July 1, 2022 admin
Haemodialysis Complications And Nursing Management
Major complications associated with haemodialysis:
When the kidneys are no longer working, hemodialysis can save lives, but it can also have serious side effects and complications. A lot of the issues stem from the development of dialysis access, which allows blood to be drawn from the body and purified in a dialysis machine. The body’s fluid and electrolyte imbalance and its effects on blood pressure and cardiac function lead to additional issues. The most popular type of dialysis is hemodialysis. It entails drawing blood from a venous access site, purifying it of toxins and extra fluids, and then reintroducing it to the body. Although hemodialysis attempts to mimic kidney function, it is not an exact science. The homeostasis of the body chemistry can be upset, leading to difficulties and side effects, if the treatment is performed too quickly or if the patient doesn’t follow the recommended food or fluid limitations.
The opening of the closed circulatory system caused by the establishment of an artificial access point in the body also carries a risk. The most prevalent worry, though not the only one, is infection. Hemodialysis (HD) access issues pose serious challenges to those receiving HD, the healthcare system, and notably those with end-stage renal disease. Chronic HD access problems lead to frequent interventions, higher morbidity and mortality, and include thrombosis, infection, ischemia steal syndrome, aneurysms, venous hypertension, hematomas, heart failure, and prolonged bleeding. Additionally, access interventions are frequently expensive, difficult, and may call for specific surgical expertise. Here are just a few of the issues that a nephrologist will look out for in a patient receiving hemodialysis and attempt to prevent.
Hypotension:
Low blood pressure is referred to as hypotension in medical terms. It frequently happens during hemodialysis that the dose and rate of the operation can result in the too quick elimination of fluids from the blood. The internal pressure in the blood arteries will inevitably decrease as a result, sometimes drastically. The patient is at the risk of formation of blood clots if there is a severe drop in blood pressure. The blood clots if remain untreated lead to various complications like seizures, strokes and heart damage and also may be in need of surgery to get rid of the clots. The restrictions on fluid intake can help to maintain the fluid balance during hemodialysis.
Electrolyte Abnormalities:
In the hemodialysis process along with the toxins and excess fluid, some amount of electrolyte is also lost. But the electrolytes play a major role in maintaining the balance in blood and body fluids. If the patient follows the recommended diet, this won’t usually be a problem. However, even following the diet may not be sufficient to avoid the condition known as hypokalemia if the patient has diabetes or takes angiotensin-receptor blockers (ARBs). Low potassium levels in the blood are referred to as hypokalemia. One of the most crucial electrolytes for controlling fluid balance, muscular contractions, and nerve impulses in the body is potassium. The breakdown of muscular tissue, ileus (lazy bowels), cardiac arrhythmia (irregular heartbeat), respiratory failure, paralysis, and atrial or ventricular fibrillation can all result from significant hypokalemia, which is defined as values below 2.5 millimoles per litre (mmol/l).
Infections:
People receiving hemodialysis are constantly at risk for infection. Bacteria and other germs have a chance to enter the bloodstream while dialysis takes place. Usually, antibiotics are used to treat the disease. Blood clots and limb ischemia can be avoided by using heparin, a form of blood thinner. The danger of infection can be considerably decreased by maintaining good hygiene and sanitary procedures. The disinfection and hygiene policies at a dialysis centre should be strictly followed to avoid such types of complications. The dialysis access should never be bumped or knocked as this could result in bleeding, especially if the graft or fistula is fresh. Infection, anaemia, and vascular aneurysm(bulging of the arterial wall) risks are all increased by bleeding.
Dialysis Disequilibrium Syndrome:
The uncommon neurological ailment is known as “dialysis disequilibrium syndrome” (DDS) usually affects persons who have just begun hemodialysis. The release of inflammatory cytokines and other inflammatory chemicals, which cause the brain to enlarge, is thought to be the body’s reaction to a technique it perceives as unnatural (cerebral edema). This is typically a transient side effect that goes away when the body gets used to the medication. To reduce swelling and pressure around the brain, intravenous saline and mannitol injections (a diuretic) are frequently combined.
Nursing Management for Hemodialysis Complications:
Patients with end-stage renal disease (ESRD) must get dialysis, but its effectiveness depends on patient compliance. It has been proposed that nursing intervention can increase compliance. The major checkpoints for nursing interventions for hemodialysis care are before dialysis, during dialysis and after dialysis.
Before Hemodialysis:
• Allow the patient to void.
• Keep track of the patient’s weight.
• Obtain vital signs- Blood pressure, pulse rate, respiratory rate, temperature
• Before the procedure, take patient’s drug history.
• To end a hypotensive episode, antihypertensives, sedatives, and vasodilators are avoided.
During the Hemodialysis:
• Take patients’ vital signs every 30 minutes or so.
• Keep patient’s body in optimal alignment and enable position changes frequently.
• Watch out for any episodes of nausea and vomiting that may happen while the surgery is being done.
• By measuring the clotting time an hour or so before the patient gets off the machine, you can look for bleeding symptoms. While receiving dialysis, monitor the clotting time every 30 to 90 minutes (normal value: 6 to 10 minutes).
After Dialysis:
• Check the patient’s weight and make note of any variations.
• Check for potential complications.
• Verify the fistula’s condition and look for bleeding symptoms.
Reference:
• 3 Hemodialysis Nursing Care Plans. (2013, July 14). Nurseslabs. https://nurseslabs.com/3-hemodialysis-nursing-care-plans/
• Guimarães, G. de L., Goveia, V. R., Mendonza, I. Y. Q., de Matos, S. S., and Guimarães, J. O. (2017). ORIGINAL ARTICLE NURSING INTERVENTIONS FOR HEMODIALYSIS PATIENTS THROUGH CENTRAL VENOUS CATHETER. 9.
• Overview of Hemodialysis Complications – Advanced Renal Education Program. (n.d.). Retrieved June 27, 2022, from https://advancedrenaleducation.com/wparep/article/overview-of-hemodialysis-complications/