dialysis therapies

Management of Patients With Renal Disorders (Dialysis Therapies):

Management of Patients With Renal Disorders (Dialysis Therapies) Karen Larson, MBA/TM, MSN, RN

Dialysis Therapies:

Dialysis Therapies Various types Works with using passive transfer of toxins by diffusion Patients need access site Anticoagulation needed, usually heparin treatment

Hemodialysis:

Hemodialysis Client selection Dialysis settings Works using passive transfer of toxins by diffusion Anticoagulation needed, usually heparin treatment

Hemodialysis Catheter:

Hemodialysis Catheter

Internal Arteriovenous Fistula and Graft:

Internal Arteriovenous Fistula and Graft

Vascular Access:

Vascular Access Arteriovenous fistula, or arteriovenous graft for long-term permanent access Hemodialysis catheter, dual or triple lumen, or arteriovenous shunt for temporary access Precautions Complications

Nursing Management of Hospitalized Patient on Dialysis:

Nursing Management of Hospitalized Patient on Dialysis Protection of vascular access: Assess site for patency Assess for s/sx of infection Do not use for b/p or blood draws Monitor fluid balance IV fluids (monitor rate, use pump) I&0 Weigh daily Cardiac/Respiratory checks Monitor b/p Hold hypertensive medications on dialysis days to avoid hypertension

Nursing Management of Hospitalized Patient on Dialysis:

Nursing Management of Hospitalized Patient on Dialysis Monitor medications Monitor dosages Avoid medications containing potassium and magnesium Stringent infection control measures Skin care: Pruritis (itching) a common problem Keep skin well moisturized Trim nails to avoid scratching Avoid invasive procedures 4 to 6 hours after dialysis Monitor for complications

Complications of Hemodialysis:

Complications of Hemodialysis Dialysis disequilibrium syndrome- refers to acute symptoms developing during or immediately after hemodialysis. Early findings include headache, nausea, disorientation, restlessness, blurred vision. It is characterized by neurologic symptoms of varying severity that are thought to be due primarily to cerebral edema . Infectious diseases Cramps Hypotension Febrile reactions Hemolysis Arrhythmias

Continuous Renal Replacement Therapy (CRRT):

Continuous Renal Replacement Therapy (CRRT) Patients requiring dialysis cannot tolerate a regular four-hour hemodialysis treatment usually due to hypotension Slow, continuous removal of toxins and fluids. By removing fluids continuously over a 24 hour period, CRRT mimics the actions of the kidneys Because there is no buildup of toxins and fluids, patients receiving CRRT can receive as much protein and fluid as Needed to achieve optimal nutrition. CRRT also allows the freedom to administer large-volume infusions whenever needed, because the therapy can be titrated to achieve specific hemodynamic goals

Continual Renal Replacement Therapy (CRRT):

Continual Renal Replacement Therapy (CRRT) Can be used in conjunction with HD Contraindication Presence of manifestations of uremia requiring rapid resolution Continued for 30 to 40 days Hemofilter change every 24 to 48 hours Ultrafiltrate should be clear yellow Uses double-lumen catheter placed in femoral, jugular, or subclavian vein Specimens may be obtained for evaluation

Continual Renal Replacement Therapy (CRRT):

Continual Renal Replacement Therapy (CRRT) CRRT versus HD Continuous rather than intermittent Solute removal by convection (no dialysate required) in addition to osmosis and diffusion Less hemodynamic instability