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Blood cells are too big to pass through the semi-permeable membrane, but water in the blood is drawn into the dialysis fluid by the glucose.
3.
Ultrafiltration is complete. Water has been drawn through the peritoneum by the glucose in the dialysis fluid by the glucose in the dialysis fluid. There is now extra water in the dialysis fluid which need to be changed.
Dialysis system HD PD
CWM Biomedical Department
2. Treatment Options
No Treatment Monitoring & Predialysis
Control symptoms Preserve Residual Renal Function
Control rising BP (Antihypertensives) Control Renal Bone Disease (Ca2+, Vit D) Prevent/Treat Anaemias (Erythropoietin, Blood)
Dialysis
Definition Artificial process that partially replaces renal function Removes waste products from blood by diffusion (toxin clearance) Removes excess water by ultrafiltration (maintenance of fluid balance) Wastes and water pass into a special liquid dialysis fluid or dialysate
Types
Haemodialysis (HD) Peritoneal Dialysis (PD) They work on similar principles: Movement of solute or water across a semipermeable membrane (dialysis membrane)
Diffusion
Movement of solute Across semipermeable membrane From region of high concentration to one of low concentration
1.
Bacterium 0.2-1.0
2.
Virus
0.02-0.4
Membrane 0.0001-0.0005
Blood cells are too big to pass through the dialysis membrane, but body wastes begin to diffuse (pass) into the dialysis solution. 3.
Diffusion is complete. Body wastes have diffused through the membrane, and now there are equal amounts of waste in both the blood and the dialysis solution.
Ultrafiltration
Made possible by osmosis Movement of water Across semipermeable membrane From low osmolality to high osmolality Osmolality number of osmotically active particles in a unit (litre) of solvent
Haemodialysis
Dialysis process occurs outside the body in a machine The dialysis membrane is an artificial one: Dialyser The dialyser removes the excess fluid and wastes from the blood and returns the filtered blood to the body Haemodialysis needs to be performed three times a week Each session lasts 3-6 hrs
Requirements for HD
Good access to patients circulation Good cardiovascular status (dramatic changes in BP may occur)
Performing HD
HD may be carried out: In a HD Unit At a Minimal Care / Self-Care Centre At Home
HD Unit
Specially designed Renal Unit within a hospital Patients must travel to the Unit 3x a week Patients are unable to move around while on dialysis; may chat, read, watch TV or eat Nursing staff prepare equipment, insert the needles and supervise the sessions
Home Haemodialysis
Use of machines set up at home Machines have many safety devices inbuilt Thorough patient training Requires the help of a partner at home every time Suitability is assessed by the haemodialysis team Ideal for patients who value their independence and need to fit in their treatment around a busy schedule
HD Access
2 types of access for HD:
Must provide good flow Reliable access
AV Fistula
AV Fistula
AV Fistula Access
Matures in about 6 weeks Ensure good working order
Avoid tight clothing or wrist watch on fistula arm Assess fistula daily; notify immediately if not working Avoid BP cuff on fistula arm Avoid blood sampling on fistula arm (except daily HD Rx) Avoid sleeping on fistula arm Grafts (synthetic) may be used to create an AV fistula
Effects of HD on Lifestyle
Flexibility:
Difficult to fit in with school, work esp if unit is far from home. Home HD offers more flexibility
Travel:
Necessity to book in advance with HD unit of places of travel
Sexual Activity:
Anxiety of living with renal failure affects relationship with partner
Body Image:
Esp with fistula; patient can be very self conscious about it
Problems with HD
Rapid changes in BP
fainting, vomiting, cramps, chest pain, irritability, fatigue, temporary loss of vision
Fluid overload esp in between sessions Fluid restrictions more stringent with HD than PD Hyper kalaemia esp in between sessions Loss of independence Problems with access
poor quality, blockage etc. Infection (vascular access catheters)
Pain with needles Bleeding from the fistula during or after dialysis Infections during sessions; exit site infections; blood-borne viruses e.g. Hepatitis, HIV
Calcium and dextrose are absorbed from the dialysate fluid into the circulation
Lactate is absorbed and converted to HCo3- by the liver Dextrose solution strengths: 1.5%, 2.5%, 4.25%
Types
Continuous Ambulatory Peritoneal Dialysis (CAPD) Automated peritoneal Dialysis (APD)
CAPD
Dialysis takes place 24hrs a day, 7 days a week Patient is not attached to a machine for treatment Exchanges are usually carried out by patient after training by a CAPD nurse Most patients need 3-5 exchanges a day i.e.
4-6 hour intervals (Dwell time) 30 mins per exchange
CAPD Exchange
APD
Uses a home based machine to perform exchanges Overnight treatment whilst patient sleeps The APD machine controls the timing of exchanges, drains the used solution and fills the peritoneal cavity with new solution Simple procedure for the patient to perform Requires about 8-10 hrs Machines are portable, with in-built safety features and requires electricity to operate
PD Access
Done under LA or GA
DIET
Why is diet important?
Managing the diet can slow renal disease The need for dialysis can be delayed The diet affects how patients feel
PROTEINS
Animal protein Dairy (milk, cheese) Meat (steak, pork) Poultry (chicken, turkey) Eggs
SODIUM
Regulates blood volume and pressure
Avoid salt
Use Alternate food seasonings: lemon and limes, spices, seafood seasoning, Italian seasoning, vinegars, peppers
FLUIDS
Healthy kidneys remove fluids as urine Check for fluid and sodium retention
PHOSPHOROUS
Phosphorus is a mineral which combines with calcium to keep bones and teeth strong Too little calcium and too much phosphorus Need to control the phosphorus in the diet Need to take a phosphate binder or a calcium supplement
VITAMINS
Folic acid Iron supplements Do not take OTCs without consulting the doctor.
Blood samples
LAB MONITORING
Haemoglobin Albumin Calcium Phosphorus GFR (24 hour urine) Sodium Potassium Urea Creatinine
Travel
Dialysis supplies can be delivered to most parts of the world; travel more flexible. APD machines are portable; will fit into a car boot, can be carried by train/air
Responsibility
Requires more responsibility from patient but more independence
Sexual Activity
May affect relations based on patient anxiety
Fluid Overload
Much less a problem than with HD
Dehydration
Less common than fluid overload
Abdominal Discomfort
Bloated feeling
Leakage
Fluid may leak around catheter exit site. (May leak into scrotum) Stop PD temporarily Resite catheter (use new one)
Infections
Exit site infections Tunnel infection peritonitis
PD
Most
Unit HD
Most Not alwys
Home HD
Most
Delivery of
Prior
Prior