DIALYSISDIALYSIS

Done by:Done by:

J.ManasiaJ.Manasia

Dialysis…Dialysis…

a method of removing toxic a method of removing toxic substances (impurities or wastes) substances (impurities or wastes) from the blood when the kidneys are from the blood when the kidneys are unable to do so. unable to do so.

most frequently used for patients who most frequently used for patients who have kidney failure, but may also be have kidney failure, but may also be used to quickly remove drugs or used to quickly remove drugs or poisons in acute situations. This poisons in acute situations. This technique can be life saving in people technique can be life saving in people with acute or chronic kidney failure.with acute or chronic kidney failure.

Dialysis: MethodsDialysis: Methods

HemodialysisHemodialysis Peritoneal DialysisPeritoneal Dialysis

Hemodialysis…Hemodialysis…

A dialysis process A dialysis process which requires a which requires a machine to machine to transport the transport the blood and blood and dialysing fluid on dialysing fluid on either side of a either side of a semi-permeable semi-permeable membrane to membrane to effect the removal effect the removal of toxic of toxic metabolites and metabolites and excess waterexcess water

How

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Hemodialysis: Hemodialysis: FunctionsFunctions

Cleanses the blood of accumulated Cleanses the blood of accumulated waste productswaste products

Removes the by-products of protein Removes the by-products of protein metabolism (metabolism (urea, creatinine & uric urea, creatinine & uric acidacid))

Removes excessive fluidsRemoves excessive fluids Maintains or restores the buffer system Maintains or restores the buffer system

of the bodyof the body Maintains or restores electrolyte levelsMaintains or restores electrolyte levels

Hemodialysis: AccessHemodialysis: Access

Subclavian and femoral Subclavian and femoral cathetercatheter

External arteriovenous External arteriovenous shuntshunt

Internal arteriovenous Internal arteriovenous fistualfistual

Internal arteriovenous graftInternal arteriovenous graft

Subclavian (vein) Subclavian (vein) Catheter…Catheter…

may be inserted may be inserted for short term or for short term or temporary use in temporary use in acute renal failureacute renal failure

usually filled w/ usually filled w/ heparin & capped heparin & capped to maintain patency to maintain patency between dialysis between dialysis treatmentstreatments

may be left in may be left in place for up to 6 place for up to 6 wks if complications wks if complications do not occurdo not occur

Femoral (vein) Femoral (vein) Catheter…Catheter…

may be inserted may be inserted for short term or for short term or temporary use in temporary use in acute renal failureacute renal failure

client should not sit client should not sit up more than 45up more than 45° ° or lean forward, or or lean forward, or the catheter may the catheter may kink & occlude.kink & occlude.

an IV infusion an IV infusion pump w/ microdrip pump w/ microdrip tubing should be tubing should be used if a heparin used if a heparin infusion through the infusion through the catheter is catheter is prescribedprescribed

External AV ShuntExternal AV Shunt

Access is formed Access is formed by the surgical by the surgical insertion of 2 insertion of 2 silastic cannulas silastic cannulas into an artery or into an artery or vein in the vein in the forearm or leg forearm or leg to form an to form an external blood external blood path.path.

External AV Shunt…External AV Shunt…

AdvantagesAdvantages DisadvantagesDisadvantages can be used can be used immediately after immediately after insertioninsertion no venipuncture no venipuncture necessary for dialysisnecessary for dialysis

external danger of external danger of disconnecting or disconnecting or dislodging the shuntdislodging the shunt risk of hemorrhage, risk of hemorrhage, infection or clottinginfection or clotting skin erosion around skin erosion around the catheter sitethe catheter site

Internal AV FistulaInternal AV Fistula

for chronic dialysis for chronic dialysis clientsclients

created surgically created surgically by anastomosis of a by anastomosis of a large artery & a large artery & a large vein in the large vein in the armarm

Maturity: veins Maturity: veins become engorged become engorged due to the flow of due to the flow of arterial blood into arterial blood into the venous system; the venous system; takes 1-2 wks.takes 1-2 wks.

Maturity is required Maturity is required before the fistula before the fistula can be usedcan be used

Internal AV Fistula…Internal AV Fistula…

AdvantagesAdvantages DisadvantagesDisadvantages less danger of less danger of clotting and bleedingclotting and bleeding can be used can be used indefinitelyindefinitely decreased decreased incidence of infectionincidence of infection no external no external dressing requireddressing required

cannot be used cannot be used immediately after immediately after insertioninsertion venipuncture is venipuncture is required for dialysisrequired for dialysis infiltration of needles → infiltration of needles → hematomahematoma aneurysm in the fistulaaneurysm in the fistula Arterial steal syndromeArterial steal syndrome

Internal AV GraftInternal AV Graft

for chronic dialysis clients for chronic dialysis clients who do not have adequate who do not have adequate blood vessels for the blood vessels for the creation of a fistulacreation of a fistula

Gore-Tex or a bovine (cow) Gore-Tex or a bovine (cow) carotid artery as artificial carotid artery as artificial vein for blood flowvein for blood flow

Procedure involves the Procedure involves the anastomosis of the graft to anastomosis of the graft to the artery, a tunneling the artery, a tunneling under the skin, and under the skin, and anastomosis to a vein.anastomosis to a vein.

can be used 2 wks after can be used 2 wks after insertioninsertion

Complications: clotting, Complications: clotting, aneurysms and infectionaneurysms and infection

Internal AV Graft…Internal AV Graft…

AdvantagesAdvantages DisadvantagesDisadvantages less danger of less danger of clotting and bleedingclotting and bleeding can be used can be used indefinitelyindefinitely decreased decreased incidence of infectionincidence of infection no external no external dressing requireddressing required

cannot be used cannot be used immediately after immediately after insertioninsertion venipuncture is venipuncture is required for dialysisrequired for dialysis infiltration of needles → infiltration of needles → hematomahematoma aneurysm in the fistulaaneurysm in the fistula Arterial steal syndromeArterial steal syndrome

How long do hemodialysis treatments last?

Usually, each hemodialysis treatment lasts about four hours and is done three times per week.