THE ROLE OF THE NURSE IN THE INITIATION OF HEMODIALYSIS AND EARLY COMPLICATIONS IN PATIENTS UNDERGOING FIRST HEMODIALYSIS

Abstract

Hemodialysis is a fundamental method of renal replacement therapy in patients with renal failure, with the first hemodialysis session representing a particularly critical period associated with an increased risk of complications. In this process, the nurse plays a key role in patient preparation, ensuring proper vascular access, preparing the dialysis equipment, and continuous monitoring during the procedure. The aim of this study is to present the importance of the nursing role at the initiation of hemodialysis, with a focus on early detection and prevention of complications in patients undergoing their first hemodialysis.
The research was conducted at a nephrology clinic through the analysis of nursing documentation and the monitoring of parameters such as arterial blood pressure, duration of dialysis, type of vascular access, age, gender, dialyzer surface area, and occurrence of complications. The data were processed using descriptive statistics. The study included 102 patients who started hemodialysis for the first time.
The results indicate that the majority of patients belong to the elderly population, with the highest prevalence in the age group between 70 and 80 years. Regarding vascular access, most patients initiated dialysis using a femoral catheter, suggesting an urgent need for treatment, while only a small number had a previously created arteriovenous fistula.Dialyzers with smaller surface areas (1.3 m² and 1.5 m²) were most commonly used, particularly in patients with lower body weight and the presence of hypotension. This approach allows gradual removal of toxins and fluids, improving hemodynamic stability.Most patients underwent detoxification hemodialysis, while a smaller number required ultrafiltration or isolation dialysis depending on their clinical condition.
Complications during the first hemodialysis session were relatively common. Out of 102 patients, 37 experienced complications, while 65 patients had no complications. The most common complications included hypotension, dialysis disequilibrium syndrome, as well as mechanical complications such as bleeding and hematoma. One patient experienced a seizure as a rare but serious complication.
The role of the nurse is crucial throughout the entire process, including patient preparation, continuous monitoring of vital signs, early recognition of complications, and timely intervention.
In conclusion, the first hemodialysis session is a high risk but essential procedure that requires an individualized approach and careful monitoring in order to reduce complications and improve patient outcomes.