No thrill or bruit, or a cool/pale/painful access limb - report immediately (possible clot or compromised flow).
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client on lithium has a level of 2.1 mEq/L and reports coarse hand tremor, vomiting, and ataxia. Which action does the nurse take first?
Answer: B. The therapeutic lithium range is 0.6 to 1.2 mEq/L; 2.1 mEq/L indicates toxicity. The first action is to hold the next lithium dose and notify the provider. There is no specific antidote; severe toxicity may require hemodialysis.
Question 2 of 3
A client undergoing hemodialysis develops a headache, nausea, restlessness, and confusion near the end of the treatment. The nurse recognizes these as signs of which complication?
Answer: A. Disequilibrium syndrome results from rapid removal of urea during dialysis, creating an osmotic gradient that shifts water into the brain and causes cerebral edema. Symptoms include headache, nausea, restlessness, confusion, and in severe cases seizures. It is more common in new or aggressively dialyzed clients.
Question 3 of 3
A client with ESRD is being assessed before hemodialysis. Which finding indicates fluid volume overload that should be reported?
Answer: A. Signs of fluid volume overload in ESRD between dialysis sessions include weight gain, hypertension, jugular venous distention, peripheral edema, and crackles in the lungs from pulmonary congestion. Flat neck veins, a low blood pressure, and weight loss instead suggest hypovolemia, not overload.
Keep the streak going with more questions like these, each with a full rationale.
What is hemodialysis?
It requires vascular access, usually an arteriovenous (AV) fistula or graft, which needs weeks to mature before use. It is used for ESRD and severe AKI to replace lost kidney function.
Key points to remember
- An AV fistula should have a palpable thrill (buzzing) and an audible bruit (whooshing) indicating patency.
- Hypotension during dialysis is common from rapid fluid and volume removal.
- Disequilibrium syndrome (headache, nausea, confusion, seizures) results from rapid solute shifts pulling fluid into the brain.
- Heparin is used during the procedure, raising bleeding risk for several hours afterward.
- Weight is measured before and after to determine fluid removed; large interdialytic gains stress the heart.
- Many medications are held until after dialysis because they would be filtered out.
Nursing priorities
- Assess the access for thrill and bruit every shift; report absence immediately as it signals clotting.
- Take blood pressure in the NON-access arm and protect that arm from constriction.
- Weigh the patient before and after treatment and monitor for hypotension during dialysis.
- Hold antihypertensives and dialyzable medications until after treatment as ordered.
- Monitor for bleeding after dialysis due to heparin use.
Labs & values
Patient teaching
- Check the fistula daily for the thrill/buzz; report if it stops.
- Do not let anyone take blood pressure or draw blood from the access arm; avoid tight sleeves, jewelry, or carrying heavy bags on it.
- Follow fluid and diet limits between treatments to prevent excess weight gain.
Red flags: report now
- No thrill or bruit, or a cool/pale/painful access limb - report immediately (possible clot or compromised flow).
- Never take blood pressure, draw blood, start an IV, or place restraints on the access arm.
- Disequilibrium syndrome signs (severe headache, confusion, seizures) require immediate intervention.
- Profound hypotension or chest pain during dialysis - stop/slow treatment and notify provider.
References
Clinical references for this topic
