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HEMODIALYTIC PROCEDURE
When starting a patient on hemodialysis a physician’s order must include the following:
Type of dialysis—conventional vs. high-efficiency or high-flux
- dialyzer
- blood flow rate
- dialysate composition—important items to consider are buffer, potassium concentration, and glucose concentration
- dialysate flow rate
- frequency and duration—schedules for patients vary from 2-4 hours, two or three times a week
- estimated ideal or dry weight and amount of fluid to remove as well as blood pressure support
- nutritional management including fluid intake—the doctor must consult with the dietician who will suggest an appropriate diet for the patient
- laboratory tests pre- and postdialysis—these include BUN, electrolytes, creatinine, calcium, phosphates, glucose, total bilirubin, cholesterol, total protein, albumin, and total blood count
- medication to be given during the treatment including erythropoietin (EPO), calcitriol, and others
- any special instructions that may be required to complete the dialysis as prescribed
Each hospital has different procedures and nursing practices for the initiation of dialysis. These procedures should begin with stated goals such as:
- Dialysis is begun with minimal or no complications
- All written physician orders are evaluated and the pre-assessment is completed
- Pre-assessment of the patient is completed prior to initiation of dialysis—vital signs, weight, evaluation of fluid status, brief interdialytic history, and access evaluation.
- Pre-assessment of the machine is completed prior to initiation of dialysis—set-up, proper dialyzer, and dialysate concentrate.
- A list of necessary equipment to begin the procedure:
