Hemodialysis, according to the free web dictionary is “the process of removal of certain elements from the blood by virtue of the difference in rates of their diffusion through a semipermeable membrane while being circulated outside the body; the process involves both diffusion and ultra filtration” (Free Web Dictionary, 2009). It is normally used for clients with acute or irreversible renal failure and fluid and electrolyte imbalances. Hemodialysis is usually the treatment of choice when toxic agents, such as barbiturate overdose, need to be removed from the body quickly (Black, & Matassarin, 1993). The procedure for hemodialysis involves diverting toxin laden blood from the client into a dialyzer and then returning the clean blood to the client. While the blood is within the dialyzer, the dialysis fluid is delivered by a mechanical proportioning pump to flow on the other side of the membrane from the blood to the dialysate. Strict asepsis must be maintained through out the procedure. The major routes of access are external arteriovenous shunts and subclavian fistulas and grafts for chronic dialysis. When the patient is to be connected to the hemodialyzer, a tube leading to the membrane compartment is connected to the arterial cannula. Blood then fills the membrane compartment and flows back to the venous cannula. When the dialysis is complete, the arterial cannula is clamped. Once the blood in the membrane compartment has been returned to the body, the venous cannula is clamped, and the ends of the two cannulas are reattached to form their U. The arteriovenous (AV) fistula is the access of choice for chronic dialysis clients. The fistula is created through a surgical procedure in which an artery in the arm is anastomosed to a vein in an end to side, side to side, side to end, or end to end fashion. These fistulas need 2 to 6 weeks to mature before they can be used there fore care must be taken (Carol, 2005).
The thrill is a buzzing feeling within the vascular access. It is felt through palpation. The bruit is listened to by use of a stethoscope at the vascular access and it is a swishing sound which is continuous, soft, and low pitched. These are an indication that the vascular access is not clotted. Bruit and thrill must be felt before any vascular needle is put into the access. The common complications include cardiac arrhythmias from potassium imbalance, air embolism, hypotension and hypertension, blood leaks, muscle cramp as a result of hyponatremia or hypo-osmolality, and infection, dialysis equilibrium syndrome which is characterized by mental confusion, deterioration of the level of consciousness, headache, and seizures and my last for several days. Nausea and vomiting is also common and it can be managed through offering antiemetic as ordered, dry foods. Nursing interventions include close monitoring of the client’s vital signs to detect deviations from the normal such as hypotension and hypertension, hyperthermia and any deterioration in mental alertness. In case these deviations are noted, the nurse reports them to the physician in charge of the hemodialysis.
Procedural nursing care includes preparing the client psychologically before the procedure to ensure that the client understands well the procedure and that any anxiety is prevented. The nurse also monitors the client throughout the procedure, the observations include monitoring of vital signs; blood pressure, pulse rate and respiration rate, and evaluation of fluid status and vascular access. The nurse also monitors the flow of blood and dialysate solution, bleeding and ensures that the client is comfortable; correct position and two hourly turning to prevent development of pressure sores and related problems (Zerwekh, 2003).
Hemodialysis is a multidisciplinary procedure where by nurses, physicians, surgeons, laboratory technicians, and specialists such as nephrologists and surgeons. The nurses are involved with the provision of nursing care which also include preparing the client psychologically for the procedure. The physicians helps in the prescription of medicines and drugs to be used while the laboratory technicians or specialists carry out all the necessary tests needed for the success of the procedure. The surgeon takes part in all surgical procedures and interventions (Thompson, 2004).
Hemodialysis as a treatment for irreversible renal failure must be continued intermittently for the client’s lifetime, unless a successful kidney transplant is done. A typical schedule would be a 3 to 4 hours of treatment 3 days per week. This schedule will vary with the size of the client, the type of dialyzer used, the rate of blood flow, the personal preference of the client, and other factors (Black, & Matassarin, 1993).
References
- Black, M. B., & Matassarin, E. J. (1993). Medical surgical nursing: A psychophysiologic approach. 4th Ed. London: WB Saunders Company.
- Carol, T. (2005). Fundamentals of nursing: The art and science of nursing care. Philadelphia: Wilkins and Williams.
- Free web dictionary, (2009). Definitions of hemodialysis. Web.
- Thompson, D. (2004). Nursing fundamentals: Caring and clinical decision making. New York: Rick Daniels.
- Zerwekh, J. (2003). Nursing Today: Transition and Trends. Philadelphia: W. B. Saunders Company.