Renal Replacement Therapy

During the transitioning process to the new hemodialysis unit, Ms. Conlon anticipated the challenges acquired by learning to set up and use new water equipment in an acute situation. In response to this, Ms. Conlon created and implemented a reverse osmosis flow sheet to assist her colleagues with the quick set-up of the portable RO in the ICU care setting. This tool resulted in a smoother transition for her colleagues, improvement in the delivery of care to the acute dialysis patient, and a decrease in the possibility of staffing overtime.

In dialysis, blood is circulated through an extracorporeal circuit for long periods of time. During this process the blood can begin to develop clot formations throughout the CVC, extracorporeal circuit, and the dialyzer itself; which causes multiple complications for the dialysis patient. In order to minimize or eliminate the

CAPD- Continuous Ambulatory Peritoneal Dialysis. When your kidneys begin to fail your blood is not clean properly and you are not able to get rid of extra waste products in your body. Continuous Ambulatory Peritoneal Dialysis replaces the work of a failed kidney, it cleans your blood and also helps to control water. A permanent catheter is placed in the abdomen whilst under local/general anaesthetic. It might be necessary for you to stay in hospital for 24-48 hours following the procedure which has just taken place, during your short stay in hospital you may have some dialysis. One to three litres of dialysis fluid are run through the catheter and into the peritoneal cavity, this fluid remains in the cavity for several hours before being drained.

In Kidney failure cases urea, creatine, uric acids and electrolytes move from the blood to the dialysate with the net effect of lowering their concentration in the blood. RBC s WBC s and plasma proteins are too large to diffuse through the pores of the membrane. Hemodialysis patient are exposed to 120 to 130 L of water during each dialysis treatment. Small molecular weight substances can pass from the dialysate in to patient’s blood. So the purity of water used for dialysis is monitored and controlled.

Ms. Mancinho continues to strive for excellence and patient care improvements in her position as staff nurse in the hemodialysis unit. She is currently the primary nurse for five of our chronic dialysis patients. All of her primary patients exceed recommended adequacy guidelines and maintain patent, infection free arterial venous fistulas/grafts. While participating in monthly interdisciplinary care plan meetings, she makes suggestions that have led to positive outcomes such as: changes in dry weights, reviews of patients medications with the nephrologist to facilitate warranted medication adjustments as needed, referrals/close coordination with other disciplines such as podiatry and wound care to prevent infection/amputation in patients with advanced vascular disease, and endocrinology for educational purposes for well controlled blood sugars. She is able to quickly assess subtle changes in her patients to then notify the charge nurse and physician for appropriate guidance in facilitating positive patient care outcomes. Through her acute assessment skills she prevented an access from clotting. Prevention of clotting leads to extended longevity of the access. She applies the nursing process to systems or processes at the team/unit/work group level to improve Veteran care. She worked with flow in the new unit which led to better patient care and staff satisfaction. She developed the time out policy: a requirement for

Describe complications that can occur as a result of dialysis and identify nursing measures that are designed to prevent these complications.

What happens when your kidneys fail? Acute renal failure is a disorder of the kidneys when it’s ceased to perform its functions. For example, the kidneys lose its ability to excrete wastes. When your kidneys fail because of a disease or injury, wastes and extra fluid can build up in the blood and make you sick. Kidneys will not be able to maintain homeostasis of electrolytes. A high level of plasma potassium, sodium concentration, and elevated pH will be evident as well.

Mark has had too much damage to his kidneys to be reversible. The kidneys are responsible for filtering out all the toxins and waste in your urine. They also effect blood pressure and can have a side effect of anemia, a condition marked by inability of cells to transport oxygen. The infection really took a toll on his body. Labs will be taken periodically to monitor for any declines in status. You should call the doctor if Mark has any swelling around his eyes or feet that causes his shoes to be too tight, or if his skin loses pallor. Also, monitoring his urine output is important. If his urine output is diminished it is important to call the physician. Either a transplant or dialysis will be needed in the future to keep Mark’s kidneys functioning. To better understand this disorder, you can refer to the National Kidney Foundation at www.kidney.org. Another great resource is Kids Health at kidshealth.org. These websites

The number of patients with end-stage renal disease (ESRD) requiring hemodialysis is constantly rising worldwide.1 Vascular hemodialysis access is considered the lifeline for patients with end-stage renal disease, and arteriovenous fistula (AVF) has been the golden standard access for hemodialysis.2 In Europe, over 25% of all hospital admissions for ESRD are for the construction or maintenance of a patent vascular hemodialysis access.3

The most commonly evaluated clinical parameter measured in the ESRD population is the delivered dose of dialysis is by Kt/V. In this case, majority of the diabetic and non-diabetic population has an adequate dialysis based on their Kt/v (sp). But still many factors are needed to be considered. We should identify the possible causes for those patients who did not meet their required clearance. Check the patient’s vascular access. A Good vascular access provides adequate dialysis. Observe proper cannulation technique and rotate sites to prevent damage of the access. Proper priming should be observed to utilize the surface area of the dialyzer. Clotting of blood due to inadequate heparinization does not produce adequate clearance. The nurse should administer heparin per facility protocol or as ordered by the doctor. Monitor patient’s Kt/V through online clearance monitoring (OCM) to immediately evaluate the current urea clearance of the patient and to provide a prompt intervention and investigation as necessary.

Acute renal failure is described as an abrupt reduction in renal function with elevation of both BUN and plasma creatinine levels. Acute renal failure can be classified as; pre-renal, intra-renal or post-renal. Moreover, it is often linked to oliguria. However, urine output could still be normal or increased. When most types of acute renal failure are diagnosed early, it is reversible.

Haemodialysis cleans blood outside the body by using a pump to pump out the blood and through a dialyser. This filters out the blood via diffusion and pumps the "clean" blood back around the body to pick up more toxins and back to the dialyser. It also takes out the excess water, this is called ultrafiltation. It needs to be done for four hours, three times a week.

Dialysis is a life-saving treatment for adults and children with acute and chronic kidney failure. While it is a life-saving treatment, it can also be life threatening. There are steps and precautions that a healthcare professional must take when assisting a patient with the initiation of dialysis treatment. Patients must also take personal precautions. Training is provided to patient care technicians, nurses and other direct patient care staff. This is to ensure the safety of the patients by having knowledgeable and educated staff. Patients are also trained on certain aspects of the treatment to ensure they receive proper care.

Nurses are using technology devices such as IV monitors, computers, cardiac monitors, medication dispensing machines, portable defibrillators, and patient remote monitoring devices every day to improve patients’ quality of life. Working as a hemodialysis nurse allows me to use more advanced technology ‘hemodialysis machines and reverse osmosis devices’ while performing the hemodialysis treatment on patients. The hemodialysis machine monitors the flow of the blood while it is outside the patient and remove the waste products and the extra fluids from the body. This machine will alarm if anything goes wrong during the treatment. This machine can be considered as a safe artificial kidney that help people with kidney failure or impairment to sustain their

Hemodialysis removes wastes, salts, and excess fluid from the body when your kidney can no longer do the work adequately. The treatment is used with end advanced kidney failure and can help maintain an active life despite failing kidneys. In any case, the process can help control blood pressure, maintain the proper balance of fluid and various minerals. A vascular access is created by a surgeon and then the site will need to heal for any a period of a few weeks to a month. This access point allows a mechanism for a small amount of blood to be removed, cleansed and then returned to your body in order for the hemodialysis to work. In a dialysis center your weight, blood pressure, pulse, and temperature are checked then the access site cleaned. Two needles are inserted, attached to a flexible plastic tubing, and then connected to a dialyzer. With other options this can be done in your own home, which is easier on your body, and may give you more freedom. Equipment that may be used includes a graft or catheter, and a hemodialysis machine if the treatment will be at home and a filter called a dialyzer. The concept behind this process is to help cleanse your blood of the toxins in your body. This will help with a better quality of life, increased well being, reduced symptoms, less cramping, headaches and shortness of breath, improved appetite, sleeping patterns, energy levels and the ability to