A Day in The Dialysis Unit: Principles, Assessment, and Management

A Day in The Dialysis Unit
A DAY IN THE DIALYSIS UNIT
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Table of contents

A Day In The Dialysis Unit 2
A Day in the Dialysis Unit...............................................................................................................2
The principles of hemodialysis........................................................................................................3
Pre and post dialysis assessment......................................................................................................4
AV fistula assessment......................................................................................................................4
Fluid overload assessment...............................................................................................................5
Dry weight formula..........................................................................................................................6
Blood interpretations in hemodialysis.............................................................................................6
Bicarbonate..................................................................................................................................6
Complications and management during dialysis.............................................................................7
The Gambro Hygienic Chain.......................................................................................................8
Alarms reasons management.......................................................................................................8
Conductivity.................................................................................................................................9
AP, VP and TMP.......................................................................................................................10
Carbon Tank...............................................................................................................................11
Reverse Osmosis Tank...............................................................................................................11
Deionizer Tank (DI)...................................................................................................................12
A Day in the Dialysis Unit
Hemodialysis is done to patients in hospitals or health centers. Furthermore, it is done on
patients with kidney failure on the advanced stage. An artificial kidney performs hemodialysis; it

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has a dialyzer that filters extra fluid and wastes from the blood. Patients who present at the renal
unit are trained to be very independent (Mayo Clinic, 2018).
The weight of each patient is taken so that the nurses can know the exact amount of fluid
each patient needs to remove. Some patients can connect themselves to dialysis machines
depending on their vascular access. Nurses entirely check them and regularly monitor their blood
pressure. Furthermore, they need excellent communication skills to communicate with patients
and make them comfortable effectively. The essay discusses a day in the dialysis unit, the
various components of a dialysis machine and how they function. Furthermore it discusses
patient education in dialysis.
The principles of hemodialysis
Hemodialysis is a process that uses an artificial kidney to remove metabolic wastes, urea,
excess fluid, and toxins from the blood. Dialysis is the movement of water and solutes across a
semi-permeable membrane along a concentration gradient. Hemodialysis is the exchange of
solutes and water between an artificial solution known as dialysate and blood in the body across
a semipermeable membrane (Mackenzie & Zawada, 2005).
The fluid exchange removes toxins and metabolic wastes in the blood. Furthermore, it
corrects the electrolytes, fluid, and acid-base arrangements. Small molecular weight solutes,
water, and uremia toxins pass through membrane pores along hydrostatic and diffusive gradients.
However, the movement of plasma proteins, large solutes, and blood cellular components are
limited to pore sizes. Excess water and other solutes are forcibly removed through the membrane
by ultrafiltration, which is produced by osmotic and hydrostatic forces in the dialysis membrane.

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The removal of uremic solutes is influenced by the concentration gradient, permeability
characteristics of the membrane, blood flow, duration of dialysis and the amount of ultrafiltration
(Blowey, 2005).
Pre and post dialysis assessment
Pre-dialysis involves intensive patient education, adherence to lifestyle modifications and
pharmacotherapy. The symptoms of uremia are handled by a nephrologist who analyses urine
tests and blood tests. Each patient is diagnosed and treated for the risk factors to reduce mortality
and comorbidity. Furthermore, the nephrologist discusses adherence to prescribed medicines,
daily exercise, healthy diet, quit habits such as smoking. Pre-assessment supports patients in
coping up with the real stress that accompanies dialysis so that they can identify renewed balance
in life (Yvo, Noeleen & Ton, 2008).
The patients experience many symptoms which are not easily recognized or treated.
Furthermore, they experience post-dialysis fatigue after dialysis sessions. The dry weight is
encountered at the end of the dialysis process, which leaves the patient with symptoms of
hypotension and low weight. The overestimation of dry weight can lead to potential hazards of
overhydration such as pulmonary edema and hypertension. Underestimation can make dialysis
patients suffer hypotensive episodes (Watson, 2008).
AV fistula assessment
The arteriovenous fistula is formed by linking the patient’s vein and artery in the limb. It
is done using a local anesthetic as an outpatient operation. The vein grows stronger as blood