HEMODIALYSIS

dangers of inappropriate uf
high uf - high volume depletion
low uf - volume overload & congestion (fluid not excreted well)
manifestations: dob, orthopnea. desaturation, rale or crackles on PE, edema, high bp,
chest discomfort, easy fatigability, malaise

hypotensive client
- position trendelenburg position
- infuse NSS (flush 200 ml)
- stop dialysis if not treated

dangers of inappropriate dry weight

too high - signs of congestions & fluid overload
Manifestations: dob, orthopnea. desaturation, rale or crackles on PE, edema, high
bp, chest discomfort, easy fatigability, malaise
too low -  signs of dehydration & volume depletion
Manifestations: tinnitus, hoarsness of voice, dizzinezz, thirst, hypotensions, cramps,
feeling wasted, malaise, headacge, tachycardia, LOC

interpreting alarms & safety indicators

task of hemodialysis machines

produce fresh dialysate
- heating ~37C
- degassing: air removal
- mixing: proportioning acid, bicarbonate & water
deliver the correctly prepared dialysate and monitor dialysate conductivity &
temperature
remove fluid form the pt's blood by ultrafiltration
handle and monitor the effluent dialysate
- detection of blood leak
providing secondary air separation
operate and monitor extracorporeal circuit
- pump the blood
- provide coagulant
 - monitor arterial and venous pressure
- monitor transmembrane pressure
- monitor for air

STAFF RESPONSE TO MACHINE ALARMS

1. mute aram; reassure the pt
2. identify the alarm
3. identify the problem
4. correct the problem
5. press reset
6. resume dialysis
7. provide an explanation to the patient
AIR DETECTOR W/ LINE CLAMP
FUNCTIONS: Detect air in the venous drip chamber and engages clamp on line (failure
to put line through clamp can result in air embolism)
What activates the alarm?
normal saline not clamped
arterial transducer protector not secure
resetting frequent machine alarms w/o correcting problem
arterial medication port not capped securely
improperly primed set up
arterial needle dislodge
BLOOD LEAD DETECTOR
detects presence of blood in used dialysate (large or small blood leak)
What activates the alarm?
breaks in dialyzer membrane
improper handling of dialyzer
ARTERIAL PRESSURE ALARM
monitors pressure b/w the arterial access and blood pump
What activates the alarm?
kink in arterial line
clamp in arterial line
hypotensive patient
arterial needle malpositioned
needle clotted
wet transducer protector
catheter dislodge or clotted
VENOUS PRESSURE ALARM
monitor pressure between the venous drip chamber & venous access
What activates the alarm?
kink and clamp on venous line
clots in the venous drip chamber
venous stenosis
malpositioned venous needle
wet transducer protector
TRANSMEMBRANE PRESSURE ALARM
measures the pressure on the dialyzer membrance
What activates the alarm?
wet or malpositioned arterial or venous transducer pretoctor
 kink in the bloodline - b/w diaylzer & velnous transducer preotector
improper flow of dialysate (kink line, clogged dialysate line filter)
high uf rate/ small dialyzer
clotting in the dialyzer
high permeability dialyzer being used
MACHINE RESPONSE TO BLOOD ALARMS
blood pump stops

DIALYSIS MACHINE ALARMS

DIALYSATE ALARMS
CONDUCTIVITY ALARM - monitors conductivity of dialysate in machine
TEMPERATURE

TEMPERATURE ALARM - monitor temp dialysate

Erythropoietin stimulating agents
warm compress to relive cramps
painful muscle cramps usually in extremities
predisposing factors
hypotension
hypovolemia
brain swelling
rapid removal of urea from  blood