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Hemodialysis

A procedure which involves removing waste products

such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure.
The blood is routed outside the body into a dialysis

machine via tubes and then back inside the body.

Procedure
Baseline vital signs taken for reference
Access point is established Patient is connected to the dialysis machine in a closed

loop circuit Blood is pumped from the body into the dialysis machine Blood is pumped back into the body after cleansing Vital signs are taken at set intervals to monitor clients condition

Preparation
Access method is determined. Arteriovenous Fistula Arteriovenous Graft Central Venous Catheter
Patient is weighed. Vital signs taken and recorded.

Precautions
Complete History must be taken into account
Risk for infection Blood pressure instability

Dizziness
Nausea and Vommiting Fatigue First Use Syndrome

Nursing Responsibilities
Verification of Doctors orders
Proper client identification Proper client education about the procedure and its

uses and effects Secure client consent Proper vital signs monitoring Maintenance of Asepsis Patient safety

Peritoneal Dialysis
Dialysis method that uses the clients peritoneal

membranes in the filtration and diffusion process of cleansing the clients blood from waste products
Cheaper than Hemodialysis

Procedure
Access point is established
Dialysate is infused into the peritoneum After a set period of time, the dialysate is drained

The volume drained is compared to the volume

infused and noted properly

Preparation
Access point is established
Sterility is ensured and maintained

Precaution
Clients diet
Risk for Infection and Peritonitis Hypovolemic shock

Edema
Hyper and Hypotension Difficulty of breathing

Nursing Responsibilities
Verification of Doctors orders
Proper client identification Proper client education about the procedure and its

uses and effects Secure client consent Proper vital signs monitoring Maintenance of Asepsis Patient safety

Cystoclysis
A continuous infusion of a sterile solution into

the bladder, usually by using a three-wayirrigation closed system with a triple-lumen catheter.
One lumen is used to drain urine;another is used to

inflate the catheter balloon, and the final lumen carries the irrigation solution.
CBI is primarily used following genitourinary surgery

to keep the bladder clear and free of blood clots or sediment

Procedure
Position client for access of catheters
Set up irrigating solutions and prime tubing Set up catheter drainage bag

Infuse irrigating solution into the bladder


Note Input and Output variations and adjust to obtain

correct client output

Preparation
3-way catheter is inserted
Maintain sterility Ensure that urine is being freely drained before

starting irrigation

Precaution
Infections
Bladder distention Bladder rupture

Nursing Responsibilities
Verification of Doctors orders
Proper client identification Proper client education about the procedure and its

uses and effects Secure client consent Proper vital signs and I&O monitoring Ensure free drainage of urine Maintenance of sterility Patient safety

Central Venous Pressure


Describes the pressure of blood in the thoracic vena

cava, near the right atrium of the heart.


CVP reflects the amount of blood returning to the

heart and the ability of the heart to pump the blood into the arterial system.

Procedure

An incision is made usually on the clients upper arm A suitable vein is located for the insertion of the catheter The catheter is threaded aseptically into the vein The catheters distal tip must rest at the point where the superior vena cava joins with the right atrium of the heart To read, a 3-way tap is used to connect the manometer to an intravenous drip set on one side, and, via extension tubing filled with intravenous fluid, to the patient on the other 3-way tap is manipulated so that the path open is from the fluid bag to the manometer and closed to the patient. Fill manometer to adequate amount 3-way tap is manipulated so that the path is open from the manometer to the client and closed to the fluid bag. The fluid in the manometer will drain into the patient and will stop at the point where CVP is currenty at

Preparation
Maintain sterility