Dialysis Nursing Care: Hemodialysis and Peritoneal Dialysis

Dialysis does the kidneys' job: it removes extra fluid, potassium, and waste. There are two main types.

Hemodialysis

Blood is cleaned by a machine, usually 3 times a week, through an AV fistula, an AV graft, or a dialysis catheter.

Caring for the fistula or graft

• Feel for a thrill (a buzzing vibration) and listen for a bruit (a whooshing sound). Both mean it is working. Report if they are missing.
• No BP cuffs, IVs, or blood draws in that arm.
• No tight sleeves or jewelry, and no sleeping on that arm.

Before and after

• Weigh the patient before and after dialysis.
• Some medications, like blood pressure pills, are often held before dialysis. Follow the order.
• After dialysis, watch for low blood pressure, bleeding at the access site, and dizziness.
• Disequilibrium syndrome: headache, nausea, confusion, or seizures from fluid shifts in the brain. Report it right away.

Peritoneal dialysis

Fluid (dialysate) goes into the belly through a catheter, sits (dwells), and then drains out, often at home or overnight.

• Cloudy drainage is the biggest warning sign. It suggests peritonitis. Report it, along with fever or belly pain.
• Warm the dialysate as directed, never in a microwave.
• If the fluid drains slowly, change the patient's position, check the tubing for kinks, and check for constipation.
• Use strict sterile technique with every exchange.

Quick answers

For learning only. Lab ranges and policies vary. Always follow your nursing program, a current drug reference, and your facility's policies.