Dialysis

Dialysis

1. Peritoneal Dialysis

   • CCPD
     • only done at night while patient is sleeping
       • has roughly four exchanges or more throughout the night
   • CAPD
     • patient can go about their day while the fluid remains in the peritoneal cavity.
       • this happens so the excess waste products are removed.
   • 3 stages: Fill, Dwell, Drain
   • catheter is placed in the abdomen
   • Complications of PD
     • Hernias
       • as a result of the pressure build up in the abdomen because of dialysis fluid
     • Peritionits
       • possibly due to a contamination of the catheter
     • Lung problems
       • lungs lose ability to expand, can result in pneumonia, collapsed lungs
     • pain in the abdomen
       • due to catheter placement, the solution used, or peritonitis
     • high insulin levels resulting in high fat production- can lead to heart disease
     • low protein
       • peritoneum is permeable- protein goes wherever the solution is going
         • Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (Eds.). (2014). Medical-surgical nursing in Canada: Assessment and management of clinical problems (3rd Cdn. ed.) (M. A. Barry, S. Goldsworthy & D. Goodridge, Cdn. Adapt.). Toronto: Elsevier Canada.
     • outflow problems
       • constipation

2. Hemodialysis

   • fistula, graft, or central venous catheter
     • connecting a vein to an artey, or accesing a jugualr vein for the CVC
   • uses a machine
     • Dialyzer and dialysate solution
       • heparin is also used to prevent clots as blood is moving
   • Complications of HD
     • Hypotension
       • dt to fast removal of fluid from patient
     • Muscle cramps
       • fast removal of soduim and water.
         • can use NS bolus to correct it
     • Sepsis
       • infection at site
         • check for low BP, fever, and high WBC
     • Hepatitis B
       • blood tranfusions or failure to prevent spread of infection
   • occurs three days a week for 3-5 hours

3. Used when kidney is no longer functional. Dialysis helps to remove waste from the blood

4. Assessment

   • check for edema
     • patient's kidney is unable to facilitate the removal of fluids
     • Daily weights
   • Lung sounds
   • Vital Signs
     • Blood Pressure
       • do not take BP on arm with a fistula
   • monitor lab values
     • creatine/bun/ electrolytes
   • check site
     • fistula
       • bruit and thrill