Hemodialysis
Mechanical blood filtration for kidney failure through external dialyzer
Definition
Hemodialysis (HD) is a renal replacement therapy in which blood is circulated through an external dialyzer that removes waste, excess fluid, and electrolytes across a semipermeable membrane, typically performed 3 to 4 times weekly, 3 to 4 hours per session.
Vascular Access
- AV fistula (preferred): Mature in 2 to 3 months.
- AV graft: Synthetic, ready in 2 weeks; higher clot/infection rate.
- Central venous catheter: Temporary; highest infection rate.
Nursing Priorities
- Palpate thrill and auscultate bruit on fistula/graft every shift. Absence = clotting, emergency
- No BP, blood draws, IVs in fistula arm
- Hold BP meds, water-soluble vitamins, and certain antibiotics before dialysis
- Daily weights before and after
- Monitor for hypotension, cramps, disequilibrium syndrome during treatment
- Educate dietary restrictions: fluid, potassium, phosphorus, sodium
NCLEX Relevance
Absent thrill/bruit = emergency. Protect the fistula arm.