Page 143 - Critical Care Notes

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■ Solute removal can occur by convection (no dialysate required), in addition
to osmosis and diffusion.
■ It causes less hemodynamic instability.
■ It requires a trained ICU RN to care for patient but does not require con-
stant monitoring by a specialized hemodialysis nurse.
■ It does not require hemodialysis equipment, but a modified blood pump is
required.
■ It is the ideal treatment for someone who needs fluid and solute control but
cannot tolerate rapid fluid removal.
■ It can be administered continuously, for as long as 30–40 days. The
hemofilter is changed every 24–48 hr or per policy.
Nursing Care
■ Monitor fluid and electrolyte balance including intake and output.
■ Weigh daily.
■ Monitor vital signs every hour. A fever may be masked by the continuous
cool fluids circulating. Assess Spo 2 by pulse oximetry as needed.
■ Perform ECG monitoring.
■ Assess and provide care of vascular access site every shift.
Complications
■ Electrolyte and pH imbalances
■ Increased blood glucose levels
■ Hypotension
■ Hypothermia
■ Clogged filters
Renal Transplant
A renal transplant is the surgical placement of a cadaveric kidney or live donor
kidney (including all arterial and venous vessels and long piece of ureter) into a
patient with end-stage kidney disease (ESKD).
Operative Procedure
The surgical procedure takes 4–5 hr. The transplanted kidney is usually placed
in the right iliac fossa to allow for easier access to the renal artery, vein, and
ureter attachment. The patient’s nonfunctioning kidney usually stays in place
unless concern exists about chronic infection in one or both kidneys.
Postoperative Care
■ Monitor vital signs frequently as per policy. Note signs and symptoms of
infection.
■ Monitor hourly urine output, and assess urine color. Strict intake and out-
put. Provide meticulous Foley catheter care.

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