a procedure where a dialysis machine and a special filter (artificial kidney or a dialyzer) are used to clean the blood from toxins.
Access
The client may have dialyis via a central catheter, a fistula, or a graft.
Fistula & Graft
A fistula is a vein and an artery joined together surgically. The high flow/pressure of the artery makes the fistula enlarge for easier dialysis access. If smaller veins, the surgeon inserts a graft, a soft tube that joins the artery and the vein.Â
Feel the thrill
The NCLEX wants you to know that you must “feel the thrill and hear the bruit (with a stethoscope)” to make sure the fistula is patent/open or not clotted off.Â
Compliance
Clients usually have dialysis 3 to 4 times a week for 3 to 4 hours at time. Compliance or following dialysis schedule is essential to prevent complications suc has fluidoverload and hyperkalemia
Abnormalities in renal failure
Make sure you know these abnormalities in renal failure. They show up frequently on the NCLEX.
Hyperkalemia
The kidney's cannot get rid of potassium, which leads to cardiac problems /death.
Hyperparathyroidism
Due to hypocalcemia, the parathyroid works overtime trying to increase calcium
Hypocalcemia
The kidneys do not make calcitriol, which is necessary to activate Vi D & absorb calcium
Hyperphosphatemia
Kidneys and dialysis cannot get rid of phosphorus. The patient must take phosphorus binders.
Peritoneal Dialysis
- This is peritoneal dialysis.Â
- The peritoneum is used as the semi-permeable membrane where fluid and waste products are removed.Â
- A catheter is inserted in the abdominal cavity.
- Dialysate is infused and drained from peritoneal space.
- If when draining dialysate, it is not coming out, turn client from side to side to promote drainage.
- The number one complication is peritonitis.Â
- Strict Aseptic technique must be taught to the client.
- Again, Aseptic technique to prevent peritonitis.
- Handwashing is the number 1 way to prevent infection