Reflection on Haemodialysis Assessment: A Nursing Perspective

This report offers a comprehensive reflection on haemodialysis assessment, focusing on critical aspects of nursing practice. It explores the management of various complications, including hypotension, cramps, vomiting, and headaches, providing insights into their causes and treatments. The assessment also covers A-V access surveillance, emphasizing the importance of timely interventions to prevent complications such as stenosis and thrombosis. Furthermore, the report delves into anticoagulation strategies used during haemodialysis, highlighting the significance of maintaining adequate blood flow and preventing coagulation. It discusses the use of heparin and alternative methods to minimize risks. The report emphasizes the importance of clinical observation, physical examination, and access flow measurement as key tools in detecting and managing access problems. The student's reflection draws on various research papers to support the analysis of the key areas in health care nursing practice and presents a detailed overview of the assessment skills in haemodialysis.

UNIVERSITY
Name of the Student
Task
Reflection on Haemodialysis assessment
Tutor

Introduction
Haemodialysis is a process of blood purification; it entails the removal of waste products in
the blood. Clinical practice is of the essence in hemodialysis nursing world. Having basic and
competent understandings of various nursing practice diagnosis is essential in the
management of the dialysis process, (Nistor, 2015). This reflection offers my assessment
skills on key areas in health care nursing practice touching on hypotension, cramps, vomiting,
headaches, vomiting, A-V Access surveillance and anticoagulant free dialysis assessment.
Hypotension management
Hypotension can occur during hospital admission or developed during the patient's
hospitalization or at times caused by iatrogenic complications. Non-traumatic conditions
occurring out of hospitals are associated with increased hospital mortality, while those
developing in emergency care settings or during acutely decompensated heart failure, COPD
and community-acquired occurrence is associated with high mortality. Its occurrence happens
at below normal blood pressures ranges of 120/80mmHg, (Dasgupta, Farrington, Simon,
Davies, Davenport & Mitra, 2016 pp. 325). Main causes can be attributed to a decrease in
cardiac output, dilation of blood vessels low blood volume, nervous system impairment, and
other medications. Intradialytic hypotension is a common hemodialysis type occurring. It
leads to a rapid reduction in the volume of blood due to the ultrafiltration process ad
reduction in extracellular osmolarity process. Its management entails usage of midodrine, and
vasopressin analogous. Further, usages of new classes of drugs such as adenosine receptor
antagonists have been used selectively to manage the state, (Kuipers et al., 2016 p. 21.
Cramps
Cramps are more observed among patients needing high ultrafiltration rates. Cramps during
dialysis are related to a reduction in muscle perfusion which occurs in response pt
hypovolemia. Vasoconstrictive responses occur which can shut the blood in the central
pathways which can promote muscle cramps. Further changes occurring in intra and
extracellular potassium balance and calcium ionization often can disturb neuromuscular
transmission casing cramps. Further, they can be linked to intra dialectic cramps which
ascertain the presence of dialytic treatment linked to cramps. Its management treatment can
be undertaken using physical manoeuvres to smoothen muscles. Moreover, usage of dialysate
of sodium, potassium, and calcium can be affected. Reassessing dry weight and patient
counseling can be effective in the reduction of interdialytic weight gain and usage of
bicarbonate dialysis, (Flythe et al., 2018).
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Vomiting, headaches, and vomiting
Vomiting and nausea are often associated with kidney. Low blood pressure and excess weight
gain are the most often associated causes. The symptoms are commonly associated with a
kidney condition, coupled with low blood pressure and weight gain can have contributing
effects. Nausea and vomiting can have effects of discontinuation of dialysis treatment
process. Medication management of nausea and vomiting entails regulation of fluid removal
levels and further prescription of anti-nausea medication, (Singh et al., 2016 pp. 803-805).
Further, the dialysis process, may at times induce severe headaches which often result in
large quantity shifts in electrolyte and water balance, (Goksan, Karaali-Savrun, Ertan &
Savrun, 2004 ). They can result from low blood pressure. Management is offered through
over the counter drugs. Over the counter drugs such as acetaminophen can be used to
minimize headaches.
A-V access surveillance
Haemodialysis vascular access often referred to as lifeline is critical to a lifeline. Functional
arteriovenous access offers a lifeline access for hemodialysis is crucial as it provides enough
blood for adequate dialysis. Common causes of AV failure are linked to stenosis and
development of thrombosis. Stenosis assessment can be detected using various techniques
which often calls close monitoring. Clinical observation, flow measurement, pressure
determination, and recirculation measurement is crucial in the assessment of stenosis.
Further, stenosis can be accessed through direct visualization though none invasive
techniques such as venography or color duplex imaging, (Inston et al., 2017 pp. 4-7).
Managing access and patency of diagnosing accuracy of A-V access depends on timely
interventions. Related linked to vascular access is often the common causes of hemodialysis
hospitalizations among dialysis patients. Thus, prevention of complication development can
be effective in reducing morbidity, mortality and reducing associated complications which
reduces the health care system.
A-V access assessment can be undertaken using physical examination process which is the
cornerstone of clinical monitoring. Elements of access can include inspection of arm,
shoulder, face, neck, and breast, palpation assessment and auscultation. Physical assessment
of vascular access is often a simple method which can be performed readily. Access flow
measurement can be further implemented; this can measure significant stenosis which
assesses monthly blood flow access. Further assessment of venous pressure monitoring can
be undertaken using a dialysis machine using a pressure transducer at the beginning of
hemodialysis, (Khawaja et al., 2016 pp. 104-107).
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Surveillance and monitoring of AV access is a critical care component in hemodialysis of
patients. Physical examination and clinical assessment are the key fundamental tools to be
used in detecting access problems.
Anticoagulation hemodialysis
Haemodialysis process entails renal replacement therapies which call for adequate blood
flow. Often some forms of the anticoagulation process such as usage of heparin are critical in
preventing thrombosis. The anticoagulation process during hemodialysis process entails
monitoring and determination of activated clotting times. Usage of low dose or minimum
heparin use methods is effective. Further other methods such as anticoagulation with citrates
and prostacyclin and heparin-protamine medicines have been effectively been used.
Anticoagulation process in normal hemodialysis often can consist of standard doses of
heparin which is offered as bolus given at the start of treatments and midpoints so as to
maintain the needed stable anticoagulation steps. Further heparin modelling can be
undertaken using initial bolus administration followed with fixed heparin infusing in order to
maintain the activated clotting time which is normally between 200-250 seconds. Activated
clotting time is often performed from activating agents in fresh samples of blood and
assessment of time taken. This therapeutic medication process offers a systematic
anticoagulation during the dialysis treatment, (Jose et al., 2015).
The anticoagulation process during dialysis is a treated approach which prevents coagulation
process. Most used agents function through inhibition of plasmatic coagulation. Other
methods of management such as immune-mediated induced heparin thrombocytopenia often
lead to life-threatening complications related to heparin therapy which calls for caution which
necessities to shift to non-heparin methods, (Wong et al., 2016 pp. 630-635).
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References
Dasgupta, I., Farrington, K., Davies, S.J., Davenport, A. and Mitra, S., 2016. UK National
Survey of practice patterns of fluid volume management in haemodialysis patients: a need for
evidence. Blood purification, 41(4), pp.324-331.
Flythe, J.E., Hilliard, T., Lumby, E., Castillo, G., Orazi, J., Abdel-Rahman, E.M., Pai, A.B.,
Rivara, M.B., Peter, W.L.S., Weisbord, S.D. and Wilkie, C.M., 2018. Fostering Innovation in
Symptom Management among Hemodialysis Patients: Paths Forward for Insomnia, Muscle
Cramps, and Fatigue. Clinical Journal of the American Society of Nephrology, pp.CJN-
07670618.
Göksan, B., Karaali-Savrun, F., Ertan, S. and Savrun, M., 2004. Haemodialysis-related
headache. Cephalalgia, 24(4), pp.284-287.
Inston, N., Schanzer, H., Widmer, M., Deane, C., Wilkins, J., Davidson, I., Gibbs, P., Zanow,
J., Bourquelot, P. and Valenti, D., 2017. Arteriovenous access ischemic steal (AVAIS) in
haemodialysis: a consensus from the Charing Cross Vascular Access Masterclass 2016. The
journal of vascular access, 18(1), pp.3-12.
Jose, M.D., Longmuir, H., Dodds, B., Bereznicki, L., Prasad, R., Batt, T.J., Strippoli, G.F.
and Palmer, S.C., 2015. Anticoagulation for people receiving long‐term haemodialysis.
Cochrane Database of Systematic Reviews, (9).
Khawaja, A.Z., Cassidy, D.B., Shakarchi, J.A., McGrogan, D.G., Inston, N.G. and Jones,
R.G., 2016. Systematic review of drug eluting balloon angioplasty for arteriovenous
haemodialysis access stenosis. The journal of vascular access, 17(2), pp.103-110.
Kuipers, J., Oosterhuis, J.K., Krijnen, W.P., Dasselaar, J.J., Gaillard, C.A., Westerhuis, R.
and Franssen, C.F., 2016. Prevalence of intradialytic hypotension, clinical symptoms and
nursing interventions-a three-months, prospective study of 3818 haemodialysis sessions.
BMC nephrology, 17(1), p.21.
Nistor, I., Palmer, S.C., Craig, J.C., Saglimbene, V., Vecchio, M., Covic, A. and Strippoli,
G.F., 2015. Haemodiafiltration, haemofiltration and haemodialysis for end‐stage kidney
disease. Cochrane Database of Systematic Reviews, (5).
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Singh, T., Guirguis, J., Anthony, S., Rivas, J., Hanouneh, I.A. and Alkhouri, N., 2016.
Sofosbuvir‐based treatment is safe and effective in patients with chronic hepatitis C infection
and end stage renal disease: a case series. Liver International, 36(6), pp.802-806.
Wong, S.S.M., Lau, W.Y., Chan, P.K., Wan, C.K. and Cheng, Y.L., 2016. Low-molecular
weight heparin infusion as anticoagulation for haemodialysis. Clinical kidney journal, 9(4),
pp.630-635.
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