Hemodialysis

Question 1

Access Device Complications

Answer 1

1. Thrombosis (most frequent) – veins respond to high-pressure arterial flow by thickening and reducing or occluding blood flow. Thrombolytic drugs can be used to bust the clot.
2. Infection – caused by staphylococcus aureus during cannulation. Be sure to prepare the skin with antibacterial agents before cannulation.
3. Aneurysm formation – caused by repeated needle punctures at the same site. Large aneurysms may require surgical repair.
4. Ischemia – occurs when fistula decreases arterial blood flow to areas below the fistula. If collateral circulation is poor, fistula may need to be surgically tied off and a new one created.
5. Heart failure – the shunting of the blood through the fistula can cause HF in patients with limited cardiac function. While rare, the fistula may need to be revised to reduce the flow.

Question 2

Dialysis disequilibrium syndrome

Answer 2

May develop during or after hemodialysis due to the rapid reduction in electrolytes and other particles. Reducing blood flow at the onset of symptoms can prevent DDS. Lessen time of procedure. Closely monitor VS, fluid balance, and neurological status. If left untreated can lead to seizures, decreased LOC, increased ICP, and/or coma.

Question 3

Cardiac Events

Answer 3

Associated with underlying cardiovascular disease. Appropriate assessments prior to dialysis can help prevent these events.

Question 4

Reaction to Dialyzers

Answer 4

Still occurs, although less frequently. Most reactions occur during a “first time” use of the filter. If suspected, do not return blood to patient and discontinue hemodialysis. Treatment includes corticosteroids.

Question 5

Hypoglycemia

Answer 5

Rare and most likely to occur when patient has diabetes. Managed by providing glucose and increasing dialysis glucose concentration in all other treatments.

Question 6

Hemorrhage

Answer 6

Occurs with needle dislodgement or circuit connections loosening; because of anticoagulation to maintain patency, patient can bleed out. Stop bleeding by applying pressure.

Question 7

Infectious Diseases

Answer 7

Hepatitis and HIV – monitor all patients receiving HD. Use standard precautions to prevent transmission. Routine screening will also help.