Hemodialysis
3x/week, 3-4h/session. Blood through semipermeable membrane against dialysate. Complications: hypotension, cramps, disequilibrium syndrome, infection, bleeding. Dry weight = target post-dialysis weight.
Peritoneal Dialysis
CAPD: 4 exchanges/day. APD: cycler overnight. Advantages: gentler, fewer restrictions. Disadvantages: peritonitis risk. Peritonitis: cloudy effluent, abdominal pain, fever — send for culture.
Vascular Access
AV fistula: artery-vein anastomosis, 2-6 months to mature, lowest infection (gold standard). AV graft: synthetic, 2-4 weeks. Tunneled catheter: immediate, highest infection. Do NOT take BP, draw blood, or start IVs in fistula arm.
Important Notes
- Never take BP, draw blood, or start IVs in fistula arm — can damage access and cause thrombosis.
- Cloudy peritoneal dialysate effluent suggests peritonitis — send for culture immediately.
Clinical Tips
- Assess fistula for thrill and bruit before and after dialysis — absence suggests thrombosis.
- Patient dry weight changes over time — reassess monthly.
Summary
Dialysis nursing requires vascular access protection, monitoring for complications, and patient education for home dialysis.
