03/01/2026
📌Topic: Nursing Management of Hemodialysis সম্পর্কে জেনে নিন 👇
🔴 Hemodialysis Nursing Management এমন একটি ক্ষেত্র যেখানে রোগীর সম্পূর্ণ নিরাপত্তা, শারীরিক স্থিতিশীলতা, dialysis machine এর সঠিক অপারেশন এবং complication প্রতিরোধ - সব কিছুর সমন্বিত নজরদারি প্রয়োজন।
✅ Hemodialysis Nursing Management -
🔹1. Pre-Dialysis Nursing Assessment
✔A. Patient Assessment
▪️Vital signs: BP, Pulse, Respiration, Temperature
▪️Weight: dry weight হিসাবের জন্য খুব গুরুত্বপূর্ণ
▪️Edema check: pedal edema, facial puffiness
▪️Respiratory status: crackles → fluid overload
▪️Skin condition: pruritus, pallor
▪️Presence of cramps, headache, nausea
✔B. Laboratory Review
▪️Electrolytes (K⁺, Na⁺, Ca²⁺)
▪️Urea, Creatinine
▪️Hemoglobin
▪️Hepatitis profile (HBsAg, Anti-HCV)
▪️Coagulation profile (if needed)
✔C. Dialysis Access Assessment
→ AV Fistula / Graft:
▪️Thrill palpate
▪️Bruit auscultate
▪️Redness, swelling, pain
▪️Infection signs
→ CVC/Temporary Catheter:
▪️Dressing condition
▪️Clamp check
▪️Line patency
▪️Infection signs
▪️No BP/IV on catheter side
✔D. Patient Preparation
▪️Explain procedure
▪️Remove tight clothing
▪️Ensure patient is not over-hydrated
▪️Check medications (যে ওষুধ dialysis এর আগে বন্ধ রাখতে হয়: antihypertensives, water-soluble vitamins ইত্যাদি)
🔹2. During Hemodialysis - Nursing Responsibilities
✔A. Vitals Monitoring
▪️Every 15–30 minutes BP
▪️Watch for hypotension (very common)
▪️Check for tachycardia, arrhythmia
✔B. Access Line Monitoring
▪️Blood leak
▪️Catheter disconnection
▪️Air embolism signs
▪️Needle (fistula puncture site) secure রাখা
✔C. Fluid Removal (Ultrafiltration) Monitoring
▪️UF target following dry weight
▪️Excessive UF → hypotension, cramps
▪️Less UF → fluid overload
✔D. Dialysis Machine Monitoring
▪️Blood flow rate (200–400 ml/min)
▪️Dialysate flow rate (500 ml/min)
▪️Conductivity
▪️Temperature of dialysate
▪️Heparin dose (if given)
✔E. Patient Symptom Monitoring
▪️Muscle cramps
▪️Headache
▪️Nausea or vomiting
▪️Chest pain
▪️Restlessness
▪️Visual disturbance
▪️Allergic reaction (dialyzer sensitivity)
✔F. Infection Prevention
▪️Strict aseptic technique
▪️Hand hygiene
▪️Catheter connection properly locked
▪️No contamination of lines
🔹3. Managing Common Complications During Dialysis
1. Hypotension
▪️Stop UF temporarily
▪️Trendelenburg position
▪️Give normal saline bolus
▪️Reassess BP
▪️Reduce UF target
2. Muscle Cramps
▪️Reduce UF
▪️Warm compress
▪️Slow stretching
▪️Small saline bolus if needed
3. Nausea / Vomiting
▪️Decrease ultrafiltration
▪️Give antiemetic if ordered
▪️Slow down dialysis rate
4. Chest Pain
▪️Stop dialysis immediately
▪️Give oxygen
▪️Check ECG
▪️Notify doctor urgently
5. Dialyzer Reaction
▪️Stop dialysis immediately
▪️Replace dialyzer
▪️Give antihistamines or steroids (as ordered)
6. Air Embolism
▪️Clamp lines immediately
▪️Left-side positioning
▪️Administer oxygen
▪️Emergency management call
🔹4. Post-Dialysis Nursing Management
✔A. Post Dialysis Assessment
▪️BP, Pulse, Respiration
▪️Patient’s weight (compare with pre-dialysis)
▪️Symptoms: dizziness, weakness, cramps
▪️Bleeding from fistula puncture site
✔B. Access Site Care
→ For AV Fistula:
▪️Apply pressure till bleeding stops
▪️Avoid tight bandage
▪️Do not allow patient to sleep over fistula arm
▪️No BP/IV/puncture on fistula arm
▪️Check thrill
→ For CVC:
▪️Change sterile dressing
▪️Lock with heparin/saline as per protocol
▪️Ensure clean and tight caps
✔C. Fluid / Diet Counseling
▪️Fluid restriction
▪️Low potassium diet
▪️Low salt diet
▪️Phosphate binder with meals
▪️Check daily weight at home
✔D. Documentation
▪️Duration of dialysis
▪️UF achieved
▪️Blood flow rate
▪️Dialysate flow
▪️Complications
▪️Access condition
▪️Patient’s response
🔹5. Patient Education (Very Important)
✔️Fistula Care
▪️Daily hand exercise (squeezing ball)
▪️Avoid tight clothes, watch, bag on fistula arm
▪️Check thrill every day
▪️Keep fistula clean
✔️Diet / Fluid
▪️Limit water
▪️Avoid banana, orange, potato, coconut water (high K⁺)
▪️Low salt intake
✔️Medication Awareness
▪️Phosphate binders
▪️Erythropoietin injections
▪️Iron therapy
▪️Which medicines to skip before dialysis
🔹 6. Special Notes for Nurses
▪️সব সময় machine alarm বুঝে action নিতে হবে
▪️Dialysis first hour is highest-risk period
▪️Elderly, cardiac patients বেশি hypotension prone
▪️Infection prevention সর্বদা top priority
