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Hemodialysis

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This document outlines guidelines for providing hemodialysis treatment, including: only using the access arm for dialysis and applying direct pressure for bleeding; using catheters only for dialysis unless otherwise ordered; postponing routine meds before/after dialysis unless ordered; avoiding IM meds/IVs for 3 hours after; weighing patients daily and prohibiting access arm procedures; and observing patients during and after treatment for adverse reactions.

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Hemodialysis Hemodialysis is provided according to physician orders by contract staff that follow their agency policy  The access arm is not used as a site for arterial blood gas sampling nor is it utilized for BP’s, IV’s, or other venipunctures or tourniquet  In the event that accidental venipuncture of the fistula/graft occurs, direct pressure is applied for ten minutes or until bleeding stops  Continue to observe for signs of bleeding  Hemodialysis catheters are used for dialysis only unless the protocol for difficult IV starts has been followed and the attending physician gives the order to utilize the line
Hemodialysis (continued)  If the Hemodialysis catheter is needed for IV infusion follow the CVC policy and physician orders for Utilization of Hemodialysis Catheters for Intermittent Intravenous Infusion  Routine medications are postponed prior to dialysis and resumed following dialysis unless specifically ordered by the nephrologist  Due to risk of hemorrhage, no IM medications are administered or IV initiated for three hours following dialysis  If venipuncture is performed within three hours of termination of dialysis, direct pressure is applied for five minutes or until bleeding stops  Apply pressure dressing for one hour to prevent further bleeding
Hemodialysis (continued)  All medications listed with the physician’s dialysis order, (for example, Epogen), are administered by the contract nursing staff in accordance with their agency policy  Hemodialysis is provided in the designated dialysis treatment room; however, hemodialysis may be provided at the bedside if the patient’s condition warrants  Patients that are isolated or who have Hepatitis B undergo hemodialysis in their room with appropriate precautions maintained
Hemodialysis (continued)  Nurse to nurse report occurs prior to and following hemodialysis  In the event that a patient becomes unresponsive, or at the discretion of the contract dialysis nurse, becomes in need of emergent care, the dialysis nurse dials 5555 or pushes the code button and reports a “Code Blue”  In addition to the administrative supervisor and the ER staff, the primary nurse reports to the treatment area  In the event that the patient is a DNR, the dialysis nurse first notifies the physician, and then the primary nurse to determine the best course of action
Hemodialysis (continued)  All dialysis patients are weighed daily and have a sign posted at bedside prohibiting needle sticks and BP’s in the access arm  Pertinent aspects of the patient’s condition are assessed before, during, and following hemodialysis  These include, but are not limited to cardiovascular, vital signs, respiratory, pharmacological, and coagulation status  Patients are observed for signs of adverse reactions, including: hypovolemia, hemorrhage, disequilibrium syndrome, electrolyte imbalance, and air embolism

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Hemodialysis

  • 1. Hemodialysis Hemodialysis is provided according to physician orders by contract staff that follow their agency policy  The access arm is not used as a site for arterial blood gas sampling nor is it utilized for BP’s, IV’s, or other venipunctures or tourniquet  In the event that accidental venipuncture of the fistula/graft occurs, direct pressure is applied for ten minutes or until bleeding stops  Continue to observe for signs of bleeding  Hemodialysis catheters are used for dialysis only unless the protocol for difficult IV starts has been followed and the attending physician gives the order to utilize the line
  • 2. Hemodialysis (continued)  If the Hemodialysis catheter is needed for IV infusion follow the CVC policy and physician orders for Utilization of Hemodialysis Catheters for Intermittent Intravenous Infusion  Routine medications are postponed prior to dialysis and resumed following dialysis unless specifically ordered by the nephrologist  Due to risk of hemorrhage, no IM medications are administered or IV initiated for three hours following dialysis  If venipuncture is performed within three hours of termination of dialysis, direct pressure is applied for five minutes or until bleeding stops  Apply pressure dressing for one hour to prevent further bleeding
  • 3. Hemodialysis (continued)  All medications listed with the physician’s dialysis order, (for example, Epogen), are administered by the contract nursing staff in accordance with their agency policy  Hemodialysis is provided in the designated dialysis treatment room; however, hemodialysis may be provided at the bedside if the patient’s condition warrants  Patients that are isolated or who have Hepatitis B undergo hemodialysis in their room with appropriate precautions maintained
  • 4. Hemodialysis (continued)  Nurse to nurse report occurs prior to and following hemodialysis  In the event that a patient becomes unresponsive, or at the discretion of the contract dialysis nurse, becomes in need of emergent care, the dialysis nurse dials 5555 or pushes the code button and reports a “Code Blue”  In addition to the administrative supervisor and the ER staff, the primary nurse reports to the treatment area  In the event that the patient is a DNR, the dialysis nurse first notifies the physician, and then the primary nurse to determine the best course of action
  • 5. Hemodialysis (continued)  All dialysis patients are weighed daily and have a sign posted at bedside prohibiting needle sticks and BP’s in the access arm  Pertinent aspects of the patient’s condition are assessed before, during, and following hemodialysis  These include, but are not limited to cardiovascular, vital signs, respiratory, pharmacological, and coagulation status  Patients are observed for signs of adverse reactions, including: hypovolemia, hemorrhage, disequilibrium syndrome, electrolyte imbalance, and air embolism