Hemodialysis (HD) is one of several renal replacement therapies used for the treatment of end stage kidney disease (ESKD) and kidney failure. Dialysis removes excess fluids and waste products and restores chemical and electrolyte balance. HD involves passing the patient’s blood through an artificial semipermeable membrane to perform the filtering and excretion functions of the kidney. One important step before starting regular hemodialysis sessions is preparing the vascular access; ideally, a vascular access should be placed weeks or months before you start dialysis. The early placement of the vascular access will allow sufficient time for the access to heal and mature. The three basic kinds of vascular access for hemodialysis are an arteriovenous (AV) fistula, an arteriovenous (AV) graft, and a venous catheter.
Peritoneal dialysis (PD) occurs though diffusion and osmosis across the semipermeable peritoneal membrane and capillaries. The peritoneal membrane is large and porous. It allows solutes and water to move from an area of higher concentration in the blood to an area of lower concentration in the dialyzing fluid (diffusion). The fluid and waste products dialyzed from the patient move through the blood vessel walls, the interstitial tissues, and the peritoneal membrane and are removed when the dialyzing fluid is drained from the body through a siliconized rubber (Silastic) catheter that is surgically placed into the abdominal cavity. PD is slower than hemodialysis (HD), however, and more time is needed to achieve the same effect.
As far as treatment options, both have complications. Hemodialysis includes Disequilibrium syndrome, muscle cramps, hemorrhage, air embolus, cardiac dysrhythmia, and Hemodynamic changes such as hypotension and anemia. Peritoneal dialysis complications include protein loss, peritonitis, hyperglycemia, respiratory distress, and bowel perforation. Hemodialysis Nursing care and roles are to monitor the patient immediately and for several hours after dialysis for any side effects from the treatment. Common problems include hypotension, headache, nausea, malaise, and vomiting, dizziness, and muscle cramps. The nurse must obtain vital signs and weight for comparison with pre-dialysis measurements. Blood pressure and weight are expected to be reduced as a result of fluid removal. Hypotension may require rehydration with IV fluids, such as normal saline. The patient’s temperature may also be elevated because the dialysis machine warms the blood slightly. If a fever results, sepsis may be present and a blood sample is needed for culture and sensitivity. The heparin required during hemodialysis increases the clotting time and thus the risk for excessive bleeding. All invasive procedures must be avoided for 4 to 6 hours after dialysis. Continually monitor the patient for hemorrhage during dialysis and for one hour after. Peritoneal dialysis nursing care and roles are to start and monitor during PD. Before treatment, assess baseline vital signs including blood pressure, apical and radial pulse rates, temperature, quality of respirations, and breath sounds. Weigh the patient, always on the same scale, before the procedure and at least 24 hours while receiving treatment. Weight should be checked after a drain and before the next fill to monitor the patient’s dry weight. Baseline laboratory tests, such as electrolyte and glucose levels, are obtained before starting PD and are repeated at least daily during the treatment. Vital signs need to be recorded every 15-30 minutes. Assess for signs of respiratory distress, pain, discomfort. Dressing around the catheter site must be checked every 30 minutes for wetness during procedure. Maintain accurate inflow and outflow records. The nurse monitors the treatment to make sure the client is...
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