5 Dialysis Practice Questions

How hemodialysis works

Hemodialysis circulates blood through an external dialyzer. Wastes move across a membrane, and ultrafiltration removes excess fluid. Hemodialysis helps remove wastes and fluid, but it does not cure kidney failure or replace every kidney function.

During treatment, a rapid change in fluid balance can cause low blood pressure, weakness, dizziness, or nausea. Assess the patient, respond to hypotension according to the dialysis-unit protocol, and alert the dialysis team. The team may need to adjust fluid removal or treatment.

Protecting hemodialysis access

An arteriovenous fistula or graft provides access for hemodialysis. Check the access daily for its usual vibration, called a thrill. A change or loss of thrill may indicate impaired blood flow or a clot and requires prompt contact with the dialysis team.

Report new redness, warmth, pain, or drainage. Keep the access clean as instructed by the dialysis team, and avoid tight clothing or sustained pressure over it. Do not use the access limb for blood pressure measurements, blood draws, or IV placement.

How peritoneal dialysis works

Peritoneal dialysis uses the peritoneum, the lining of the abdomen, as a filtering membrane. Dialysis solution enters the abdomen through a catheter and remains there for a dwell period. Wastes and excess fluid move into the solution, which is then drained.

Cloudy effluent or abdominal pain may indicate peritonitis. Contact the dialysis team promptly for urgent evaluation and follow its instructions for the effluent and treatment. Do not wait until a routine visit or independently change the prescription.

Preventing infection and managing drainage

To reduce the risk of infection during an exchange, perform hand hygiene and use the trained aseptic technique for connections and disconnections. Follow routine exit-site care instructions. Do not reuse a disposable cap or handle the catheter connection with unwashed hands.

If drainage is slower than usual, check for a kink or clamp in the tubing and use only the troubleshooting steps taught by the peritoneal dialysis team. Contact the team if drainage does not improve. Do not forcefully flush the catheter or independently add solution or alter the prescribed exchange.

Clinical priorities

Follow the patient’s prescription and facility protocol in clinical practice. For changes in access function, signs of infection, symptoms during hemodialysis, cloudy effluent, abdominal pain, or persistent drainage problems, seek guidance from the dialysis team promptly.