Nursing Procedure and Interventions for Hemodialysis

Hemodialysis – Cleansing the blood of accumulated waste products

1. Short term therapy in acutely ill clients
2. Long term use in clients with end-stage renal disease

Hemodialysis requires five things:
1. Access to patient’s circulation (usually via fistula)
2. Access to a dialysis machine and dialyzer with a semipermeable membrane
3. The appropriate solution (dialysate bath)
4. Time: 12 hours each week, divided in 3 equal segments
5. Place: home (if feasible) or a dialysis center

Three ways to access to client’s circulation for dialysis:

Access Route for Hemodialysis



Arteriovenous Fistula


A section of vein is directly sutured to an artery. It is usually placed in the nondominant arm, using the cephalic vein and radial artery

Arteriovenous Graft

Connection tube is client’s own (autologous) saphenous vein, or made from polytetrafluoroethylene (PTFE)

Central Venous Catheter


Catheter inserted by directly cannulating the vein. Usual CVC sites are: femoral, internal jugular, or subclavian veins

Procedure for hemodialysis
1. Patient’s circulation is accessed
2. Unless contraindicated, heparin is administered
3. Heparinized (heparin: natural clot preventer) blood flows through a semipermeable membrane in one direction
4. Dialysis solution surrounds the membranes and flows in the opposite direction
5. Dialysis solution is:
a. Highly purified water
b. Sodium, potassium, calcium, magnesium, chloride and dextrose
c. Either bicarbonate or acetate, to maintain a proper pH
6. Via the process of diffusion, wastes are removed in the form of solutes (metabolic wastes, acid-base components and electrolytes)
7. Solute wastes can then be discarded or added to the blood
8. Ultrafiltration removes excess water from the blood
9. After cleansing, the blood returns to the client via the access

Complications related to vascular access in Hemodialysis
1. Infection
2. Catheter clotting
3. Central venous thrombosis
4. Stenosis or thrombosis
5. Ischemia of the affected limb
6. Development of an aneurysm

Nursing interventions for Hemodialysis
1. Explain procedure to client
2. Monitor hemodynamic status continuously
3. Monitor acid-base balance
4. Monitor electrolytes
5. Insure sterility of system
6. Maintain a closed system
7. Discuss diet and restrictions on:
a. Protein intake
b. Sodium intake
c. Potassium intake
d. Fluid intake
8. Reinforce adjustment to prescribed medications that may be affected by the process of hemodialysis
9. Monitor for complications of dialysis related to:
a. Arteriosclerotic cardiovascular disease
b. Congestive heart failure
c. Stroke
d. Infection
e. Gastric ulcers
f. Hypertension
g. Calcium deficiencies (bone problems such as aseptic necrosis of the hip joint)
h.  Anemia and fatigue
i. Depression, sexual dysfunction, suicide risk

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