NCLEX-PN

There are two primary types of dialysis : hemodialysis and peritoneal dialysis . Both can be administered in various settings, including dialysis centers, acute care facilities, and home settings (when manageable by the client and their caregiver). Hemodialysis Hemodialysis serves as a permanent or ongoing treatment for end-stage renal failure , offering a substitute for the kidney's natural diffusion, osmosis, and ultrafiltration functions. Long-term renal failure clients typically undergo hemodialysis three times a week , with each session lasting three to five hours. Hemodialysis is administered through an AV fistula, an AV graft , or a vascular access central line . The choice of access is carefully considered based on factors such as infection risk and long-term viability. ●​ AV Fistula : Surgically placed in the upper arm or lower forearm, AV fistulas remain usable for an extended period, offering reduced infection and clotting risks. ●​ AV Graft : Used when AV fistula placement is not feasible, AV grafts are more prone to clotting and infection. ●​ Vascular Access Central Line : Reserved for short-term dialysis or cases where other access options aren't viable. Pre-Hemodialysis Before the surgical placement of an AV fistula, vascular mapping is performed using a Doppler ultrasound to assess blood vessel suitability. After placement, it takes about two to three months for the fistula to mature and be usable. During Hemodialysis ●​ The nurse collects pre-procedure data, including vital signs, weight, and blood glucose levels. ●​ The nurse monitors the vascular access site and patency. ●​ Blood is drawn from the client through an arterial needle inserted into the fistula, processed through the hemodialysis machine, and returned to the client via a venous needle. Complications and Care During Hemodialysis ●​ Complications can include infection, clotting, and decreased blood flow due to scar tissue. ●​ The nurse monitors the hemodialysis process, administers anticoagulants if ordered, measures and records intake and output (including dialysate volume), assesses drainage color, and troubleshoots machine issues. ●​ The nurse also assesses the client for complications like disequilibrium syndrome, fatigue, infection, clotting, hypotension, and hypovolemia.

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