side by side comparison
Hemodialysis vs Peritoneal Dialysis: Machine vs Abdomen — Access, Schedule, Complications
An NCLEX question describes cloudy drainage from an abdominal catheter — you pick peritonitis. Another asks about a missing bruit in the arm — you recognize AV fistula clotting. Mixing up which access and which complication belongs to which dialysis type costs you the question every time.
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Side-by-side2 compared
Focus
Dimension
Hemodialysis
Peritoneal Dialysis
Mechanism / access
- Blood filtered through external machine
- AV fistula (preferred), graft, or CVC
- Peritoneum is the filter membrane
- Tenckhoff catheter in abdomen
- Dialysate dwells, then drains
Patient experience
- 3–4 hr/session, 3× per week
- Rapid fluid removal
- High hypotension risk
- CAPD 4–5 manual exchanges/day
- CCPD nightly cycler
- Daily exchanges done at home
- Slow, continuous fluid removal
Access assessment
- ★Palpate thrill, auscultate bruit (fistula)
- Absent thrill/bruit = clotted emergency
- Inspect exit site for erythema/drainage
- Assess effluent clarity each drain
Nursing priorities
- No BP, IV, or venipuncture on fistula arm
- Monitor intradialytic hypotension
- Weigh before & after each session
- Strict aseptic technique, mask on
- Warm dialysate to body temp
- Track inflow vs outflow volume
Diet & medication needs
- Strict K⁺, Na⁺, phos & fluid limits
- Phosphate binders, EPO
- Hold antihypertensives before HD
- More liberal diet
- ↑ protein (lost in effluent)
- Watch glucose load from dialysate
- Phosphate binders, EPO
Patient teaching
- Protect access arm
- No tight sleeves or sleeping on arm
- Keep all dialysis appointments
- Book guest center to travel
- Sterile technique for exchanges
- Report cloudy effluent
- Daily exit-site care
- Travel with PD supplies
Red flags — escalate
- ★Disequilibrium: headache, nausea, seizures
- Severe hypotension during session
- ★Cloudy effluent = peritonitis until ruled out
- Abdominal pain, fever, rebound tenderness
Complications
- Access clotting, infection, stenosis
- Hypotension, muscle cramps
- Peritonitis (most common)
- Exit-site infection, hernia, hyperglycemia
Mechanism / access
Hemodialysis
- Blood filtered through external machine
- AV fistula (preferred), graft, or CVC
Peritoneal Dialysis
- Peritoneum is the filter membrane
- Tenckhoff catheter in abdomen
- Dialysate dwells, then drains
Patient experience
Hemodialysis
- 3–4 hr/session, 3× per week
- Rapid fluid removal
- High hypotension risk
Peritoneal Dialysis
- CAPD 4–5 manual exchanges/day
- CCPD nightly cycler
- Daily exchanges done at home
- Slow, continuous fluid removal
Access assessment
Hemodialysis
- ★Palpate thrill, auscultate bruit (fistula)
- Absent thrill/bruit = clotted emergency
Peritoneal Dialysis
- Inspect exit site for erythema/drainage
- Assess effluent clarity each drain
Nursing priorities
Hemodialysis
- No BP, IV, or venipuncture on fistula arm
- Monitor intradialytic hypotension
- Weigh before & after each session
Peritoneal Dialysis
- Strict aseptic technique, mask on
- Warm dialysate to body temp
- Track inflow vs outflow volume
Diet & medication needs
Hemodialysis
- Strict K⁺, Na⁺, phos & fluid limits
- Phosphate binders, EPO
- Hold antihypertensives before HD
Peritoneal Dialysis
- More liberal diet
- ↑ protein (lost in effluent)
- Watch glucose load from dialysate
- Phosphate binders, EPO
Patient teaching
Hemodialysis
- Protect access arm
- No tight sleeves or sleeping on arm
- Keep all dialysis appointments
- Book guest center to travel
Peritoneal Dialysis
- Sterile technique for exchanges
- Report cloudy effluent
- Daily exit-site care
- Travel with PD supplies
Red flags — escalate
Hemodialysis
- ★Disequilibrium: headache, nausea, seizures
- Severe hypotension during session
Peritoneal Dialysis
- ★Cloudy effluent = peritonitis until ruled out
- Abdominal pain, fever, rebound tenderness
Complications
Hemodialysis
- Access clotting, infection, stenosis
- Hypotension, muscle cramps
Peritoneal Dialysis
- Peritonitis (most common)
- Exit-site infection, hernia, hyperglycemia
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Clinical Pearl
Fistula arm — feel thrill, hear bruit; peritoneal catheter — cloudy effluent means peritonitis until proven otherwise.
Component Topics
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