This is the care the paediatric nurse renders to a child undergoing the process of getting rid of body waste, excess salts and water. This procedure is recommended by a paediatrician when the kidney is unable to adequately perform such functions.
Aims
· Improve renal function
· Provide emotional support
· Prevent complications
· Maintain fluid and electrolyte balance
Types
· Haemodialysis
· Peritoneal dialysis
Requirements
a. Anticoagualant
b. Weighing scale
c. Central venous catheter (femoral vein/artery, jugular, subclavian artery)
d. IV cannula
e. Dialysate
f. BP apparatus
g. Antimicrobial solution (methylated spirit, povidone)
h. IV fluids (normal saline)
i. Sterile gauze
j. Sterile swabs
k. Tourniquet
l. Sterile gloves
m. Haemodialysis machine for small infant
n. A dialyzer
o. Pulse oximeter
p. Thermometer
q. Sterile Drapes
r. Mackintosh with towel/bed mat
s. Syringes and needles
t. Adhesive tape
u. Examination gloves
v. A comfortable bed
w. Drip stand with infusion pump
Steps
1. Welcome child and caregiver to the unit
2. Establish rapport (Refer to steps)
3. Explain procedure to child/caregiver thoroughly especially if it is the first time
4. Allay the anxiety of child/caregiver and allow them to ask questions
5. Allow child/caregiver interact with other children who have under gone same procedure
6. Obtain informed consent before dialysis
7. Obtain weight of child before and after dialysis
8. Perform five moments of hand hygiene
9. Put child in a desirable position
10. Check and record baseline vital signs (temperature, pulse, respiration, ain, SPO2, blood pressure)
11. Monitor random blood sugar and intervene when necessary
12. Auscultate the chest for rhythm, crackles, rate and quality
13. Ensure laboratory requests are done and available before the procedure
14. Evaluate the previous dialysis session for any complications if necessary
15. Ensure strict aseptic measures to prevent infection
16. Ensure adequate nutrition of the child by restricting sodium intake
17. Monitor intake and output
18. Ensure continuous pulse oximetry
19. Provide emotional support to child/caregiver
20. Put child in supine position after the procedure with face turned away from insertion of the fistula
21. Wear examination gloves
22. Remove old inner dressing and discard
23. Remove examination gloves and wear sterile gloves
24. Clean the insertion site with an antimicrobial solution (povidone) and allow to air dry
25. Apply a new sterile gauze over the insertion site and the catheter
26. Apply barrier cream on the skin
27. Teach child/caregiver of the dialysis schedule, dietary management, medication, prevention of infection and emergency measures
28. Educate child/caregiver on the need for regular follow up and home base care
29. Express appreciation to child/caregiver
30. Dispose off, decontaminate and clean all used items and remove sterile gloves
31. Document findings manually or electronically
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