Dialysis nurses, also called nephrology nurses, manage the care of patients who have impaired kidney function. Dialysis filters the blood to remove toxins, returns needed electrolytes, and removes extra fluid that the kidneys normally would excrete. Dialysis nurses deliver care to both adults and children who have developed kidney disease.
Many of the patients have end-stage renal disease. This condition can be treated using hemodialysis or peritoneal dialysis. Dialysis nurses are skilled technicians in both running the machines that provide this life-saving treatment and carefully monitoring patients to make sure they tolerate the procedure. In addition, they anticipate changes in the patient’s blood pressure from shifts in blood volume and must always be on alert for other potentially serious reactions.
Dialysis nurses also manage the care of those with acute episodes of renal failure, such as those in the ICU recovering from a severe illness or other medical conditions that have overtaxed their kidneys. Whether dialysis is needed temporarily or long-term, the dialysis nurse must teach patients and families what to expect and how to manage changes in their daily lives.
Dialysis nurses often receive advanced training to improve their skills. Some become advanced practice registered nurses (APRNs) either as certified nephrology nurse practitioners (CNN-NPs) or clinical nurse specialists (CNSs).
Dialysis nurses perform some of the same activities as other nurses, but they are mainly focused on renal care. Dialysis care can be divided based on the technique used. Each has separate duties, though dialysis nurses are experienced in managing multiple methods.
Hemodialysis
- Run dialysis machine, usually for 4 hours, to remove toxins, wastes, and fluid from the body
- Access fistulas and monitor for bleeding
- Monitor blood pressure, fluid balance, electrolytes, transfuse blood and give antibiotics
Peritoneal Dialysis
- Access peritoneal catheter using sterile technique
- Administer dialysate or drain used fluid from the abdomen and monitor for sepsis
- Hook up a cycler machine for overnight runs
- Teach patient and family how to self-administer
Continuous Renal Replacement Therapy
- Monitor machines that are hooked up 24 hours a day, usually on ICU patients
- Check that the access remains intact through the neck or groin
- Monitor that heparin levels are appropriate to prevent clotting and observe for signs of bleeding
- Check lab work, fluid balance, electrolyte balance, and machine pressure levels
Dialysis nurses deliver care that supports a patient’s lack of renal function. Since they use multiple types of machinery, they need advanced technical skills to set parameters and monitor readings. Accessing a fistula or shunt must be done with great care to avoid clot formation. Heparin is used to prevent clotting but exposes the patient to the risk of bleeding. Dialysis nurses must have sharp assessment skills to anticipate patient risks inherent to being attached to any dialysis machine. Closely tracking the patient’s blood pressure will ultimately help decide if the patient can tolerate an entire dialysis cycle.
Dialysis nurses must communicate the patient’s status with the physician in case changes are needed in the solutions used to dialyze them. In addition, dialysis nurses need strong teaching skills to instruct families and patients on lifestyle practices to reduce more injury to their kidneys and how patients must protect their access sites from injury.