Hemodialysis — Procedure & Complications

Hemodialysis removes waste and excess fluid by pumping blood through an extracorporeal circuit across a semipermeable membrane against dialysate. A typical session runs 3–4 hours, three times per week. The most common intradialytic complication is hypotension, caused by rapid ultrafiltration removing fluid faster than it can shift from interstitial to intravascular space. Nursing response: stop ultrafiltration, place the client in Trendelenburg (unless contraindicated), and administer a normal saline bolus per protocol. Dialysis disequilibrium syndrome occurs when urea is cleared from blood faster than from brain tissue, creating an osmotic gradient that pulls water into the brain — presenting as headache, nausea, seizures, and altered LOC, most commonly during first treatments or when BUN is very high. Other complications include muscle cramps (from rapid fluid and electrolyte shifts), air embolism (sudden dyspnea, chest pain — clamp the line, position client on left side in Trendelenburg), and blood loss from circuit disconnection. Heparin is used throughout the session to prevent clotting in the circuit, so monitor for bleeding from the access site, gums, and mucous membranes. Post-treatment, monitor weight (expect 0.5–1.5 kg loss per session), vital signs, and access site.