What Are The Nursing Care Given To Haemodialysis Patients

When your kidneys do not work well, dialysis is needed to remove extra fluid and waste products such as creatinine and urea, as well as free water from the blood in your body.  It can be done either by haemodialysis or peritoneal dialysis, where the former is the most common choice among patients.

Hemodialysis is a type of dialysis that uses a machine with an artificial filter to remove wastes and extra fluids from the blood. This treatment also helps control the chemical balance in your body and helps control blood pressure. Each treatment takes about 4 hours and is done 3 times each week. 

The need for dialysis may be acute (when there is high and increasing level of serum potassium, fluid overload-impending pulmonary edema, increasing acidosis, pericarditis and severe confusion) or chronic (e.g., End Stage Renal Failure, presence of uremic sign and symptoms affecting all body systems, hyperkalemia, fluid overload not responsive to diuretics and fluid restriction, and a general lack of well-being).

Nursing Care

Pre dialysis care

• assess vital sign as a baseline information to help evaluate the effects of haemodialysis
• weigh and record patient's weight
• assess vascular access site for palpable pulsation or vibration and for signs of inflammation.  Absence of pulsation/vibration should be reported to doctors and dialysis can no longer be done in the assessed access site.
• no procedure should be done on the extremities with vascular access site to avoid damage of blood vessels leading to the failure of the arteriovenous fistula.

Post dialysis care

• assess and document vital signs, weight and vascular access site condition
• rapid fluid and solute removal during dialysis may lead to hypotension, cardiopulmonary changes and weight loss
• assess client general condition for dialysis disequillibrium
• rapid changes in BUN (Blood Urea Nitrogen), pH and electrolyte level during dialysis may lead to cerebral edema and increase intracranial pressure
• assess for bleeding at the access site
• heparinization during dialysis increase the risk of bleeding
• provide psychological support; listen actively, address concerns and explain about the dialysis

Haemodialysis can be an outpatient or inpatient therapy.