Question

Which observation by the nurse indicates that the client performing home dialysis needs further teaching? A. The client facilitates dialysis outflow by changing positions. B. The client uses sterile cotton swabs and a circular motion to clean around the catheter. C. The client uses a heating pad to warm the dialysate before instilling it. D. The client removes the old dressings before washing his hands.

Short answer

Answer: The client uses a heating pad to warm the dialysate before instilling it.

Step-by-step solution

Understanding the situation

In this exercise, a nurse observes a client performing home dialysis. We need to identify the observation that indicates the client needs further teaching. Thus, it is essential to find the option in which the client is doing something incorrect or unsafe during the dialysis process.

Analyzing each option

A. The client facilitates dialysis outflow by changing positions – This is a correct practice as changing positions can help facilitate the outflow of dialysate, so it does not indicate the need for further teaching. B. The client uses sterile cotton swabs and a circular motion to clean around the catheter – This is also a correct practice as it is essential to keep the area around the catheter clean to prevent infections. C. The client uses a heating pad to warm the dialysate before instilling it – This is an incorrect practice. Warming the dialysate with a heating pad can cause uneven heating, which can lead to discomfort and potential injury to the patient. Instead, the client should use a proper dialysate warmer designed for this purpose to ensure even and safe heating of the dialysate. D. The client removes the old dressings before washing his hands – This is a correct practice as it ensures that the old dressings are removed before sterilizing the hands, preventing contamination.

Selecting the correct answer

Based on our analysis of each option, we find that option C is the incorrect practice that indicates the client performing home dialysis needs further teaching, as they should be using a proper dialysate warmer instead of a heating pad to warm the dialysate. So, the correct answer is C.

Key concepts

Dialysis Outflow Management

Effective outflow management is crucial for home dialysis patients to ensure that the dialysis process is efficient and complication-free. One important aspect is the position of the body during dialysis. Patients can facilitate better dialysis outflow by adjusting their positions, as it helps in reducing the pressure inside the abdomen and allows the dialysate fluid to drain more easily.

It's important that patients understand various positions like lying on one side, turning onto their back, or standing up for short periods can assist the gravitational pull on the fluid. Additionally, they should be educated on signs that might indicate poor outflow, such as a slow drainage rate or discomfort, and know when to contact their healthcare provider.

Furthermore, patients should be instructed to look out for any alarming signs such as the presence of fibrin or blood in the outflow, which could indicate potential complications and require immediate medical attention.

Catheter Site Care

The catheter site is a critical area for home dialysis patients, and proper care is essential to prevent infections. Patients should use sterile techniques when touching or cleaning the catheter area. Sterile cotton swabs and antiseptic solutions should be applied using a gentle, circular motion to clean around the catheter site. This cleaning method helps to remove bacteria and reduce the chance of infection.

Proper hand hygiene before and after touching the catheter or changing dressings is non-negotiable. Hands should be washed thoroughly using antibacterial soap and water or hand sanitizer. It's also essential for the patient to wear gloves during the procedure and to change dressings as directed by their healthcare provider.

Practice Tips:

• Always wash hands before and after catheter site care.
• Use sterile materials for cleaning or dressing the catheter site.
• Follow specific instructions given by healthcare providers to ensure proper catheter maintenance.

Dialysate Warming Practices

Warming the dialysate to body temperature prior to infusion is important for the comfort of the home dialysis patient. Cold dialysate can cause pain and discomfort, while very warm dialysate can result in burns or damage to the peritoneum.

The correct method for warming dialysate involves using a dedicated dialysate warmer, which is specifically designed to evenly distribute heat and bring the fluid to a safe temperature compatible with the patient's body. It is unsafe to use heating pads, microwaves, or other non-approved heating methods as they can lead to uneven or excessive heating, posing a risk to the patient.

Patients should be educated on the proper use of dialysate warmers, including checking temperature settings and testing the fluid's warmth before use. Some warmers might also have specific instructions for different types of dialysate bags or volumes, and it's important for patients to follow these instructions to ensure effective and safe warming.