Today our topic of discussion is Role of Nurse in care of Patient on Hemodialysis.
Role of Nurse in care of Patient on Hemodialysis
Role of Nurse in Care of Patient on Hemodialysis with Double Lumen Catheter
- Wash the hands
- Prepare venous access
- Clamp the tubing to prevent the air entry into the catheter
- Clean each catheter extension tube clamp and luer-lock injection cap with povidone-iodine sponge to remove the contaminants Place a sterile 4″ x 4″ gauze pad under the extension tubing and place two 5 ml syringe and two sterile gauze pads on the drape
- Prepare the anticoagulant regimen as ordered
- Identify the arterial and venous blood lines and replace them near the drape
- Remove clothes and ensure the catheter patency, remove the catheter cap and attach syringe to each catheter port.
- Open one clamp and aspirate 1.5-3 mL of blood
- Close the clamp and repeat the procedure with other port
- Flush each port with 5 ml. of heparin flush solution
- Attach bloodline to patient access, remove the syringe from the arterial port, attach the line to arterial port, and administer heparin according to the protocol which prevents extracorporeal circuit
- Grasp venous bloodline and attach to venous port, open the clamp on extension tubing and secure the tubing to patient’s extremity with a tape to reduce the tension on the tube and minimize the trauma in the insertion site, begin the hemodialysis according to the unit protocol.
Post-procedure Care
- Wash your hands
- Clamp the extension tubing to prevent air entry
- Clean all connection point on the catheter and bloodlines as well as clamps to reduce the risk of systemic or local infections
- Place a clean drape under the catheter and to sterile 4″ x 4″ gauze pad on the drape beneath the catheter lines, soak the pad with povidone-iodine solution and then prepare the catheter flush solution with normal saline or heparin flush solution as ordered
- Put clean gloves. Grasp each bloodline with a gauze pad and disconnect each line from the catheter
- Flush each port with a saline solution to clean the extension tubing and the catheter of blood, administer additional heparin flush solution as ordered to ensure catheter patency then attach a luer-lock cap to prevent entry of air or loss of blood
- Clamp the extension tubing
- Hemodialysis is complete redress the catheter in the insertion site also redresses if occluded or soiled
- Position the patient in supine with his face turned away from the insertion site
- Wash your hand and remove the outer occlusive dressing, put on the sterile gloves.
- Remove the old inner dressing and discard the gloves and the inner dressing
- Set up a sterile field and absorb the site for drainage
- Obtain a drainage sample for culture
- Notify the doctor if the suture is missing
- Put on a sterile glove and clean the insertion site with a alcohol sponge and then clean the site with povidone- iodine sponge and allow to air dry
- Put a precut gauze dressing over the insertion site and under the catheter and place another gauze dressing over the catheter
- Apply a skin barrier preparation to the skin surrounding the gauze dressing, cover the gauze and catheter with a transparent occlusive dressing
- Apply 4 or 5 piece of two inch tape over the cut edge of the dressing to reinforce the over edge.
Role of Nurse in Care of Patient on Hemodialysis with an All Fistulas (Fig. 29.118)
- Flush the fistula needles using attached syringe containing heparin flush solution
- Place a Mackintosh under the patient’s arm
- Using aseptic technique clean the area of the skin over the fistula with povidone-iodine sponge (3″ x 10″) Discard each pad after one wipe
- Apply the tourniquet above the fistula to distant the vein and facilitate the venous puncture
- Put on clean gloves; perform a venous puncture with a fistula needle
- Remove the needle guard and squeeze the wing tip firmly together
- Insert arterial needle at least one inch above the anastomosis, be careful not to puncture the fistula
- Release the tourniquet and flush the needle with heparin
- Clamp the arterial needle with hemostat and secure the wing tip of the needle with adhesive tape few inches above the arterial needle; flush the needle with heparin flush solution
- Clamp the venous needle tubing and secure they tip of the venous needle
- Remove the syringe form the end of the arterial tubing and uncap the arterial line from the hemodialysis machine and connect the two lines wing
- Tape the connection secretly to prevent from separating during the procedure
- Repeat the above two steps for venous lines
- Release the hemostat and start hemodialysis.
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