How Does Haemodialysis Works?

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.

A dialysis machine pumps small amounts of blood out of the body and through a filter called an artificial kidney or dialyzer. This kidney filters extra fluid and wastes from the blood. The blood is then pumped back into your body. Medicine will be given to you to prevent your blood from clotting. Fluid, called dialysate, is added to the dialysis machine to: 

1. Help filter out extra fluid and wastes that have built up
2. Add chemicals that your body uses The dialysate is a mixture of water and chemicals that are present in your blood. This fluid can be adjusted, based on your lab values, to give you the best filtering with fewer side effects.

For your safety, the machine has pumps, sensors, monitors and alarms to let the staff know if there is any problem.                  

Access Site

For this treatment, there needs to be a site where the blood is taken out of the body and then returned to the blood stream. This is called an access. After the access is made and healed, 2 needles connected to tubing are inserted into the access. One needle draws a small volume of blood out and pumps it through to the dialysis machine and filter. After the blood is filtered, it is return to the body through the other needle. 

There are three main types of access sites:

1. Fistula – With minor surgery, an artery is joined to a vein under the skin. This is most often done in an arm. This increases the amount of blood that flows through the vein, and makes it bigger. This is the best access because it has fewer complications and lasts longer.
2. Graft – With minor surgery a soft plastic tube is used to join the artery and vein under the skin.
3. Catheter – There are two kinds of catheters, temporary and permanent. The temporary catheter is used for 1 to 2 weeks. This catheter is used until a more permanent access is placed. A permanent catheter is placed in the neck vein and tunneled under the skin. It is good for about a year. The catheter has a risk for infection and is used only until a fistula or graft can be placed. Both the fistula and graft need 2 to 6 weeks to heal and mature before they are able to be used.

Side Effects of Hemodialysis

During treatment:

• Feel tired and sleepy
• Feel dizzy
• Be cold
• Have muscle cramps
• Have nausea

Complication

• Hypotension
• Painful muscle cramps
• dialysis diequillibrium
• chest pain
• dysrythmias
• air embolism (through the line)
• haemorrhage (due to heparin)

Let the staff know how you are feeling so that they can help you be more comfortable.

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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.

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