Peritoneal Dialysis and Hemodialysis Nursing Considerations

Dialysis is the removal of metabolic excess by artificial means. This is done to patients with renal failure.

Two Mechanisms in Dialysis:

  1. Diffusion – movement of particles from an area of high concentration to one of low concentration across a semipermeable membrane.
  2. Osmosis – movement of water through a semipermeable membrane from an area of lesser concentration of particles to one of greater concentration.

Rationale of Dialysis

  • a. Removal of end products of protein metabolism from blood
  • b. Maintain tolerable levels of electrolytes
  • c. Correct acidosis and replenish blood bicarbonate
  • d. Removal of excess fluid

Types of Dialysis:

A. Peritoneal Dialysis – The dialysate solution is introduced into the peritoneal area, the peritoneum serves as a semipermeable membrane between the dialysate and blood in the abdominal vessels.

Three types of Peritoneal Dialysis:

  • 1. Intermittent peritoneal dialysis
  • 2 Continuous ambulatory peritoneal dialysis
  • 3. Continuous cycling peritoneal dialysis

Nursing Considerations:

Patient Preparation:

  1. Allow the client to void before catheter insertion.
  2. Institute abdominal skin preparation
  3. Document the client’s weight before the dialysis
  4. Take baseline vital signs

During the Procedure:

  1. Monitor the level of electrolytes.
  2. Obtain samples of return dialysate for culture
  3. Compare the client’s weight before and after the procedure
  4. Monitor the vital signs every 30 minutes and report any deviations
  5. Provide proper positioning for the dialysate to return from the peritoneal cavity. Place the patient in semi-Fowler’s position.

Possible complications of peritoneal dialysis:

  1. Peritonitis
  2. Respiratory difficulty
  3. Hypertension
  4. Pulmonary edema
  5. Hyperglycemia
  6. Hyperosmolar coma
  7. Intestinal perforation

B. Hemodialysis – This process involves shunting of the blood from the client’s vascular system through an artificial dialyzing system and return of dialyzed blood to the client’s circulation. Dialysis coil acts as the semi-permeable membrane.

Three Routes of Hemodialysis

  • 1. External AV shunt
  • 2. AV fistula
  • 3. Femoral or subclavian cannulation

Nursing Considerations:

Before the Hemodialysis

  1. Allow the client to void.
  2. Document the client’s weight.
  3. Obtain vital signs as baseline.
  4. Check the medications history of the patient before the procedure. Antihypertensives, sedatives and vasodilators are prevented in order to do away with hypotensive episode.

During the Hemodialysis:

  1. Obtain vital signs periodically between 30 minutes.
  2. Observe proper body alignment, allow frequent position changes.
  3. Monitor for episodes of nausea and vomiting which may occur during the procedure.
  4. Monitor for signs of bleeding by taking clotting time about 1 hour before the client comes off the machine. Observe clotting time at 30 to 90 minutes while on dialysis (Normal value: 6 – 10 minutes)

After Dialysis:

  1. Check the client’s weight, note any difference.
  2. Assess for complications.
  3. Check for signs of bleeding and status of the fistula.

Complications of Dialysis:

  1. Hypovolemic Shock – result of rapid removal or ultrafiltration of fluid from the intravascular compartment
  2. Dialysis-disequilibrium syndrome – caused by rapid, efficient dialysis resulting in shifts in water, pH and osmolarity between fluid and blood.

Signs and Symptoms:

  1. Nausea & Vomiting
  2. Headache
  3. Hypertension
  4. Agitation
  5. Disorientation
  6. Twitching
  7. Peripheral paresthesias
  8. Convulsions

Photo credits:

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

What Do You Think?