Understanding Dialysis: The Basics for Medical-Surgical Nurses

When your patient has kidney failure, they may require dialysis, a treatment that filters waste products from the blood. The procedure of dialysis itself requires special training and is usually done in an outpatient setting a few times a week.  When a dialysis patient is admitted to the hospital setting, it is important for the nurse caring for them to have a basic understanding of this treatment and complications to watch for.

How Does Dialysis Work?

Hemodialysis

Hemodialysis is administered either through a central venous catheter, an AV fistula, or an AV graft. These are special access sites that are placed by surgeons. The central catheter tends to look like a larger than usual central line. Never use this site to flush or for medication! It will usually be marked very clearly to avoid this. The AV (arteriovenous) fistula or graft will be located in the large artery/vein of an arm. A specially trained dialysis nurse is the only one to access these sites, using a needle to connect the site to the dialyzator, a large machine that filters the blood, balances electrolytes, and removes excess fluid. Hemodialysis can take 3 to 5 depending on the patient's tolerance and other medical conditions.

Hemodialysis patients have a regular schedule of when they go to have their dialysis done. Make a note of when this is. It is usually something like "Tuesday, Thursday, Saturday" or "Monday, Wednesday, Friday." Find out when your patient's last session was or if they have missed any recent appointments. Letting the doctor know you are taking care of a dialysis patient will help to get the nephrologist on board to give specific orders regarding how often dialysis is given in the hospital.

Peritoneal dialysis

Peritoneal dialysis is administered through a catheter placed in the abdomen. This is a type of dialysis that is more commonly used in home situations and can be self-administered. The patient infuses the dialysate solution into their peritoneal space (which functions as a semipermeable membrane). The solution needs to sit in the peritoneal space for anywhere from 2 to 6 hours, depending on the patient.

Common Complications

With dialysis patients, the main complications to watch for include the following:

1- Infection at the catheter site

Teach your patient to be on the lookout for any redness (especially streaking), swelling, tenderness, or foul-smelling drainage from the dialysis site.

2- Fluid imbalance

With dialysis, large amounts of fluid are moved in and out of the body in a matter of hours, something that happens through healthy kidneys more gradually. The dialysis nurse will keep a record of blood pressure(s) throughout the procedure and will let you know, as the floor nurse, if you need to contact the doctor regarding any abnormal readings. This fluid shift can cause low blood pressure. If you are aware that your patient is receiving dialysis on your shift, you'll want to make sure and check with the dialysis nurse regarding which medications to hold. This usually includes any blood pressure medications. 

3- Infection at the site of dialysis access

Again, you are responsible for assessing these sites for any redness, swelling, tenderness, or foul odor. Ongoing infection prevention teaching is key for these patients.

4- Electrolyte imbalance

It's not just fluid and wastes that dialysis filters out. It also filters out electrolytes. Labs are usually taken daily on these patients to watch their electrolyte levels for this reason. Keep in mind that it is not unusual for dialysis patients to have electrolyte levels that tend on the high side because their kidneys are no longer filtering.

Dialysis is a life-saving procedure for those with kidney failure. An accurate, focused assessment and knowledge of common complications will enable you to take excellent care of your dialysis patient!

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References/Resources

5 Complications of Hemodialysis: Verywell Health

Dialysis Nursing Basics You Need to Know: Straight A Nursing