Access Route for Hemodialysis

Abbreviation Description

Arteriovenous Fistula

AVF A section of vein is directly sutured to an artery. It is usually placed in the nondominant arm, using the cephalic vein and radial artery

Arteriovenous Graft Connection tube is client’s own (autologous) saphenous vein, or made from polytetrafluoroethylene (PTFE)

Central Venous Catheter

CVC Catheter inserted by directly cannulating the vein. Usual CVC sites are: femoral, internal jugular, or subclavian veins

Procedure for hemodialysis1. Patient’s circulation is accessed2. Unless contraindicated, heparin is administered3. Heparinized (heparin: natural clot preventer) blood flows through a semipermeable membrane in one direction4. Dialysis solution surrounds the membranes and flows in the opposite direction5. Dialysis solution is:a. Highly purified waterb. Sodium, potassium, calcium, magnesium, chloride and dextrosec. Either bicarbonate or acetate, to maintain a proper pH6. Via the process of diffusion, wastes are removed in the form of solutes (metabolic wastes, acid-base components and electrolytes)7. Solute wastes can then be discarded or added to the blood8. Ultrafiltration removes excess water from the blood9. After cleansing, the blood returns to the client via the accessComplications related to vascular access in Hemodialysis1. Infection2. Catheter clotting3. Central venous thrombosis4. Stenosis or thrombosis5. Ischemia of the affected limb6. Development of an aneurysmNursing interventions for Hemodialysis1. Explain procedure to client2. Monitor hemodynamic status continuously3. Monitor acid-base balance4. Monitor electrolytes5. Insure sterility of system

6. Maintain a closed system7. Discuss diet and restrictions on:a. Protein intakeb. Sodium intakec. Potassium intaked. Fluid intake8. Reinforce adjustment to prescribed medications that may be affected by the process of hemodialysis9. Monitor for complications of dialysis related to:a. Arteriosclerotic cardiovascular diseaseb. Congestive heart failurec. Stroked. Infectione. Gastric ulcersf. Hypertensiong. Calcium deficiencies (bone problems such as aseptic necrosis of the hip joint)h.  Anemia and fatiguei. Depression, sexual dysfunction, suicide risk

 hemodialysis (also haemodialysis) 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. Hemodialysis is one of three renal replacement therapies (the other two being renal transplant; peritoneal dialysis).

Advantages

Low mortality rate

Better control of blood pressure and abdominal cramps

Less diet restriction

Better solute clearance effect for the daily hemodialysis: better tolerance and fewer

complications with more frequent dialysis [17]

[edit]Disadvantages

Restricts independence, as people undergoing this procedure cannot travel around

because of supplies’ availability

Requires more supplies such as high water quality and electricity

Requires reliable technology 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[17]

Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease. The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis).

The process of doing peritoneal dialysis is called an exchange. You will usually complete 4 to 6 exchanges each day using the following steps:

1. Fill: Dialysis fluid enters your peritoneal cavity.2. Dwell: While the fluid is in your peritoneal cavity, extra fluid and waste travel across the

peritoneal membrane into the dialysis fluid.3. Drain: After a few hours, the dialysis fluid is drained and replaced with new fluid.

There are different types of peritoneal dialysis. Discuss these treatment methods with your doctor to decide which one might work best for you.

Continuous ambulatory peritoneal dialysis (CAPD). During CAPD, the dialysate solution stays in your belly for about 4 to 6 hours. After this time, the solution is drained out of your belly. Your belly is then refilled with fresh solution. You need to change the solution about 4 times a day. This is the most commonly used form of peritoneal dialysis.

Continuous cycling peritoneal dialysis (CCPD). During CCPD, a machine automatically fills and drains the dialysate from your belly. This process takes about 10 to 12 hours, so you can perform CCPD at night while you sleep.

Peritoneal dialysis (per-ih-tuh-NEE-ul di-AL-uh-sis) is a way to remove waste products

from your blood when your kidneys can no longer do the job adequately. During

peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your

kidneys, with the help of a fluid (dialysate) that flows into and out of the peritoneal

space.

Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering

procedure. With peritoneal dialysis, you can give yourself treatments at home, at work

or while traveling. You may be able to use fewer medications and eat a less restrictive

diet than you can with hemodialysis.

Peritoneal dialysis isn't an option for everyone with kidney failure. You need manual

dexterity (or a reliable caregiver) and the ability to care for yourself at home.

The kidneys are responsible for filtering waste products from the blood.Dialysis is a procedure that is a substitute for many of the normal duties of the kidneys. The kidneys are two organs located on either side of the back of the abdominal cavity. Dialysis can allow individuals to live productive and useful lives, even though their kidneys no longer work adequately.