90935 Hemodialysis procedure with single evaluation by a physician or other qualified health care professional

Name of the Procedure:

Hemodialysis with Single Evaluation
Common Names: Dialysis, Blood Dialysis
Medical Term: Hemodialysis

Summary

Hemodialysis is a medical procedure that uses a machine to filter wastes, salts, and fluids from the blood when the kidneys are no longer able to function properly. During this procedure, a physician or another qualified healthcare professional performs a single evaluation to monitor the patient's condition and adjust the treatment as needed.

Purpose

Hemodialysis is primarily used to treat chronic kidney disease (CKD) and acute kidney injury (AKI). Its goal is to replace some of the kidney’s functions, remove toxins and excess fluids from the bloodstream, regulate electrolytes, and balance other waste materials in the body.

Indications

• End-stage renal disease (ESRD)
• Severe chronic kidney disease
• Acute kidney injury (in serious cases)
• Symptoms like fluid overload, severe hyperkalemia (high potassium levels), or metabolic acidosis

Patients appropriate for this procedure typically have significantly reduced kidney function and require dialysis to maintain balance in their bloodstream.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Medication adjustments may be required, as per the doctor's instructions.
• Blood tests (e.g., serum electrolytes, BUN, creatinine) are necessary before the procedure.
• An arteriovenous (AV) fistula or central venous catheter may be prepared for vascular access.

Procedure Description

1. The patient is seated or reclined in a dialysis chair.
2. A healthcare professional inserts needles into the vascular access (AV fistula or central venous catheter).
3. Blood is then pumped from the body to a dialysis machine.
4. The machine filters out waste products and excess fluids from the blood.
5. Cleaned blood is returned to the body.
6. Throughout the procedure, a physician or qualified health care professional conducts a single evaluation to ensure proper function and manage any immediate concerns.

Tools used include the dialysis machine, blood tubing set, dialyzer, and heparin for anticoagulation if necessary. No anesthesia or sedation is generally required.

Duration

Hemodialysis sessions typically take about 3 to 5 hours and are usually performed 3 times a week.

Setting

This procedure is commonly performed in a hospital dialysis unit, outpatient dialysis center, or at home (with special training and equipment).

Personnel

• Nephrologists or other qualified physicians for evaluation
• Dialysis nurses and technicians

Risks and Complications

• Hypotension (low blood pressure)
• Muscle cramps
• Blood clots in the access site
• Infection at the access site
• Sepsis (rare but severe infection)
• Electrolyte imbalances
• Heart-related complications in patients with pre-existing conditions

Benefits

• Removal of toxins and excess fluids from the blood
• Regulation of blood pressure and electrolytes
• Improved quality of life and symptom relief for patients with reduced kidney function
• Maintenance of bodily functions when the kidneys fail

Recovery

• Post-procedure monitoring for any immediate side effects like dizziness or low blood pressure.
• Patients can usually return to their normal activities shortly after the procedure.
• Follow-up appointments are important to track kidney function and overall health.

Alternatives

• Peritoneal dialysis (a different form of dialysis using the lining of the abdomen)
• Kidney transplantation
• Conservative management with medication and dietary control in some cases

Peritoneal dialysis offers more convenience and fewer dietary restrictions but requires daily treatment. Kidney transplantation can potentially eliminate the need for dialysis but involves surgery and the risk of rejection.

Patient Experience

• During the procedure, patients may feel a slight pinprick when needles are inserted.
• Some may experience fatigue, muscle cramps, or low blood pressure.
• Comfort measures include warm blankets, reclining chairs, and sometimes TVs or personal devices for entertainment.
• Pain management typically involves ensuring proper needle placement and providing support for comfort.