Hemodialysis- What is it?

Process, safety considerations, diet, and labs

What is hemodialysis?

The process of removing waste and excess fluid from the bloodstream through a machine called a dialyzer. (Poinier, 2014)


*The main function of our kidneys are to get rid of waste within our body. When the kidneys are not working properly, they are unable to eliminate waste that builds up in our bloodstream. Therefore, hemodialysis is neccessary. (Poinier, 2014)

How Does it Work?

First we must have access to your blood. You will be required to have an ateriovenous fistula, which is a device that is surgically implanted in your forearm. This is the point of access for blood exchange. (Fontwit, 2013)


1) Blood is removed from the body and diverted to the machine.

2) The dialyzer filters the blood, while the dialysate fluid helps remove toxins from the blood through osmosis, diffusion, and ultrafiltration.

3) Clean blood is returned to the body. (Fontwit, 2013)

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What will I experience during hemodialysis?

Beginning the process:

  • measure weight,
  • blood pressure,
  • pulse, and
  • temperature.
  • Cleanse access site


Symptoms you may experience during process:

  • Nausea
  • Abdominal cramps


**Rate may need to be adjusted


What to monitor during process:

  • Blood pressure
  • Pulse


Finishing the process:

  • Remove IV
  • Bandage access site
  • Re-measure weight


*Continue with normal daily activities when finished (Mayo Clinic, 2013)

Time Committment

1) How long will I have to do this?


  • For the rest of your life.


2) How often will I have to do this?


  • Usually, 3 times a week.


3) How long is each session?


  • 3-5 hours


*You may watch tv/dvd, read, rest/sleep, or talk to patients beside you during the procedure. (Fontwit, 2013)

Safety Considerations

*The most important safety issue is prevention of infection*


1) What are the signs and symptoms of infection?


  • Redness,
  • Swelling,
  • heat,
  • bleeding,
  • drainage, and/or
  • Tenderness of the access site (Pellico, 2014)
  • Temperature above 100.4F


***Report to health care provider if this occurs.


2) What can be done to prevent infection?


  • Hand hygiene- washing hands 15-20 seconds with soap and water or alcohol-based hand sanitizer.
  • Proper use of PPE-gloves, gown, mask, goggles
  • Aseptic (sterile) technique before, during, and after procedure
  • Dispose of sharps (needles) immediately
  • Cleaning/disinfecting all equipment (Pellico, 2014)


*Always be sure staff is adhering to infection prevention methods


Other considerations include:


  1. Feeling for a thrill or vibration over the AV fistula. A thrill should be present.
  2. Avoid compressing AV site
  • Dot not allow iv access or blood to be drawn from the implanted arm.
  • Do not allow blood pressure to be taken on that arm.
  • Do not wear tight clothing
  • Do not lie on AV site, and
  • Do not carry bags on the side the fistula is on (Pellico, 2014)

Diet

Continue with diabetic diet, as well as what is listed below:


Limit/Avoid:

  • Fluid intake: 500-800 ml/day- *Maintain weight gain under 1.5 kg or 3.3 lbs/ day.
  • Sodium: 2-3 grams/day- Avoid salt substitutes with potassium. (Pellico, 2014)
  • Phosphorus- milk, yogurt, and cheese are high in phosphorous.
  • Potassium- avoid fruit such as, oranges, kiwi, nectarines, prunes, bananas, melons and vegetables such as, potatoes, tomatoes, pumpkins, spinach, or asparagus. (Dietary Guidelines, 2015)


Eat more:

  • High Protein foods- (1.2-1.3 g/kg/day) 8-10 ounces of meat, fish, poultry, fresh pork, and eggs every meal. 1 ounce= 1 egg, 1/4 cup of tuna, 1 slice low sodium lunch meat. 3 ounces= 1/2 chicken breast, medium fish fillet, medium pork chop, or 1/4 lb hamburg patty.
  • Salt substitutes- herbs, spices, and low-salt enhancers.
  • Grains/cereal/bread- 6-11 ounces (follow diabetic diet to manage Carbohydrate intake). Serving examples: 1 slice of white or rye bread, 1 cup cold cereal, 1/2 cup cooked cereal, 1/2 cup cooked rice, 10 vanilla wafers, 4 unsalted crackers, 1/2 cup of pasta, or 1/2 bagel.
  • Dairy low in phosphorous: cream cheese, ricotta cheese, non-dairy whipped cream, sherbet, or butter/tub margarine. (1/2 cup of milk or 1/2 cup of yogurt, or 1 ounce cheese a day is okay)
  • Fruit low in potassium- 2-3 servings a day. 1 serving= 1/2 cup or 1 small fruit of apples, grapes, pears, berries, peaches,pineapple, plums, and watermelon.
  • Juice- 4 ounce glass of apple cider, cranberry juice, grape juice, and lemonade.
  • Vegetables- 2-3 servings each day. 1 serving= 1/2 cup of broccoli, carrots, celery, cucumber,lettuce, onion, peppers, zucchini/yellow squash, or garlic. (Dietary Guidelines, 2015)


***READ FOOD LABELS- ask physician to meet with a dietitian about meal planning.

Labs to be monitored

Weekly blood work measurements/goals


Kidney function- measures protein in the blood:

  • Blood urea nitrogen- BUN should be between 40-60 mg/dL (Lab values, 2015)


Anemia:

  • Hemoglobin- measures amount of oxygen carrying RBCs in the blood (Normal value is 14-18 g/dL)
  • Hematocrit- measures amount of RBCs in the blood (Normal value is 40-60%) (Lab values, 2015)


Electrolyte Imbalances:

  • Calcium- measures bone health (8.4-9.5 mg/dL for dialysis patients)
  • Phosphorus- measures bone health (normal range 3.5-5.5 mg/dL) (Corr, 2007)
  • Potassium- measures heart/muscle health (normal range 3.5- 5 mg/dL)
  • Sodium- measures fluid balance (normal range 135-145 mEq/L)


Diabetes:

  • glucose- blood sugar (Normal range 65-110 mg/dL)
  • A1C- measures blood sugar control within 3 months (Normal range is less than 6.5%) (Lab Values, 2015)


Nutrition- measures the amount of protein in the blood for good nutrition:

  • Serum albumin- The goal is greater than 4.0 g/dL for dialysis patients (Lab Values, 2015)


Lipids (fats)- measures heart/blood vessel problems:

  • Total cholesterol- Should be less than 200
  • HDL (bad) cholesterol- Should be higher than 40
  • LDL (good) cholesterol- Should be less than 100
  • Triglycerides- Should be less than 150 (Corr, 2007)


Dialysis Dosing- determines how much dialysis is needed:

  • kt/v- Target should be 1.2
  • urea reduction rate- Target should be 65% (Corr, 200)

References

Corr, C. (2007). A "New Normal": Life on Dialysis- The First 90 Days. New York, NY: National Kidney Foundation, INC. https://www.kidney.org/sites/default/files/docs/11-10-0307_dialysistransitionbk2_oct07_lr_bm.pdf


Dietary Guidelines for Adults Starting on Hemodialysis. (2015) New York, NY: National Kidney Foundation, INC. https://www.kidney.org/atoz/content/dietary_hemodialysis


Fontwit, K. (2013) What is Hemodialysis and How does it work?https://www.aakp.org/education/resourcelibrary/dialysis-resources/item/hemodialysis-how-does-it-work.htm


Lab Values Explained. (2015) Madison, Wis: Medical Education Institute, INC. http://lifeoptions.org/kidneyinfo/labvalues.php


Mayo Clinic Staff. (2013) What can you expect. http://www.mayoclinic.org/tests-procedures/hemodialysis/basics/what-you-can-expect/prc-20015015


Pellico, L. (2014) Focus on Adult Health Medical-Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.


Poinier, A. (2014) Hemodialysis. http://www.webmd.com/a-to-z-guides/hemodialysis-20667