Synopsis
Understand how haemodialysis removes solute and fluid, assess a routine treatment safely, and recognise prescription, access and haemodynamic problems requiring renal-team action.
- Haemodialysis circulates blood through a dialyser: diffusion clears small solutes down concentration gradients, while transmembrane pressure produces ultrafiltration of water.
- A functioning arteriovenous fistula is generally preferred for long-term access when appropriate; grafts and tunnelled central venous catheters have distinct advantages, maturation needs and infection risks.
- The prescription is individual: treatment time, frequency, blood and dialysate flows, dialyser, dialysate composition, temperature, anticoagulation and ultrafiltration target are renal-specialist decisions.
Key red flags
Unresponsiveness, absent breathing or pulselessness during dialysis requires the resuscitation algorithm, immediate circuit management by trained staff and early defibrillator use when indicated.
Investigation priorities
Evaluate fluid removal, haemodynamic tolerance and departure safety during each treatment.
Management branches
A patient arrives for a planned treatment and is clinically stable.
- Verify identity, prescription, allergies, interval events and medicines, then record weight, observations, symptoms and an access examination.
- Agree the ultrafiltration goal against current target weight and haemodynamic tolerance, escalating major weight or clinical discrepancies before connection.
Key medicines
Circuit anticoagulationUse the unit's unfractionated or low-molecular-weight heparin protocol, individualised to session length, access and bleeding risk.
Intravenous iron during haemodialysisGive the renal-unit product-specific maintenance or repletion regimen after iron indices and infection context have been reviewed.