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Hemodialysis - HEMODIALYSIS In hemodialysis(HD blood is...

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HEMODIALYSIS In hemodialysis (HD), blood is shunted through an artificial kidney (dialyzer) for removal of toxins/excess fluid and then returned to the venous circulation. Hemodialysis is a fast and efficient method for removing urea and other toxic products and correcting fluid and electrolyte imbalances but requires permanent arteriovenous access. Procedure is usually performed three times per week for 4 hr. HD may be done in the hospital, outpatient dialysis center, or at home. NURSING DIAGNOSIS: Injury, risk for [loss of vascular access] Risk factors may include Clotting; hemorrhage related to accidental disconnection; infection Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Dialysis Access Integrity (NOC) Maintain patent vascular access. Be free of infection. ACTIONS/INTERVENTIONS Hemodialysis Therapy (NIC) Independent Clotting Monitor internal AV shunt patency at frequent intervals: Palpate for distal thrill; Auscultate for a bruit; Note color of blood and/or obvious separation of cells and serum; Palpate skin around shunt for warmth. Notify physician and/or initiate declotting procedure if there is evidence of loss of shunt patency. RATIONALE Thrill is caused by turbulence of high-pressure arterial blood flow entering low-pressure venous system and should be palpable above venous exit site. Bruit is the sound caused by the turbulence of arterial blood entering venous system and should be audible by stethoscope, although may be very faint. Change of color from uniform medium red to dark purplish red suggests sluggish blood flow/early clotting. Separation in tubing is indicative of clotting. Very dark reddish-black blood next to clear yellow fluid indicates full clot formation. Diminished blood flow results in “coolness” of shunt. Rapid intervention may save access; however, declotting must be done by experienced personnel.
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ACTIONS/INTERVENTIONS Hemodialysis Therapy (NIC) Independent Clotting Evaluate reports of pain, numbness/tingling; note extremity swelling distal to access.
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