Hemodialysis Care Essentials

Overview

Topic: Hemodialysis care for patients with end-stage chronic renal failure.
Focus: indications for dialysis, access types, nursing considerations, common lab abnormalities, and treatments given during dialysis.
Purpose: concise study notes for nursing or medical students on managing hemodialysis patients.

End-stage renal disease: last phase where kidney function ~15% or less.
Chronic causes: long-term high blood pressure, high blood sugar, chronic hypoxia, or chronic overload damage kidneys.
Expect minimal to no urine output in dialysis patients; any output is usually very small.

AV fistula: surgically created connection in the arm; preferred for long-term hemodialysis.
Quinton catheter: temporary central venous catheter placed subclavian or jugular (neck).
Quinton catheters are handled only by dialysis nurses; do not flush them as a general nurse.

Patients are on strict fluid restriction; all intake must be accounted for.
Isotonic fluids and careful intake monitoring are essential.
Diuretics may still be used to try to obtain any possible urine output even with minimal kidney function.

Fluid overload between dialysis sessions increases cardiac workload and causes hypertension.
Antihypertensive medications are commonly prescribed between dialysis treatments.
Avoid giving antihypertensives immediately before dialysis because dialysis can remove medications and reduce effectiveness.

Hold certain medications before dialysis; dialysis can remove drugs from circulation.
Do NOT administer blood pressure medications right before dialysis — they may be filtered out by the machine.
Teach patients to avoid potassium-containing supplements and iron supplements without guidance.

Expect elevated potassium (hyperkalemia) between dialysis treatments.
Blood urea nitrogen (BUN) and creatinine are markedly elevated (e.g., creatinine may be very high compared to normal ~1.2).
Hemoglobin and hematocrit (H&H) are chronically low due to reduced erythropoietin production.
Typical H&H for dialysis patients often hovers around 8–9 g/dL (normal ~12–15 g/dL).

Kidney failure reduces erythropoietin production, causing chronic anemia.
Treatments:
- Erythropoietin (EPO) injections (often given during or after dialysis).
- Packed red blood cell transfusions (commonly given with dialysis if H&H critically low).
Assess trends before reacting; consistently low H&H may prompt transfusion orders.

Hemodialysis machine filters blood and returns it to the patient; it can remove fluid, electrolytes, and some medications.
Because dialysis “cleans out” blood, lab values and medication levels fluctuate around dialysis sessions.
Educate patients on dietary restrictions (potassium, sodium) because intake affects levels until next dialysis.

AV Fistula: surgically created connection between artery and vein for dialysis access.
Quinton Catheter: temporary central venous dialysis catheter (subclavian or jugular).
Hemodialysis: blood-based dialysis using an external machine to filter and return blood.
Erythropoietin (EPO): hormone that stimulates red blood cell production; given as medication when kidneys fail.
H&H: hemoglobin and hematocrit, measures of red blood cells and oxygen-carrying capacity.

Restrict fluid intake; measure and record all fluids.
Avoid high-potassium and high-sodium foods; follow renal diet.
Do not self-administer potassium or iron supplements without provider approval.
Understand dialysis schedules and why some medications are held before treatment.
Recognize signs of anemia (fatigue, pallor) and report them.

Monitor and document fluid intake and output closely.
Check labs (electrolytes, BUN, creatinine, H&H) and trend results.
Coordinate timing of medications around dialysis sessions; hold meds that will be removed.
Communicate with dialysis nurse regarding vascular access care and catheter handling.
Administer EPO or arrange transfusion per orders for chronic anemia management.