SARASOTA MEMORIAL HOSPITAL
NURSING PROCEDURE
TITLE:
ISSUED
FOR:
CARE OF THE DIALYSIS PATIENT ON
THE INPATIENT NURSING UNIT
(dhd16)
Nursing
PURPOSE:
1/80
DATE:
9/15
REVIEWED:
1 of 3
PAGES:
RESPONSIBILITY:
Staff RN,LPN, and RN-Hemodialysis
1. To prevent complications pre and post-dialysis treatment.
and to provide a safe environment.
2. To prevent transmission of bacteria.
DEFINITION:
Bruit:
Audible sound of blood flow present in the fistula.
Thrill:
Palpable “buzz” of blood flow present in the fistula.
Fistula:
An internal surgical anastomosis of an artery and
vein which is usually found on the forearm or upper
arm. Normally the area is engorged and tender
postoperatively.
Gore-tex
Graft:
Insertion of a “man-made” tubing between an artery
and a vein, which is also internal. Bruit and thrill
must always be present. The area is normally
engorged and tender postoperatively.
KNOWLEDGE BASE:
Dialysis personnel are on call twenty-four hours a day. Call the
telephone operator for beeper number.
PROCEDURE:
1.
Pre Dialysis Routine Care:
a.
b.
c.
d.
e.
f.
g.
h.
Check and document condition of access every shift.
Indicate the presence of bruit and/or thrill.
Obtain daily weights using the same scale and
weighing at the same time each day.
The following are NOT done on the dialysis extremity:
1) Do not take blood pressures.
2) Do not start IVs.
3) Do not give injections.
4) Do not do venipunctures.
Place a pink identification band on the dialysis
extremity.
Provide an early meal prior to treatment. Hold meal
on new or nauseated patients.
Send the chart and patient labels to dialysis with the
patient.
A pre-procedural checklist in SCM must be done if
patient is going for insertion of dialysis access prior to
hemodialysis treatment.
Avoid the administration of anti-hypertensives,
TITLE:
CARE OF THE DIALYSIS PATIENT ON AN
INPATIENT NURSING UNIT
(dhd16)
PAGE:
2 of 3
narcotics, or antibiotics prior to treatment. If any
questions about withholding medications, consult with
the Dialysis nurse.
i. If it is necessary for the Dialysis RN to draw lab work,
notification should be given in the form of a pretreatment report. Send any Labels from the lab with
the patient.
j. Use “Hand off” communication guidelines to discuss
medications/labs/isolation precautions/etc.
k. The patient will be taken to dialysis by the transport
team, via wheelchair, stretcher or bed when the unit is
called. If the patient meets criteria as established in
the SMH policy 01.PAT.23, then a nurse must
accompany the patient on the transport. If the patient
is from a critical care unit, they need to be transported
with a cardiac monitor and an RN.
2.
Post-Dialysis Routine Care:
a.
b.
c.
d.
e.
f.
g.
h.
3.
Post-dialysis: The dialysis nurse will give a patient
report to the receiving nurse. In the event the patient
does have to go to another procedure, a nurse from
Hemo will accompany the patient if criteria met as per
01.PAT.23. Otherwise, the patient may be transported
to the next procedural area via Transport Services
after a nurse-to-nurse communication.
Check the access upon returning to the unit postdialysis. Document condition of the patient including
any changes from pre-dialysis condition.
Thrill and bruit will be checked each shift.
Check the access each shift for hematoma, swelling or
oozing.
Apply direct pressure for 5-10 minutes if there is
oozing or slight bleeding from the fistula. DO NOT
apply pressure dressings!
Notify the dialysis physician immediately for profuse
bleeding or absence of thrill. Apply direct pressure for
bleeding.
Band-aids covering dialysis sites can be removed
eight hours after dialysis.
All medications will be resumed post treatment
including daily medication dosages unless new orders
are written.
Post-Surgical:
a.
b.
c.
Moderate pain and edema of extremity is common.
Elevate with pillow and check fingers for good
circulation.
Severe pain is unusual. Check bruit and thrill before
medicating. (Clotting may be occurring.)
Slight oozing of blood is common. Note amount and
TITLE:
CARE OF THE DIALYSIS PATIENT ON AN
INPATIENT NURSING UNIT
(dhd16)
d.
e.
PAGE:
3 of 3
reinforce dressing. Do not apply a pressure dressing.
Do not use ice on access. Temperature change may
cause clotting.
Observe for bruit and thrill and bleeding with routine
postop vital signs, eventually tapering to an every-shift
check. Call surgeon if there are any problems.
DOCUMENTATION:
Assessment/Reassessment flowsheet (under the
Peripheral/Vascular section) (or forms appropriate to special
care areas): Document the access checks and
reassessments.
REFERENCE:
SMH Policy. Handoff Communication Guidelines. (01.PAT.25).
SMH: Author.
SMH Policy. Transportation and Monitoring of Patients
(01.PAT.23). SMH: Author.
SMH Nursing Department Policy. Guidelines for Intra-hospital
Transporting of Adult Special Care Patient. (126.442). SMH:
Author.
REVIEWING AUTHOR(S):
B. Kruger RN, CCRN, CNN, CPS, Critical Care/Hemodialysis
S. Olsen RN,BS,CCRN, CM, Hemodialysis
Jackie Bland, BSN, RN Medical Wound Care
Doris Cahueque, MS, RN, CNL APN, Medical-Surgical Division
Wendy Kline, MSN, RN, PCCN, Clinical Manager, 7WT
APPROVAL:
Clinical Practice Council 9/3/15