# Dialysis Nursing Care > Nursing notes on dialysis nursing: AV fistula protection, intra-dialytic hypotension, disequilibrium syndrome, CAPD technique and peritonitis recognition. - Canonical URL: https://prepelephant.com/topics/allied/nursing/dialysis-nursing-care - Exam / course: Allied Health · Subject: Nursing - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Dialysis Nursing Care", PrepElephant, https://prepelephant.com/topics/allied/nursing/dialysis-nursing-care ## Direct answer Dialysis replaces renal clearance either by pumping blood across an extracorporeal semi-permeable membrane (haemodialysis, typically four hours thrice weekly) or by using the peritoneum as the membrane in continuous ambulatory peritoneal dialysis (CAPD) with four exchanges of two to two and a half litres daily. Haemodialysis nursing protects the arteriovenous fistula — no pressure, cannulation or intravenous lines in that arm, bruit and thrill checked daily — and manages intra-dialytic hypotension and disequilibrium. Peritoneal dialysis nursing is aseptic technique plus early recognition of peritonitis, whose earliest and most reliable sign is cloudy effluent. ## What you must remember - Haemodialysis removes solutes by diffusion down the concentration gradient and water by pressure-driven ultrafiltration; adult extracorporeal blood flow runs around 300 to 400 mL per minute with heparin anticoagulation. - The arteriovenous fistula is the preferred access and matures over roughly 6 to 8 weeks before first use; grafts and tunnelled catheters serve earlier or failed access. - Fistula rules: no blood pressure cuff, venepuncture or intravenous cannulation on that arm; check the thrill at the anastomosis and bruit on auscultation daily — loss of both means thrombosis and is an emergency. - Intra-dialytic hypotension is the commonest complication of a session: nausea, cramps, yawning and fall in pressure with fluid removal — reduce or stop ultrafiltration, give a normal saline bolus and place the head down. - Dialysis disequilibrium syndrome affects first sessions and very high urea patients: headache, nausea, restlessness and seizures as solutes shift — prevented with shorter, lower-efficiency initial dialyses. - Between sessions the patient restricts fluid (roughly urine output plus 500 to 1000 mL daily) and potassium; interdialytic weight gain tracks salt and water excess against the target dry weight. - CAPD uses a Tenckhoff catheter and four exchanges daily; strict asepsis and hand hygiene precede every connection because touch contamination causes most peritonitis. - Peritonitis diagnosis: cloudy effluent with abdominal pain or fever; confirm with effluent white cell count above 100 per microlitre with neutrophil predominance, before antibiotics are instilled intraperitoneally. ## A session and a peritonitis scare A maintenance patient arrives for her Tuesday session 2.8 kg above dry weight, having attended a wedding. The nurse screens her — weight, temperature, access examination, thrill present — and cannulates the fistula with a rotating-site technique after local anaesthetic. Ninety minutes in, she yawns repeatedly, complains of calf cramps and her pressure falls from 140/85 to 95/60. The response sequence is textbook: stop ultrafiltration first, saline 250 mL bolus, legs raised if tolerated, pressure rechecked every 5 to 10 minutes; the doctor reduces the session's fluid-removal target and re-education on salt follows. Contrast the CAPD patient who phones because his overnight bag looks like cloudy diluted milk without much pain. He is called in the same day: the effluent cell count confirms peritonitis, specimens go for culture before intraperitoneal antibiotics are started per protocol, and the exchange technique is observed step by step — handwashing, mask, cleaning the connecting surfaces, the five-minute drain-fill discipline — because most infections trace to one skipped step. Two settings, one principle: in dialysis, the nurse's eyes (thrill, cloudiness, cramps) outrun every laboratory. ## Where students slip The blood-pressure cuff question is answered wrongly under time pressure: the fistula arm is forbidden for cuffs, needles and infusions — the classic "which arm" MCQ. Students also reorder the hypotension response, reaching for a vasopressor before stopping ultrafiltration and giving saline, and confuse disequilibrium syndrome (early sessions, neurological shift) with routine hypotension. In peritonitis items, abdominal pain is chosen as the earliest sign; the tested answer is cloudy effluent, since pain can be late or mild. Protein requirements are quoted identically for both modalities, forgetting the peritoneal losses that raise CAPD needs. ## Frequently asked questions ### What must never be done to the fistula arm? Blood pressure measurement, venepuncture, intravenous cannulation or tight clothing — anything that compresses or punctures the access risks thrombosis and loss. ### How is fistula patency checked? Palpate for the thrill at the anastomosis and auscultate for the bruit daily; absence of both signals thrombosis needing urgent intervention. ### What is dialysis disequilibrium syndrome? Headache, nausea, restlessness and sometimes seizures during early or aggressive dialysis, caused by solute shifts; it is prevented with shorter, gentler initial sessions. ### What is the first nursing action for intra-dialytic hypotension? Stop or reduce ultrafiltration, give an intravenous normal saline bolus and recheck blood pressure, before considering any drug therapy. ### What is the earliest sign of CAPD peritonitis? Cloudiness of the dialysate effluent, with or without pain or fever; effluent is sent for cell count and culture before intraperitoneal antibiotics. ### How do protein needs differ between the two modalities? Haemodialysis patients need about 1 to 1.2 g per kg daily, while peritoneal dialysis patients need 1.2 to 1.5 g per kg to replace protein lost into dialysate.