(hē″mō-dī-al′ĭ-sĭs, ′ĭ-sēz″) pl. hemodialyses [hemo- + dialysis] The clearing of urea, metabolic waste products, toxins, and excess fluid from the blood by use of an artificial kidney. This procedure is used to treat end-stage renal failure, transient renal failure, and some cases of poisoning or drug overdose. In the U.S., more than 345,000 patients undergo hemodialysis regularly for end-stage renal disease. The primary use of hemodialysis is to manage renal failure, a disorder in which fluids, acids, electrolytes, and many drugs are ineffectively eliminated in the urine. Hyperkalemia, uremia, fluid overload, acidosis, and uremic pericarditis are other indications for hemodialysis. SEE: table; hemoperfusion; Nursing Diagnoses Appendix.
Routine Precautions for the Care of All Hemodialysis Patients
|Patients should have specific stations assigned to them, and their chairs and beds should be cleaned after each use. |
|Ancillary supplies, e.g., trays, blood pressure cuffs, clamps, scissors, and nondisposable items, should not be shared by patients. |
|Nondisposable items should be cleaned or disinfected appropriately after each use. |
|Medications and supplies should not be shared among patients, and medication carts should not be used. |
|Medications should be prepared and distributed from a centralized area. |
|Clean areas and contaminated areas should be separated, e.g., handwashing, handling of blood samples, and equipment cleaning should be kept distinct from areas for preparation of food, drink, and medications. |
Hemodialysis separates solutes by differential diffusion through a cellophane membrane placed between the blood and the dialysate solution, and involves the following: 1) establishing access to the circulation, e.g., via an arteriovenous fistula, cannula, or via a synthetic or bovine graft or temporary catheter; 2) anticoagulating the patient's blood to prevent extracorporeal clotting; 3) pumping the blood to a dialysis membrane; 4) adjusting the diffusion of solutes from the blood into a buffered dialysate solution; 5) returning the cleansed and buffered blood to the patient.
Adequacy of hemodialysis is determined by the amount of fluid and solute, esp. urea, removed from the body. Typically, hemodialysis lasts about 3 or 4 hr per treatment and is repeated several times a week.
Even with regular hemodialysis sessions, patients with end-stage renal disease have high mortality rates. In the U.S., about 25% of all patients receiving hemodialysis die each year, usually because of heart disease, stroke, or pre-existing diabetes mellitus. SYN: renal dialysis. SEE: dialysis; hemofiltration; uremia.
Hemodialysis has many potential complications, including hypotension, infection of the site of access, sepsis, air embolism, hypersensitivity reactions, dialysis disequilibrium, muscle cramping, anemia, and bleeding.
PATIENT CARE: Preprocedure: If this is the patient's first hemodialysis session, the purpose of the treatment and expected ...