Embed Size (px)
Citation preview
BASIC
HEMODIALYSIS TRAINING
Prepared by: Armando Darino NgojoSenior Engineer, Biomedical & Facility
Aims
To provide basic understanding about the Hemodialysis Machine
To perform and understand the basic technical troubleshooting steps and PPM tasks
2NGOJO
Objectives
- as a result of completing this module, the biomedical technician / engineer should be able to understand the concept of the Hemodialysis Unit including its applications and basic maintenance tasks.
3NGOJO
What is Hemodialysis?
The process of removing waste products &
excess fluid from the body such as: potassium and urea as well as free water from the blood when
the kidneys are in renal failure
And it also involves partial replacement of
Kidney’s function
NGOJO 4
What Kidneys do?
Remove waste products from the body
Remove drugs form the body Balance the body's fluids Release hormones that regulate
blood pressure Produce an active form of vitamin D Control the production of red blood
cells NGOJO 5
Kidney Failure
Acute Renal Failure (ARF)
Chronic Renal Failure (CRF)
NGOJO 6
How Kidney failure treated?
Hemodialysis
Peritoneal Dialysis
Kidney transplantation
NGOJO 7
Definition of Hemodialysis
means Blood
“Hemo”
“Dialysis”
means To pass through
(Filtering)
NGOJO 8
Principles Involved
Diffusion
Osmosis
Ultrafiltraion
Convection
NGOJO 9
Diffusion
A flow of solutes from an area of higher concentration to a lower solute concentration across a semipermeable membrane.
NGOJO 10
Osmosis
The movement of water through a membrane from lower to a higher water concentration area.
Only in Peritoneal Dialysis
NGOJO 11
Ultrafiltration
The movement of fluid through a membrane caused by a pressure gradient
NGOJO 12
Convection
The movement of solutes with a water flow
Only during Isolated Ultrafiltration (ISO-UF) NGOJO 13
Hemodialysis (HD)
The transport of uremic wastes by diffusion
The process in which of particles move across a semipermeable membrane from the area of higher concentration (Blood) to the area of lower concentration (Dialysate)
NGOJO 14
Preparation & Handling of Fresh Dialysate
Monitoring Systems
Handling of Used Dialysate & Ultrafiltrate
R.O.water
Drain
Dialyser
Patient
Hydraulics
Basic Hemodialysis Setup
NGOJO 15
Fresenius 4008S HD machine
Monitoring System
Extracorporeal System
Hydraulic System
NGOJO 16
Bbraun Dialog +
Monitoring System
Extracorporeal System
Hydraulic System
NGOJO 17
Hemodialysis Flow
NGOJO 18
Hemodialyser Artificial Kidney Containing of bundle of thousands of
hollow fibres Separated by two compartments (Blood & Dialysate)
NGOJO 19
Hollow fiber dialyzer - A plastic cylinder containing a bundle of thousands of tiny hollow cellophane-like fibers
Separated by two compartments
(Blood & Dialysate)
Hemodialyser
NGOJO 20
Dialysis Membrane
NGOJO 21
Efficiency of Dialysis
Dialysate flow
Blood flow
Counter Flow
NGOJO 22
Dialysate
To remove waste products To normalize the electrolytes by
removing some ions To normalize the pH by adding some
buffer To maintain all vital substances
NGOJO 23
Types of Dialysate
Acetate
Bicarbonate
Acid Concentrat
e
Bicarb Concentra
te
NGOJO 24
Dilution ratio
1:35.83 (1 : 34 : 1.83) 1:34
1 denotes Acid part
34 denotes Water part
1.83 denotes Bicarb part
NGOJO 25
Ion composition of Bicarb Dialysate
Sodium 138.00 mmol/l
Potassium 2.00 mmol/l
Calcium 1.75 mmol/l
Magnesium 1.00 mmol/l
Chloride 109.50 mmol/l
Acetate 3.00 mmol/l
Bicarbonate 32.00 mmol/l
NGOJO 26
Measurement Technique
Patient
HD machine
Dialysate Out
Dialysate In
CD Cell 110
CD Cell 7
Dialyser
Blood In
Blood Out
NGOJO 27
Prescription In the North America and UK, 3-4 hour
treatments (sometimes up to 5 hours for larger patients) given 3 times a week are typical.
Twice-a-week sessions are limited to patients who have a substantial residual kidney function.
Four sessions per week are often prescribed for larger patients, as well as patients who have trouble with fluid overload.
NGOJO 28
Side-effects and complications
Hemodialysis often involves fluid removal (through ultrafiltration-(occurs at the barrier between the blood and the in the renal corpuscle or Bowman's capsule in the kidneys
. ) because most patients with renal failure pass little or no urine.
Side effects caused by removing too much fluid and/or removing fluid too rapidly include low blood pressure, fatigue, chest pains, leg-cramps, nausea and headaches.
NGOJO 29
Access
In hemodialysis, three primary methods are used to gain access to the blood:
an intravenous catheter
an arteriovenous (AV) fistula
or a synthetic graft.NGOJO 30
Fistula Needles
NGOJO 31
Fistula Needles
NGOJO 32
Arterial/venous ports
NGOJO 33
Blood linesArterial line Venous
line
connectors Venous drip chamber
ArterialDrip chamber
portsclamp
clamp
redblue
NGOJO 34
Tunnelled catheter access
NGOJO 36
non-tunneled catheters
NGOJO 37
non-tunneled catheters, ...
NGOJO 38
NGOJO 41
Patient Connections
NGOJO 42
Cont….
NGOJO 43
Cont…
NGOJO 44
Cont…
NGOJO 45
Equipment
The newest dialysis machines on the market are highly computerized and continuously monitor an array of safety-critical parameters including :
blood and dialysate flow ratesdialysis solution conductivity temperature, and pH and analysis of the dialysate for evidence of
blood leakage or presence of air.
NGOJO 46
Dialysis Machine
The dialysis machine is about the size of a dishwasher. This machine has three main jobs:
pump blood and watch flow for safety
clean wastes from blood watch your blood pressure and the
rate of fluid removal from your body NGOJO 47
Equipment
Any reading that is out of normal range triggers an audible alarm to alert the patient-care technician who is monitoring the patient.
Manufacturers of dialysis machines include companies such as:
Fresenius, Gambro, Baxter, B. Braun, and Bellco.
NGOJO 48
Fresenius 4008 Cleaning MenuProgram
No.Description Solution
Display during cleaning program
RinsePgm 1Pgm 2
RinseRinse endless
RO waterRO water
-R--R endless-
Hot Rinse
Pgm 1Pgm 2Pgm 3
Hot rinseHot rinse without Cooling rinseIntegrated hot rinseIntegrated hot rinse with cooling rinse
RO waterRO waterRO waterRO water
-F-HR-C-F-HR--IHR--IHR-C-
Disinfection
Pgm 1Pgm 2Pgm 3Pgm 4
DisinfectionHot disinfectionDisinfection + Hot rinseHot disinfection + Hot rinse
Puristeril 340CitrostrilPuristeril 340Citrostril
-F-D-M--F-HDIS-M--F-D-M-HR--F-HDIS-M-HR-
Pgm 5 Cleaning (front supplied) Sporotal 100(Hypochlorite)
-F-D(F)-M-
NGOJO 50
Maintenance Schedule
S.No. Description 4008B 4008S/H Solution
1. End of treatmentPgm No.1 in Rinse Menu Rinse R.O.Water
2. End of the dayPgm No.2 in Disinfection Menu Hot Disinfection Citrostril
3. End of the weekPgm No.4 in Disinfection Menu
Hot Disinfection + Hot Rinse Citrostril
4.
End of unknown patient dialysis treatment(HIV, Hep B, Hep. C)
Pgm No.5 in Disinfection Menu
Cleaning (Front supplied)
Hemoclean
NGOJO 51
Thank You
NGOJO 52
