Research

HEMODIALYSIS

 Hemodialysis - is a method for removing waste products such as creatinine and urea, as well as free water from
the blood when the kidneys are in renal failure.

Types:

Conventional hemodialysis - The procedure of conventional hemodialysis are: patients attached to a dialysis
machine; the function of a dialysis machine is to push blood to circulate through the patient’s body and machine, at
the same time, monitor temperature, blood pressure and time of the procedure; if patient is using fistula or graft, two
huge-gate needles on patients’ side: one brings wastes- full blood from patients’ body to the dialyzer, while another
needle carries clean blood back to the body; it is offered three times a week and 3 or 4 hours per session. Patients
are required to follow their rigid schedule.

Daily hemodialysis - The procedure of daily hemodialysis is similar to the conventional hemodialysis except it is
performed six days a week and about 2 hours per session.

Nocturnal hemodialysis - the procedure of nocturnal hemodialysis is similar to conventional hemodialysis except it is
performed six nights a week and six-ten hours per session while the patient sleeps

Indication

A) Absolute indications

Uremic Pericarditis

Uremic Encephalopathy or Neuropathy

Pulmonary edema (unresponsive to diuretics)

Severe Hypertension

Severe hyperkalemia

Intractable acidosis

Severe Bleeding diathesis

Persistent gastrointestinal symptoms

S.Creatinine more than 12 mg/dl, BUN more than 100 mg/dl

  B) Relative indications

Mild encephalopathy or neuropathy

Severe edema (unresponsive to diuretics)

Progressive gastrointestinal symptoms

Recurrent GI “itis”: stomatitis, gastritis, dudenitis, pancreatitis

Ascitis without hepatic disease

Mild Bleeding diathesis

Pruritus

Infectious complications

Depression

  C) Early indications

Decrease ideal body weight

Decrease in muscle mass (decrease s creatinine or its clearance)

Decrease in s.albumin to less than 4 g/l

GFR less than 15 ml/min (by I iothalamate)

S. Creatinine >10 mg/dl and bun >100 mg /dl

Decrease in s.transferrin

Low total cholesterol

Growth retardation in children

Contraindication

Advanced malignancy (except multiple myeloma)

Alzheimer’s disease

Multi-infarct dementia

Hepatorenal syndrome

Advanced liver cirrhosis with encephalopathy

Hypotension unresponsive to pressors

Terminal illness

Organic brain syndrome

Advantages

Low mortality rate

Better control of blood pressure and abdominal cramps

Less diet restriction

Disadvantages

Restricts independence, as people undergoing this procedure cannot travel around because of supplies’ availability

Requires reliable technology such as high water quality and electricity

Requires more supplies like dialysis machines

The procedure is complicated and requires that care givers have more knowledge

Requires time to set up and clean dialysis machines, and expense with machines and associated staff

Procedures

Equipment and Procedures

When you first visit a hemodialysis center, it may seem like a complicated mix of machines and people. But once you
learn how the procedure works and become familiar with the equipment, you’ll be more comfortable.

Graft.

Dialysis Machine

The dialysis machine is about the size of a dishwasher. This machine has three main jobs:

pump blood and watch flow for safety

clean wastes from blood

watch your blood pressure and the rate of fluid removal from your body

Dialyzer
Structure of a typical hollow fiber dialyzer.The dialyzer is a large canister containing thousands of small fibers through
which your blood is passed. Dialysis solution, the cleansing fluid, is pumped around these fibers. The fibers allow
wastes and extra fluids to pass from your blood into the solution, which carries them away. The dialyzer is sometimes
called an artificial kidney.

Reuse. Your dialysis center may use the same dialyzer more than once for your treatments. Reuse is considered
safe as long as the dialyzer is cleaned before each use. The dialyzer is tested each time to make sure it’s still
working, and it should never be used for anyone but you. Before each session, you should be sure that the dialyzer is
labeled with your name and check to see that it has been cleaned, disinfected, and tested.

Dialysis Solution

Dialysis solution, also known as dialysate, is the fluid in the dialyzer that helps remove wastes and extra fluid from
your blood. It contains chemicals that make it act like a sponge. Your doctor will give you a specific dialysis solution
for your treatments. This formula can be adjusted based on how well you handle the treatments and on your blood
tests.

Needles

Many people find the needle sticks to be one of the hardest parts of hemodialysis treatments. Most people, however,
report getting used to them after a few sessions. If you find the needle insertion painful, an anesthetic cream or spray
can be applied to the skin. The cream or spray will numb your skin briefly so you won’t feel the needle.

Most dialysis centers use two needles—one to carry blood to the dialyzer and one to return the cleaned blood to your
body. Some specialized needles are designed with two openings for two-way flow of blood, but these needles are
less efficient and require longer sessions. Needles for high-flux or high-efficiency dialysis need to be a little larger
than those used with regular dialyzers.
Arterial and venous needles.

Some people prefer to insert their own needles. You’ll need training on inserting needles properly to prevent infection
and protect your vascular access. You may also learn a “ladder” strategy for needle placement in which you “climb”
up the entire length of the access session by session so that you don’t weaken an area with a grouping of needle
sticks. A different approach is the “buttonhole” strategy in which you use a limited number of sites but insert the
needle back into the same hole made by the previous needle stick. Whether you insert your own needles or not, you
should know these techniques to better care for your access.

There are different procedures: hemodialysis (HD), hemodiafiltration (HDF) and hemofiltraton (HF). HD are
procedures to clean blood via diffusion and microfiltration. HDF are combined procedures to clean blood per diffusion
and convection. HF are procedures to clean blood via convection and microfiltration.

Nursing responsibilities

Perform the tasks associated with hemodialysis nurse activities. 

Perform hemodialysis on patients with kidney problems. 

Obtain clinical data from patients suffering from kidney problems. 

Obtain water specimens from kidney patients for assessment purposes. 

Perform analysis of patient data. 

Plan and organize patient schedules and treatments. 

Administer medications and fluid therapies as prescribed by doctor. 

Provide hemodialysis nursing support for water system and equipment. 

Monitor and maintain dialysis systems and equipment. 

Develop and administer hemodialysis plans. 

Bleeding

Complications

Sepsis

Hypotension
Nausea

Fatigue

Headache