Dialysis and Kidney Transplant
Hemodialysis, peritoneal dialysis and transplant nursing
Hemodialysis access
- AV fistula (preferred: lowest infection risk; takes weeks to months to mature), AV graft, or central catheter.
- Check every shift: feel the thrill (vibration), listen for the bruit (whoosh). Absent → clot: report now.
- No BP, IVs, blood draws, tight sleeves, jewelry or sleeping on the access arm.
- Watch for bleeding after needle removal; signs of infection.
Around hemodialysis
- Weigh before and after; vital signs; labs.
- Hold antihypertensives and dialyzable drugs before dialysis as ordered; give after.
- Hypotension and muscle cramps during treatment (fluid removed too quickly).
- Dialysis disequilibrium syndrome (early sessions): headache, nausea, restlessness, confusion, seizures.
- Bleeding risk (heparin used during dialysis).
Peritoneal dialysis (PD)
- Fluid (dialysate) runs into the abdomen, dwells, then drains out: inflow → dwell → outflow.
- Warm the dialysate (dry heat, never a microwave): reduces cramping.
- Strict aseptic technique with exchanges and catheter care.
- Outflow should be clear, pale yellow, and about equal to or more than inflow.
- Cloudy outflow + abdominal pain + fever = peritonitis: report, send a sample.
- Poor outflow: check for kinks, reposition the patient, check for constipation (full bowel blocks drainage).
- Shortness of breath during dwell: raise the head of bed.
- Dextrose in dialysate → weight gain, high glucose; protein loss → higher-protein diet.
Dialysis diet
- Higher protein (lost in dialysis).
- Limit sodium, potassium, phosphorus; fluid limit (often urine output + ~500–1,000 mL/day on hemodialysis).
- Thirst tips: ice chips (count as fluid), sugar-free hard candy, small cups.
- High-K⁺ foods: bananas, oranges, potatoes, tomatoes, avocados, dried fruit, salt substitutes.
Kidney transplant
- Rejection: fever, ↓ urine output, rising creatinine, weight gain, tenderness over the graft, ↑ BP.
- Lifelong immunosuppressants (tacrolimus, mycophenolate, steroids): take on schedule; drug levels; no grapefruit with tacrolimus/cyclosporine.
- Infection risk: hand hygiene, avoid sick contacts, no live vaccines; skin cancer screening.
- Large urine volumes early: watch fluids and electrolytes.