Hemodialysis vs Peritoneal Dialysis NCLEX Review

Dialysis is a treatment for kidney failure that rids the body of wastes by filtering and flushing out excess fluid and electrolytes.

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Table of contents

    Introduction to Hemodialysis vs Peritoneal Dialysis

    When performing dialysis, there are two main options for clients: hemodialysis and peritoneal dialysis. While both of these processes remove waste products from the body, they each have their benefits and drawbacks.

    Hemodialysis requires a machine known as an artificial kidney, while peritoneal dialysis uses a special fluid called dialysate, which is infused into the abdomen through the catheter. Both hemodialysis and peritoneal dialysis require clients to have a catheter in their arm or leg, connecting them to a machine that does the cleaning work.

    Hemodialysis gives clients with kidney failure better control over their symptoms than peritoneal dialysis. It cleanses blood more quickly than peritoneal dialysis, which can mean less frequent treatments for clients undergoing this procedure. Because of this, hemodialysis can be more effective at preventing hospitalizations and other serious complications.

    Memory trick: Any time you see the word “dial,” in dialysis, think of the soap – it cleans the blood.

    Before Dialysis

    Before a client begins dialysis, nursing assessments include: assessing their fluid status, weight, and vital signs. They will also need to hold off on these meds:

    • Antihypertensives
    • Ace & Arbs
    • Beta Blockers
    • Ca Channel Blockers
    • Diuretics
    • Dilators
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    Fistula of the Shunt

    A shunt is an artificial tube that is an access point to a major artery for dialysis. Fistulas of the shunt are caused by leakage from these tubes and can lead to serious complications if left untreated. 

    A fistula of the shunt occurs in some clients receiving hemodialysis or peritoneal dialysis because the needle (used to put in the internal catheter for dialysis) is inserted too deep and causing an abscess, which leads to a fistula.

    Clients with a fistula of the shunt need to take precautions because they’re at higher risk for infection. They may also experience symptoms like swelling or pain in their arm if they have an infection or inflammation of their shunt.

    Dialysis Disequilibrium

    Dialysis disequilibrium syndrome (DDS) is a condition where solutes are removed too quickly from the blood, causing brain cells to swell with fluid. This results in increased intracranial pressure (ICP) – possibly leading to coma and death.

    Key signs of dialysis disequilibrium syndrome (DDS):

    • Restlessness and disorientation
    • Vomiting
    • Headache

    Nursing Interventions

    Nursing Interventions for Hemodialysis

    Monitor

    • Infection
    • Bleeding

    Avoid

    • Restrictive clothing or jewelry
    • Sleeping on the affected arm
    • Creams or lotions
    • Lifting over 5 lbs

    Nursing Interventions for Hemodialysis Peritoneal Dialysis

    Monitor

    • Fluid balance and electrolytes
    • Blood pressure and heart rate
    • Abdominal distention (and report any changes)

    Provide

    • Education about the disease process and its management
    • Client’s repositioning
    • Preparation for treatment
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    Hemodialysis vs Peritoneal Dialysis Conclusion

    Hemodialysis and peritoneal dialysis are the two main methods used to perform dialysis. Both procedures remove waste from the body, and each has advantages and disadvantages.

    Some clients receiving hemodialysis or peritoneal dialysis develop a fistula of the shunt because the needle (used to introduce the internal dialysis catheter) is inserted too deeply.

    When solutes are eliminated from the blood too quickly during dialysis, a condition known as dialysis disequilibrium syndrome (DDS), causes brain cells to expand with fluid. This results in increased intracranial pressure (ICP), which could cause a coma or even death.

    Sources

    https://www.umms.org/ummc/health-services/kidney/dialysis/types 

    https://www.kidney.org/atoz/content/peritoneal# 

    https://www.mayoclinic.org/tests-procedures/peritoneal-dialysis/about/pac-20384725 

    https://www.nhs.uk/conditions/dialysis/pros-cons/ 

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