Dialysis

Definition

Dialysis is a renal replacement therapy that removes waste products, excess fluid, and electrolytes from the blood when the kidneys fail. It does not cure kidney disease but sustains life until transplant or palliation.

Types

• Hemodialysis (HD): Blood circulated through an external dialyzer 3 to 4 times weekly, 3 to 4 hours each. Requires vascular access (AV fistula preferred).
• Peritoneal dialysis (PD): Dialysate instilled into peritoneum; waste exchanged through peritoneal membrane. Performed at home daily (CAPD/CCPD).

Nursing Priorities for HD

Assess thrill and bruit on AV fistula each shift (ABSENCE = clotting). Do NOT take BP, draw blood, or start IV in the fistula arm, such as hold BP medications, water-soluble vitamins, and certain antibiotics before dialysis. Monitor for hypotension, cramps, disequilibrium syndrome during and after treatment.

Nursing Priorities for PD

Warm dialysate to body temperature, monitor outflow color (cloudy indicates peritonitis; pD’s most serious complication), maintain aseptic technique, weigh before and after exchange.

NCLEX Relevance

Protect the AV fistula. Cloudy PD return = peritonitis.