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Related Concept Videos

Hemodialysis I: Introduction01:25

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
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Peritoneal dialysis, or PD, utilizes the peritoneal membrane as a filter to eliminate excess fluid and waste products. Effective nursing management is essential for ensuring patient safety, preventing complications, and promoting optimal function of the peritoneal dialysis process.Assessment and MonitoringNurses must thoroughly assess the patient before, during, and after each dialysis session. Regular monitoring includes vital signs, daily weight, fluid intake and output, and laboratory values...
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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
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Related Experiment Video

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Shared decision-making in hemodialysis vascular access practice.

Mariana Murea1, Carl R Grey2, Charmaine E Lok3

  • 1Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Kidney International
|July 11, 2021
PubMed
Summary

Shared decision-making (SDM) in hemodialysis vascular access is crucial for patient-centered care. Shifting from paternalistic recommendations to collaborative planning improves treatment alignment with individual patient goals and quality of life.

Keywords:
arteriovenous fistulaarteriovenous grafthemodialysisshared decisionvascular access

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Area of Science:

  • Nephrology
  • Medical Ethics
  • Health Services Research

Background:

  • Shared decision-making (SDM) involves patients and physicians collaboratively choosing treatments.
  • In hemodialysis, SDM is ethically imperative but underutilized for vascular access planning.
  • Current practice often favors a paternalistic, fistula-centered approach, overlooking patient preferences and quality of life.

Purpose of the Study:

  • To review the current state of hemodialysis vascular access.
  • To present arguments for the necessity of SDM in vascular access planning.
  • To explore barriers, solutions, and future research for SDM implementation.

Main Methods:

  • Literature review of current vascular access practices.
  • Analysis of arguments supporting SDM in hemodialysis.
  • Discussion of implementation challenges and future research directions.

Main Results:

  • SDM is not widely applied in hemodialysis vascular access despite ethical importance.
  • Physician recommendations are often prescriptive and may not align with patient goals.
  • Existing guidelines and financial models reinforce a suboptimal, fistula-centric approach.

Conclusions:

  • A shift towards patient-centered care and SDM is needed in hemodialysis vascular access.
  • Overcoming barriers to SDM implementation is essential for improving patient outcomes.
  • Further research is required to establish effective physician-patient participative decision-making systems.