HEMODIALYSIS

CLINICAL PRESENTATION ON ADVANCED NURSINGPRACTICE TOPIC : HEMODIALYSIS PRESENTED BY: Mr. RAVI BASARGI Msc Nsg I Year

INTRODUCTION
Dialysis is used to remove fluid &uremic waste products from the body when kidneys are unable to do so It may be used to treat patients with edema that does not respond to other treatment hyperkalemia ,hypercalcemia ,hypertension & uremia Need for dialysis may be acute or chronic Acute dialysis may be indicated when there is high &increasing level of serum potassium ,fluid overload ,increasing acidosis ,pericarditis, severe confusion ,.It is also be used to remove certain

TYPES OF DIALYSIS
1.HEMODIALYSIS 2.PERITONEAL DIALYSIS

HEMODIALYSIS
Hemodialysis is the most common method of dialysis more than 280000americans currently recieve chronic hemodialysis It is the process of purifying the blood & removing the waste products from the blood outside the body &the purified blood is reinfused Hemodialysis is used for patients who are acutely ill & require short term dialysis (days to weeks)for patients with ESRD who require long term or permanent therapy

For patients with chronic renal failure hemodialysis prevents death ,it does not cure renal disease &does not compensate for the loss of endocrine or metabolic activity of kidneys Treatment usually occurs 3 times a week for 3 to 4 hrs /treatment Patients receive chronic or maintenance dialysis when they require dialysis therapy for survival &control uremic symptoms

OBJECTIVES
TO extract toxic nitrogenous substances from the blood &to remove excess water In hemodialysis the blood laden with toxins & nitrogenous wastes is diverted from the patient to a machine a dialyzer where toxins are removed & blood is returned to the patient

PRINCIPLES
Diffusion Osmosis Ultrafiltraton

DIFFUSION
The toxins &waste in the blood are removed by diffusion that is they move from an area of higher concentration in blood to an area of lower concentration dialysate The dialysate is a solution made up of all the important electrolytes in their ideal extracellular concentration The electrolyte level in the patients blood can be brought under control by properly adjusting the dialysate bath The semipermeable membrane impends the diffusion of large molecules such as RBCs & proteins

OSMOSIS

Excess water is removed from the blood by osmosis In which water moves from an area of lesser solute concentration (the blood)to an area of more solute concentration (the dialysate bath

ULTRAFILTRATION
Water moves under high pressure to to an area low pressure This process is much more efficient than osmosis at water removal &is accomplished by applying negative pressure or a sunctioning force to the dialysis membrane because patients with renal disease usually can not excrete water this force is necessary to remove fluid to achieve fluid balance The anticoagulant heparin is administered to keep blood from clotting in dialysis circuit cleansed blood is returned to the body by the end of the dialysis treatment ,many waste products have been restored to normal

TYPES OF DIALYSERS
1. HOLLOW FIBER 2. PARALLEL FLOW PLATE 3. THE COIL

1. HOLLOW FIBER DIALYSER

2.PARALLEL FLOW PLATE DIALYSER

3.COIL DIALYSER

COMPOSITION OF DIALYSATE FLUID

sodium 140.0 potassium 1.0 calcium 1.25 bicarbonate 34.0 magnesium 0.5 chloride 107.5 glucose 5.5

Equipment
For preparing the hemodialysis machine For hemodialysis with a double-lumen catheter: For hemodialysis with an AV fistula For hemodialysis with an AV shunt For discontinuing hemodialysis with a double-lumen catheter For discontinuing hemodialysis with an AV fistula For discontinuing hemodialysis with an AV shunt

HEMODIALYSIS ACCESS SITES

1.SUBCLAVIAN VEIN CATHETERISATION

2.FEMORAL VEIN CATHETERISATION

3.ARTERIO VENOUS FISTULA

4.ARTERIOVENOUS SHUNT

5.ARTERIO VENOUS GRAFT

PREPARATION OF EQUIPMENTS

WORKING OF HEMODIALYSIS

IMPLEMENTATION
Check vital signs Give comfortable position Use standard precaution

1.Beginning hemodialysis with a double-lumen catheter

2.Beginning hemodialysis with an AV fistula

3Beginning hemodialysis with an AV shunt

4. Discontinuing hemodialysis with a double-lumen catheter

5. Discontinuing hemodialysis with an AV fistula

6.Discontinuing hemodialysis with an AV shunt

Special considerations

Home care

COMPLICATIONS
FEVER DIALYSIS DISEQUILIBRIUMS SYNDROMES HYPOVOLEMIA HYPERNETREMIA HYPERGLYCEMIA

DOCUMENTATION
Record the time treatment began and any problems with it. Note the patient's vital signs and weight before and during treatment. Note the time blood samples were taken for testing, the test results, and treatment for complications. Record the time the treatment was completed and the patient's response to it.