Clinical Practice of Hemodialysis Nursing
Before treatment
Assess the patient before touching the machine: weight, BP (lying and standing), pulse, temperature, and the access - palpate for a thrill, auscultate for a bruit, inspect for redness, swelling, or drainage. Compare pre-weight with the target (dry) weight; the difference is the starting point for the ultrafiltration goal, not the whole answer.
Calculating the UF goal
UF goal = pre-weight − target weight + prime volume + rinse-back volume + planned saline. Because 1 kg of water ≈ 1 L, a patient arriving at 82.0 kg with a target of 80.0 kg, a 200 mL prime, and 200 mL rinse-back needs 2.4 L removed - the 400 mL that questions love to test. Divide by treatment time for the UF rate; rates above roughly 13 mL/kg/h are poorly tolerated.
During and after treatment
Check BP and symptoms at least every 30 minutes. Intradialytic hypotension (systolic fall ≥20 mmHg or below 90, with cramps, nausea, yawning, or restlessness) is managed by stopping UF, placing the patient supine or Trendelenburg, giving a saline bolus, and slowing UF - not by speeding the pump. After treatment, achieve access haemostasis with appropriate pressure, draw post-BUN samples correctly (slow pump, timed sample), reweigh, and teach the patient about fluid and access care.
Traps
- Confusing dry weight with the patient's own ideal body weight.
- Missing orthostatic change by reading only the standing BP.
- Continuing UF through cramps, which usually signal volume removal outpacing refill.
- Forgetting that cool dialysate (35–36 °C) and sodium modelling reduce hypotension.