Page 388 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 373

Blood removed
for cleansing
Dialyzer

Clean blood returned
to the body
FIGURE 8–2 • Hemodialysis.

blood is running through the machine filters in HD. The patient needs either a
patent internal or external access site (see Figure 8–2). Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
In HD, blood is removed from the body, pumped through a machine where
toxins are removed by a filter, and returned to the patient. An internal or external
vascular access is needed to remove and return blood. For short-term or emer-
gency therapy, an external vascular access in the form of a dual-lumen central
access line is inserted to access the arterial and venous systems. These are known
as vascular access sites.
Internal jugular or femoral veins are usually catheterized in the case of ARF
or when a previously placed internal access is not functioning. These can be
inserted quickly at the bedside. The catheter’s terminal end is in the central
vein. Once inserted by the physician, blood can be removed and returned to
the patient when caps on the lines are removed and connected to the appropri-
ate HD line without sticking the patient. Caps are color-coded red for arterial
and blue for venous. Once the dialysis treatment is finished, the central lines
are capped, flushed with heparin, and clamps are closed to prevent accidental
exsanguination. Follow your institutional guidelines for accessing these lines,
but most physicians prefer that the external venous access is restricted to dial-
ysis use only (see Figure 8–3).
Complications of external sites include infection, clotting and/or kinking of
the central line catheter, and hemorrhage from the catheter if clamps are not
closed and capped. Nursing care of this site includes