HemodialysisHemodialysis- is a medical procedure designed to remove wastes, toxins and fluids from the blood when the kidneys have failed. It is the most common treatment for end-stage renal disease (ESRD), more commonly known as kidney failure. This process usually lasts for about four hours and a patient has to undergo such procedure three times a week. HD may be done in the hospital, outpatient dialysis center, or at home.

Two types of dialysis

  • Hemodialysis– blood is passed through an artificial kidney (hemodialyzer) to clean it.
  • Peritoneal dialysis– uses a filtering process similar to hemodialysis, but the blood is cleaned inside the body rather than in a machine. The good thing about this process is that patient can do this at home three to four times a day, provided that he/she has knowledge in using the facility.

Nursing Diagnosis:Risk for excess Fluid Volume

Risk factors may include

  • Rapid/excessive fluid intake: IV, blood, plasma expanders, saline given to support BP during dialysis

Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

Desired Outcomes

  • Maintain “dry weight” within patient’s normal range; be free of edema; have clear breath sounds and serum sodium levels within normal limits.

Hemodialysis Nursing Care Plan-Risk for excess Fluid Volume

Nursing actions Rationale
Measure all sources of I&O. Weigh routinely. Aids in evaluating fluid status, especially when compared with weight. Weight gain between treatments should not exceed 0.5 kg/day.
Monitor BP, pulse. Hypertension and tachycardia between hemodialysis runs may result from fluid overload and/or HF.
Note presence of peripheral/sacral edema, respiratory rales, dyspnea, orthopnea, distended neck veins, ECG changes indicative of ventricular hypertrophy. Fluid volume excess due to inefficient dialysis or repeated hypervolemia between dialysis treatments may cause/exacerbate HF, as indicated by signs/symptoms of respiratory and/or systemic venous congestion.
Note changes in mentation. (Refer to CP: Renal Dialysis; ND: Thought Processes, risk for disturbed.) Fluid overload/hypervolemia may potentiate cerebral edema (disequilibrium syndrome).
Monitor serum sodium levels. Restrict sodium intake as indicated. High sodium levels are associated with fluid overload, edema, hypertension, and cardiac complications.


Restrict PO/IV fluid intake as indicated, spacing allowed fluids throughout a 24-hr period. The intermittent nature of hemodialysis results in fluid retention/overload between procedures and may require fluid restriction. Spacing fluids helps reduce thirst.

Image credits:kundankidneycare.com