Patients with ARF are sometimes so hemodynamically unstable that they cannot tolerate conventional hemodialysis. These patients may benefit from continuous renal replacement therapy (CRRT), which more slowly removes plasma water and compensates for the loss of intravascular volume. Ultrafiltration methods include continuous arteriovenous hemofiltration (CAVH) and continuous venovenous hemofiltration (CVVH).
The chosen type of fluid and or solute removal depends on the patient’s cause for renal failure, current hemodynamic status, vascular access, and healthcare providers’ equipment and training.
Community level/dialysis center, although inpatient acute stay may be required during initiation of therapy.
Anemias (iron deficiency, pernicious, aplastic, hemolytic)
Heart failure: chronic
Psychosocial aspects of care
Total nutritional support: parenteral/enteral feeding
Transplantation: (postoperative and lifelong)
Patient Assessment Database
Refer to CPs: Renal Failure: Acute; Renal Failure: Chronic, for assessment information.
Discharge plan considerations:
DRG projected mean length of inpatient stay: 2.2 days to initiate therapy
May require assistance with treatment regimen, transportation, activities of daily living (ADLs), homemaker/maintenance tasks
Refer to section at end of plan for postdischarge considerations.
Studies and results are variable, depending on reason for dialysis (e.g., removal of excess fluid or toxins/drugs), degree of renal involvement, and patient considerations (e.g., distance from treatment center, cognition, available support).
1. Promote homeostasis.
2. Maintain comfort.
3. Prevent complications.
4. Support patient independence/self-care.
5. Provide information about disease process/prognosis and treatment needs.
1. Fluid and electrolyte balance maximized.
2. Complications prevented/minimized.
3. Discomfort alleviated.
4. Dealing realistically with current situation; independent within limits of condition.
5. Disease process/prognosis and therapeutic regimen understood.
6. Plan in place to meet needs after discharge.
This section addresses the general nursing management issues of patient receiving some form of dialysis.