Hemodialysis separates solutes by differential diffusion through a cellophane membrane placed between the blood and dialysate solution, in an external receptacle. Blood is shunted through an artificial kidney (dialyzer) for the removal of excess fluid and toxins and then returned to the venous circulation. Because the blood must actually pass out of the body into a dialysis machine, hemodialysis requires an access route to the blood supply by an arteriovenous fistula or cannula or by a bovine or synthetic graft. Hemodialysis is a fast and efficient method of removing urea and other toxic products. It is usually performed three times per week for four hours and can be done in a hospital, outpatient dialysis center, or at home.
Nursing Care Plans
Nursing care planning and goals for patients who are undergoing hemodialysis include monitoring of the AV shunt patency during the process, preventing risk for injury, monitoring fluid status, and providing information.
Here are three (3) nursing care plans (NCP) and nursing diagnosis for hemodialysis:
Risk for Injury
Patients undergoing hemodialysis are at risk for injury due to the invasive nature of the procedure and the need for vascular access. There is a risk of infection, bleeding, and clotting associated with the insertion and maintenance of vascular access devices, such as catheters or arteriovenous fistulas. Additionally, hemodialysis can have other complications, such as hypotension, cramping, and dizziness, which can increase the risk of falls or other injuries.
- Risk for Injury
Risk factors may include
- Hemorrhage related to accidental disconnection
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
- The client will maintain patent vascular access.
- The client will be free of infection.
Nursing Assessments and Rationales
1. Monitor internal AV shunt patency at frequent intervals:
- 1.1. Palpate for a distal thrill.
The thrill is caused by turbulence of high-pressure arterial blood flow entering the low-pressure venous system and should be palpable above the venous exit site.
- 1.2. Auscultate for a bruit.
Bruit is the sound caused by the turbulence of arterial blood entering the venous system and should be audible by a stethoscope, although may be very faint.
- 1.3. Note the color of blood and/or obvious separation of cells and serum.
Change of color from uniform medium red to dark purplish red suggests sluggish blood flow and/or early clotting. Separation in the tubing is indicative of clotting. Very dark reddish-black blood next to clear yellow fluid indicates full clot formation.
- 1.4. Palpate skin around the shunt for warmth.
Diminished blood flow results in the “coolness” of the shunt.
2. Evaluate reports of pain, numbness, or tingling; note extremity swelling distal to access.
This may indicate inadequate blood supply.
3. Assess skin around vascular access, noting redness, swelling, local warmth, exudate, and tenderness.
Signs of local infection, which can progress to sepsis if untreated.
4. Monitor temperature. Note the presence of fever, chills, and hypotension.
Signs of infection or sepsis requiring prompt medical intervention.
5. Monitor PT, and activated partial thromboplastin time (aPTT) as appropriate.
Provides information about coagulation status, identifies treatment needs, and evaluates effectiveness.
6. Culture the site and obtain blood samples as indicated.
Determines the presence of pathogens.
Nursing Interventions and Rationales
1. Notify the physician and/or initiate a Declotting procedure if there is evidence of loss of shunt patency.
Rapid intervention may save access; however, Declotting must be done by experienced personnel.
2. Avoid trauma to shunt. Handle tubing gently, and maintain cannula alignment. Limit activity of extremity. Avoid taking BP or drawing blood samples in the shunt extremity. Instruct patient not to sleep on the side with a shunt or carry packages, books, purses on the affected extremity.
Decreases risk of clotting and disconnection.
3. Attach two cannula clamps to the shunt dressing. Have a tourniquet available. If cannulas separate, clamp the arterial cannula first, then the venous. If tubing comes out of the vessel, clamp the cannula that is still in place and apply direct pressure to the bleeding site. Place tourniquet above site or inflate BP cuff to pressure just above patient’s systolic BP.
Prevents massive blood loss while awaiting medical assistance if the cannula separates or the shunt is dislodged.
4. Avoid contamination of the access site. Use an aseptic technique and masks when giving shunt care, applying or changing dressings, and when starting or completing the dialysis process.
Prevents the introduction of organisms that can cause infection.
5. Administer medications as indicated:
- 5.1. Heparin (low-dose)
Infused on the arterial side of the filter to prevent clotting in the filter without systemic side effects.
- 5.2. Antibiotics (systemic and/or topical)
Prompt treatment of infection may save access, and prevent sepsis.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans and nursing diagnoses related to reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 10 Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy (TAHBSO) | 6 Care Plans
- Mastectomy | 15 Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans
4 thoughts on “3 Hemodialysis Nursing Care Plans”
very good information
For deficient fluid volume shouldn’t there be AEB since it is not a “risk for”?
Hey Sam, that diagnosis should be Risk for Deficient Fluid Volume.