Nursing management of hemodialysis

for nursing students

1. Prepared by
Demonstrator at faculty of nursing MTI university



02 01064423095
02 01144127776
[email protected]

2. Nursing Management Of Hemodialysis
1 . Before dialysis
2 . During dialysis
3 . After dialysis

1 . Before dialysis :
Initial Nursing Assessment
a. Weight
Present weight – dry weight = Target
weight
b. Vital signs
1. BP – standing, sitting
2. Cardiac rate and rhythm
3. Pulse rate
4. Respiratory rate
5. Temperature
2 . During the dialysis:
Care of patient during the dialysis.
Nursing Action
1. Promote patient comfort during the procedure
A. Provide physical comfort measures.
a. Back care
b. Elevate head of the bed
c. Assist in turning
B. Keep pt. informed of progress and results.

3. C. Provide any kind of activities as reading newspaper .
D. Provide care and attention to pt. considering physiological, psychological care, remembering
his needs, reactions and concerns.
2. Maintain good outflow of blood.
A. Monitor alarms of the machine.
B. Monitor vital signs. - a drop in blood pressure may indicate rapid fluid loss that may
lead to dehydration.
3. Monitor changes in fluid and electrolyte status , weight changes.
A. Laboratory studies
B. Assess level of responsiveness at the beginning, throughout and at the end of the
dialysis .
C. Pre and post dialysis weight
4. Monitor for complications
A. Infection - Bacteremia is an unwanted complication
1. Watch for chills/fever – ( Antibiotics may be given after the treatment )
2. Redness around the access-- ( Request for blood culture )

Observe strict aseptic technique!
B. Bleeding
1. Observe site for any blood leaks
2. Monitor vital signs.
3. Monitor for hypertension/ hypotension
3- Post dialysis:
1 .Check for any blood works or medicines to be given before terminating dialysis.
2 . Upon removal of fistula needle apply pressure dressing using sterile gauze and wait until
the puncture site has clotted.
3 . Tape on a new pressure dressing and instruct pt. to remove 4 to five hrs later when
possible bleeding may occur.

4. 4 . Ask your patient to rest at least 15 minutes and dangle their legs to prevent postural
hypotension after dialysis.
5 . Reinforce diet and fluid requirements of patient on dialysis.
6 . Remind their about next schedule of their dialysis.
7 . Weigh patient before they leave the center.

Care of Vascular Access: Central Catheters:
 Keeps the catheter dressing clean and dry.
 Make sure the area of insertion site is clean and change the dressing at each dialysis
session.
 Instruct patient on how to change dressings in an emergency
 Instruct patient not shower or swim; but tell him/her that he/she may take a bath.
 Wear a mask over nose and mouth anytime the catheter is opened to prevent bacteria
from entering the catheter and the bloodstream.
 The caps and the clamps of the central catheter should be kept tightly closed when not
being used for dialysis.
 Monitor exit site for soreness/ redness.
Care of Vascular Access: AV Fistulas/Grafts:
 Keep the access site clean at all times.
 Avoid injections, intravenous (IV) needles or fluids, or taking blood samples in the
access site arm.
 Needle insertions for hemodialysis treatments should be rotated.
 Do not take blood pressure or put pressure on the access arm.
 Advise patients to avoid wearing jewelry or tight clothing, sleeping on, or lifting
heavy objects with the access arm.
 Check the access arm for adequate circulation.
 Check for signs of infection at the access site.