One of the most important elements of performing safe home dialysis is recording basic information on each and every treatment so that your physician and dialysis provider can monitor and make adjustments to your care as needed.
Full Answer
What is dialysis patient safety?
Patient safety is the foundation of high-quality health care. More than 350,000 patients receive dialysis in the United States, and the safety of their care is ultimately the responsibility of the facility medical director.
What is monitored during dialysis?
Following dialysis, the client’s vital signs are monitored to determine whether the client is remaining hemodynamically stable. Weight is measured and compared with the client’s predialysis weight to determine effectiveness of fluid extraction.
Why do dialysis facilities need scripted communication guides?
These transitions are common among dialysis patients as they undergo access procedures, hospitalizations, and specialist consultations. Facilities should evaluate scripted communication guides so that vital data are readily available and shared with providers.
What are the elements of a culture of safety in dialysis?
Elements of a Culture of Safety. If a dialysis caregiver neglects to follow an established process or procedure or behaves in ways that endanger patients, then peer review, remediation, and disciplinary action may be required. A robust safety system includes both individual peer review and system root cause analysis.
What should you monitor during dialysis?
While you're receiving hemodialysis, you'll need to carefully monitor your intake of fluids, protein, sodium, potassium and phosphorus.
Why is Patient monitoring important in dialysis?
One promising technological advance for improving home dialysis uptake is remote patient monitoring. Remote patient monitoring could increase home dialysis use by decreasing some of the burden of home dialysis, improving the patient experience, and diminishing both patient and provider hesitancy with home dialysis.
What are special precautions one must be aware of when on hemodialysis?
Patients who undergo dialysis treatment have an increased risk for getting an infection. Hemodialysis patients are at a high risk for infection because the process of hemodialysis requires frequent use of catheters or insertion of needles to access the bloodstream.
What are major things the nurse should assess after dialysis?
After dialysis, assess the vascular access for any bleeding or hemorrhage. When you move the patient or help with ambulation, avoid trauma to or excessive pressure on the affected arm. Assess for blebs (ballooning or bulging) of the vascular access that may indicate an aneurysm that can rupture and cause hemorrhage.
How often are vital signs checked during dialysis?
You will be placed on a monitor to check your vital signs (blood pressure, temperature, and pulse) every 15 minutes. Then, your dialysis nurse will connect you to the dialysis machine to start your treatment.
What side effects does dialysis have?
10 Dialysis Side Effects and How To Prevent ThemHernia. A hernia is a possible side effect of PD, a type of home dialysis treatment. ... Feeling too full. ... Bloating and weight gain. ... Low blood pressure. ... Muscle cramps. ... Blood clots. ... Itchy and/or dry skin. ... Infection.More items...
What are dialysis precautions?
The CDC has a set of standard precautions to be followed by dialysis facilities that should be consistently adhered to, such as gloving, handwashing, face shields, dedicated clean and dirty areas, segregation of machines and equipment, proper personal protective equipment (PPE), etc.
Which is care of before dialysis?
1) Keep your access area clean and free of any trauma. Your dialysis care team will teach you how to carefully wash it before each treatment. Look for signs of infection,including pain, tenderness, swelling or redness around your access area. Also, be aware of any fever and flu-like symptoms.
How do you care for a dialysis patient?
These seven tips can help you learn key management tips for caring for the patient while simultaneously supporting your own needs.Do Your Research. ... Take Notes. ... Ask Questions. ... Set a Schedule. ... Know Their Limits. ... Know YOUR Limits. ... Be Positive.
What are the responsibilities of a dialysis nurse?
Their duties include:Educating patients, families, and caregivers about their disease and treatment plan.Overseeing the dialysis treatment from start to finish including priming the dialyzer and bloodlines.Recording patients' medical information and vital signs.Managing multiple dialysis patients throughout treatment.More items...•
Why are policies and procedures important for dialysis?
Policies and procedures are developed and taught to dialysis staff. Many of these are specifically designed to prevent errors and keep patients safe. Nonetheless, clinicians sometimes ignore or are unaware of policies and do not follow procedures as prescribed. A study of Pennsylvania dialysis patients reported that failure to follow protocol represented >12% of reported dialysis adverse events ( 28 ). A survey of dialysis staff asked which factors they thought most prominently contributed to breaches in patient safety. The number one factor chosen was staff nonadherence to policies and procedures ( 6 ). There are many reasons why staff may not follow policies and procedures. Engaging human factors tools can help understand why this is happening in a dialysis facility and suggest mechanisms and tools to correct it. Factors leading to an improved culture of safety in dialysis facilities can be identified ( 29 ).
Why is standardization important in dialysis?
Standardization reduces potential errors as, for example, when dialysis nurses use one dialysis machine with procedures designed for another, or when multiple central venous access devices, each with their own recommended package insert instructions, are used in a dialysis facility.
How many deaths are caused by complications of RRT?
A retrospective Scottish study of mortality among all patients treated with RRT showed that only 2.1% of deaths were directly ascribed to complications of RRT ( 19 ). In an additional 3.5% of deaths, while complications of RRT were not the direct cause of death, RRT factors that may have contributed to death were identified. Death rate due to complications of RRT was 1.35 deaths/1000 RRT patients per year. Death from hemorrhage from vascular access was very uncommon, occurring at the same frequency as death related to treatment-related accident. Death from hyperkalemia was 6-fold more common than either of these two causes. Of note, there were no cases of dialysis equipment failure causing death. The causes of potentially preventable complications leading to death were: ( 1) recognition and treatment of hyperkalemia, ( 2) medication prescription issues, ( 3) care after hours, and ( 4) prevention of infection and management of vascular access. These authors conclude that efforts to improve the safety of RRT should focus on the human factors involved in care rather than focusing only on the technical aspects.
How common are falls in dialysis patients?
In another study, 3% of all dialysis patients fell and sustained a bone fracture, and the overall fall rate was 1.18 falls/patient per year ( 65 ). This rate is substantially higher than in the no-dialysis elderly population. Falls were common at home and were more common in the first half of the interdialytic cycle. The Renal Physicians Association survey of patients found that approximately 5% reported a fall in the previous 3 months ( 37 ). Factors associated with falls include age, diabetes, motor strength, visual acuity, previous falls, and medications (including antidepressants) ( 33 – 39 ). Strategies to reduce the risk of falls include staff education concerning fall risk, fall-risk assessment, gait assistance, use of in-floor weight scales, and reducing clutter ( 64 – 70 ).
What are the causes of dialysis errors?
Errors in dialysis care can cause harm and death. While dialysis machines are rarely a major cause of morbidity, human factors at the machine interface and suboptimal communication among caregivers are common sources of error. Major causes of potentially reversible adverse outcomes include medication errors, infections, hyperkalemia, access-related errors, and patient falls. Root cause analysis of adverse events and "near misses" can illuminate care processes and show system changes to improve safety. Human factors engineering and simulation exercises have strong potential to define common clinical team purpose, and improve processes of care. Patient observations and their participation in error reduction increase the effectiveness of patient safety efforts.
What is the importance of high reliability in dialysis?
High-reliability organizations establish and maintain a culture of safety in which all staff members are encouraged to report errors or potentially harmful events in a blame-free environment without fear of punishment. At the same time, a safe organizational culture does require appropriate accountability: Each individual is responsible for his or her own action.
How to reduce medication errors in dialysis?
However, this will be effective only if the electronic record is patient-centered, where all prescribers access and modify the single medication list that is centered on the patient rather than multiple providers and institutions. Regular and systematic use of medication reconciliation techniques can reduce errors ( 32, 33 ). Other tools can be “hardwired” into the transitions of care process, such as required medication review, checklists, and sign-offs when patients return to the dialysis facility from other care settings. Human factors engineering can help physicians and others more accurately and consistently communicate about medications at times of patient admission and discharge from the hospital and dialysis facility, as well as other transitions of care. Patients and their families can play a primary role in keeping current medication lists and being proactive in questioning their caregivers about these medications, particularly at times of care transition.
What is dialysate fluid?
Dialysate is the fluid that help remove waiste products from the body. It contains a number of substance. What are the substances that have to be prescribed for a dialysate solution?
Why is water removed from blood?
Water is removed from blood because there is a pressure gradient between blood and dialysate
Can you reuse a dializer?
Dializer performance can be affected by reuse. The sets of potential problem that maybe related to reuse are:
Where is blood pumped through the dialyzer?
Blood and dialysate are pumped through the dialyzer, on opposite sides of a semipermeable membrane. Solutes and excess fluid pass from the blood, through the membrane, and into the dialysate for removal
How many daltons are in a dialyzer?
The molecular weight cut of a dialyzer is 12,000 daltons.
What is the fluid that helps remove waste products from the body?
Dialysate is the fluid that helps remove waste products from the body. It contains a number of substances. Choose the group that might be prescribed for a dialysate solution
What is first use syndrome?
First use syndrome is a hypersensitivity reaction to a dialyzer. It is characterized by
Is Dialysis at risk for hepatitis B?
Dialysis patients are at high risk for Hep B. The best way to prevent infection transmission of hepatitis is to
What is the purpose of dialysis?
Dialysis is primarily used to provide an artificial replacement for lost kidney function (renal replacement therapy) due to renal failure. Dialysis works on the principles of diffusion of solute through a semipermeable membrane that separates two solutions. Direction of diffusion depends on concentration of solute in each solution.
What is the term for rapid, efficient dialysis resulting in shifts in water, pH and os?
Dialysis-disequilibrium syndrome – caused by rapid, efficient dialysis resulting in shifts in water, pH and osmolarity between fluid and blood.
How does ultrafiltration work in dialysis?
The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane.
How does hemodialysis remove waste?
I. Hemodialysis. Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane. In hemodialysis, the patient’s blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane.
How long does it take for a dialyzer to remove fluid?
This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several litres of excess fluid during a typical 3 to 5 hour treatment.
Why is the temperature elevated after dialysis?
The client may have an elevated temperature following dialysis because the dialysis machine warms the blood slightly. If the temperature is elevated excessively and remains elevated, sepsis would be suspected and a blood sample would be obtained as prescribed for culture and sensitivity purposes. Question 16.
Where is the peritoneal membrane used in dialysis?
In peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semipermeable membrane.
How to protect yourself from dialysis?
Wash your hands often or use hand sanitizer. Cover your nose and mouth when you cough or sneeze. Learn about the dialysis process and know what to expect during treatment. Learn about things staff do to protect you from infections and read the CDC Audit Tools and Checklists.
What is PD dialysis?
There are several different dialysis treatment options which include: Peritoneal dialysis (PD). Each treatment option has varying risks for infection. It is important to discuss the different treatment options with your doctor and decide which is best based on your individual needs.
What is the treatment for kidney failure?
Dialysis Treatment Options. Your kidneys play a vital role in cleaning your blood, eliminating waste from your body, and supporting other important functions. Dialysis is a medical treatment for people with kidney failure or kidneys that do not work properly, but it is not a cure to restore kidney function. There are several different dialysis ...
What is central line catheter?
Central line catheters are designed for short-term use and can be placed quickly. Any of the three access types (AV Fistula, AV Graft, or central line catheter) could develop an infection, but AV fistulas have the lowest risk of infection, while central line catheters have the highest risk of infection.
Can dialysis cause respiratory infections?
People receiving dialysis may also be at risk for infections that are not related to the blood and can lead to serious outcomes. These infections may include intestinal and respiratory infections such as:
Can dialysis patients get viruses?
Infections caused by viruses are also a concern for people receiving dialysis. Viruses in the blood spread when an infected persons blood enters the body of someone who is not infected. This could happen in a variety of ways, including through surfaces and equipment in the dialysis facility. Symptoms of viral infections vary. Examples of viral infections are:
Can you use a fistula on dialysis?
If you have a central line catheter, ask staff if you can use a fistula or graft for your dialysis treatment. Make sure all staff clean their hands before and after caring for you or your access. In some cases, you may be asked to take additional actions to prevent infections. For example, during the COVID-19 pandemic.