Nursing care plan hemodialysis HD

I. Procedure
a. Removal of urea and other toxic products and correction of
fluid and electrolyte imbalances
b. Blood is shunted through an artificial kidney or membrane
(dialyzer) for removal of toxins and excess fluid and then
returned to the venous circulation.
c. Requires placement of vascular access
i. Arteriovenous (AV) fistula: usually requires at least 2 to
4 months to heal before it can be used, providing
sufficient time so that those involved are prepared and
can perform home hemodialysis, if appropriate
ii. AV graft: may be indicated in presence of small veins,
usually ready for use within 2 to 3 weeks
iii. Temporary access: provides immediate access with insertion
of a catheter into a vein in the neck, chest, or groin

II. Types
a. Intermittent HD procedure
i. Requires permanent AV access, such as primary AV
fistula or synthetic graft
ii. Usually performed three times per week for 3 to 5 hours
per procedure, or six to seven times per week for 1.5 to
2 hours
b. Continuous renal replacement therapy (CRRT) (Paton, 2007)
i. Blood is usually accessed via a central venous catheter.
ii. Treatment for acute renal failure (ARF) with fluid and
toxins removed at a continuous and slower rate than
intermittent HD
iii. May be indicated for clients with ARF and who are too
hemodynamically unstable to tolerate conventional
iv. Commonly used types of CRRT
1. Slow continuous ultrafiltration (SCUF)
2. Continuous venovenous hemofiltration via ultrafiltration
and convection
3. Continuous venovenous hemofiltration
4. Continuous venovenous hemodialysis
5. Continuous venovenous hemodiafiltration

III. Statistics
a. Morbidity: In 2005, and estimated 312,000 Americans
received in-center hemodialysis and 2,000 received home
dialysis (National Kidney and Urologic Diseases
Information Clearinghouse [NKUDIC], 2008).
b. Cost: Estimates vary from $35,000 to $60,000 annually
per client; in 2002, Medicare payments for outpatient
hemodialysis were approximately $3.4 billion (U.S. Renal
Data System [USRDS], 2004).

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