Hemodialysis III: Nursing Management

Before hemodialysis, nurses must record vital signs including blood pressure, heart rate, respiratory rate, and temperature to establish a baseline for detecting hypotension or other adverse reactions. Document pre-dialysis weight to determine fluid removal targets, assess the vascular access site for infection signs, and review laboratory results including potassium, sodium, BUN, creatinine, and hemoglobin levels to evaluate electrolyte balance and overall patient condition.

Nurses confirm vascular access function by palpating the access site for a thrill, which is a vibration felt under the fingertips indicating blood flow. They also auscultate using a stethoscope to listen for a continuous bruit, an audible sound produced by blood flowing through the access. Both findings indicate proper functioning of the arteriovenous fistula or graft.

Nurses must hold medications that can be removed during dialysis, such as ACE inhibitors or ARBs, to reduce hypotension risk. Water-soluble vitamins may also require adjustment. However, essential medications like erythropoietin, which aids red blood cell production, should be administered before the procedure. Medication review and adjustment are critical pre-dialysis nursing responsibilities.

During hemodialysis, nurses monitor vital signs every 15 to 30 minutes and watch for complications including hypotension, muscle cramps, nausea, and headaches. Continuous assessment allows nurses to adjust the ultrafiltration rate or administer medications as needed. Prompt identification of adverse reactions ensures patient safety and treatment effectiveness throughout the dialysis session.

Post-dialysis disequilibrium syndrome (DDS) is a condition occurring after dialysis characterized by headache, nausea, dizziness, or confusion, particularly in patients new to dialysis or those with high BUN levels. Nurses monitor for these symptoms during post-dialysis assessment and provide necessary care. Recognizing and managing DDS promptly prevents patient complications and improves treatment tolerance.

Fluid removal is managed based on the prescribed ultrafiltration rate, which is individualized according to the patient's dry weight, cardiovascular status, and tolerance to fluid shifts. Nurses aim to remove excess fluid while avoiding hypotension and maintaining appropriate removal rates to prevent fluid overload. Effective fluid balance management requires continuous monitoring and rate adjustments based on patient response.

After dialysis, nurses recheck vital signs, record post-dialysis weight to calculate fluid removed, and inspect the vascular access site for bleeding or infection. They reinforce dietary restrictions including low-sodium, low-potassium, and low-phosphorus diets, administer previously held medications, and document the patient's response to hemodialysis procedure and complications. Communication with the nephrologist ensures ongoing coordinated care.