Escolar Documentos
Profissional Documentos
Cultura Documentos
Hemodialysis Machines
Contents
Introduction
Anatomy & Physiology
History
Principle of Operation
Maintenance
Introduction on Dialysis
Dialysis is a treatment for people in the
acute or chronic renal insufficiency (kidney
failure). This treatment cleans the blood and
removes wastes and excess water from the
body . Normally, this work is done by
healthy kidneys.
Effects of Dialysis
Dialysis will not cure the Kidney
disease,but it does some of the work of
healthy Kidney.
Dialysis need to carried out for a life time
until
Kidney
transplant
is
done
successfully.
Kidney
No. of Kidneys
: Two
Shape
: Bean shape
Weight
: 120-170 grams
Size
: 11-13cm in length
Breadth
Thickness
Location
either
5 - 7cm
2.5 - 3cm
: The kidneys are located on the
side of the spine at approximately
above 6-8 cm waist level.
Kidney Functions
A quick summary of the functions of the kidney:
Family history.
High Blood pressure.
Unknown factors.
Hemodialysis
Peritoneal dialysis
Renal
Transplant
10
Renal Transplant
Transplant is the surgical implantation
of a healthy kidney from a donor to a
patient.
11
Hemodialysis
In Hemodialysis, blood is passed through
an Artificial kidney machine to clean it.
Hemo means
Filtration
Blood,
Dialysis
means
12
Peritoneal dialysis
Peritoneum, the inner lining of the
abdomen
is
a
semi-permeable
membrane, that allows the removal of
waste materials & excessive water
from the patient body.
13
14
15
16
17
18
19
20
21
Sequential therapy.
Ultra filtration profile.
Sodium Profile.
Automatic NIBP measurement during treatment
OCM
22
Hemodialysis
At
Home
In a
HDU
centers
Peritoneal Dialysis
At
Home self
Dialysis
In Dialysis Unit
Or
ICU,ICCU,
Pediatric Dep
IPD
Self
Dialysis
Self &
Nurse
assisted
Dialysis
Living Related
Donor Kidney
IPD
CAPD
CCPD
Kidney Transplantation
CAPD
CCPD
Unrelated
Cadaver
Kidney
23
Hemodialysis
Hemodialysis means The cleaning of the blood.
90% of end stage renal failure patient will go for
Hemodialysis Treatment.
Hemodialysis process is based on two function
Removal of waste product by Diffusion &
Convection.
Removal of excess water by Ultra filtration.
24
Hemodialysis
25
Hemodialysis
Disadvantages of Hemodialysis
Patient needs to visit the center & spend five hours
every three times a week.
Expensive.
Patient cant lead a standard life due to the frequent
visit to center
Infection during the treatment.
26
Peritoneal Dialysis
Peritoneum is a membrane that covers the Organs
in the Abdominal Cavity.
27
Peritoneal Dialysis
A person on PD has a Catheter (Approximately 6cm in
length) in the lower part Abdomen all the time which is fix by
a Doctor by a small operation.
Dialysis fluids are then regularly introduced into the
Abdomen & allowed to remain for a time period. Then the fluid
will be drained & again filling process will take place.
The cycle of Fill,Dwell,Drain & Treatment time will differ
from patient to patient.
28
Types-Peritoneal Dialysis
Two Major Peritoneal dialysis
(1) CAPD- Continuous Ambulatory Peritoneal Dialysis.
29
Types-Peritoneal Dialysis
Continuous Ambulatory Peritoneal Dialysis
CAPD is the only type of PD that is done without Machines. Patient
can do it themselves.
Dialysate bag fixed in the stomach which connected to Peritoneal
cavity through the catheter.A new bag will be changed each time after
it drain the waste from Peritoneal cavity.
CAPD Treatment is four or five times a day, dialysate (1.5-2 L)
remains in Peritoneal cavity for about four to six hours each time.
While the dialysate is in Peritoneal cavity, Patient can go to usual
activates.
30
31
or Plugging
Abdominal cavity
of
the
Catheter
in
32
Kidney Transplantation
Transplant is the surgical implantation of a healthy
kidney from a donor to a Patient. The procedure is
carried out after an extensive examination &
Investigation have been performed on both the donor &
Patient. To ensure the best possible outcome & to
Minimize any complication to both of them.
Only one kidney is removed surgically from the donor &
Placed in the lower part of the Patient Abdomen. After
transplant patient need to be on special life-long
medication to prevent rejection.
33
Kidney Transplantation
Types of Kidney Transplant
Living Related Individual :Close Family Members are Potential Donors. Potential donors are required to under
go extensive examination, Investigation & Counseling . The best matched individuals
will be considered.
Living Non-Related Individual:-
Transplant of this nature is not carried out in Malaysia but are performed in some
foreign countries. These transplant are commercial in nature. The Transplant
procedure are same as above.
Cadaver:Cadaver transplant involves the harvesting of organs from a donor who is certified as
Brain Dead. Written Family consent is further required. The Transplant procedure
are same as above.
34
35
37
38
39
Renal Artery
Renal Vein
Urethra
Nephrons
Cortex
Medula
Calix
Renal Pelvis
40
Two
41
42
43
44
Glomerulus's
The Glomerulus consists of a network of thinwalled capillaries closely surrounded by a pearshaped epithelial membrane called Bowmans
Capsule.
Blood enters the capillary tuft through an afferent arteriole. Because of the blood pressure
in the capillaries & because of their thin walls, Ultra filtration occurs.
Water & Solutes of molecular weight less than 68,000 d(Albumin) pass freely into
Bowmans Space. Such solutes include Electolytes & Urea, creatine ,uricacid, glucose,
aminoacids & Low molecular weight proteins. This Fluid is the Glomerular Filtrate Rate
(GFR).
A man of Average size has about 180L of filtrate per day, or 125ml/min.
Ninety nine Percent of this filtrate is reabsorbed in the Tubules.
45
Reabsorption
Secretion
46
47
48
49
50
51
Prerenal
It causes reduced
blood flow to the
Kidney sufficiently to
impair function.
Symptoms are Heart
Failure, Blockage of
Renal arteries
Intrarenal
It is caused by direct
damage to Kidney
tissue. Which Causes
75% of Renal Failure.
Postrenal
52
of
function
53
54
55
56
57
Kidney Diagnosis
Procedures to diagnosis disorders of the kidneys and urinary tract may
include urine analysis, blood tests that reflect kidney function, imaging
procedures,tissue and cell sampling.
Urine Analysis:Protein, Glucose, Ketones, Blood in the urine, Nitrites,acidity,
concentration of urine & Urine cultures.
Common blood tests that detect and measure this include the BUN (B-U-N or
blood urea nitrogen) and creatinine
Imaging Procedures:An x-ray of the abdomen can show the size and position of the kidneys, but an
ultrasound scan is usually better for this purpose.
58
Kidney Diagnosis
Ultrasound scanning uses sound waves to produce an image of
anatomic structures.
The technique is simple, painless, and safe. It can be used to study
the kidneys, ureters, and bladder, with the added advantage that
good pictures can be obtained.
Ultrasound scans provide some indirect information about kidney
function.
Ultrasound scanning is an excellent way to estimate kidney size and
to diagnose a number of kidney abnormalities, including bleeding in
the kidneys. Ultrasound scanning is used to locate the best place for
a biopsy.
59
Kidney Diagnosis
Kidney Function Tests:Kidney function can be assessed by analyzing a blood sample as well
as a urine sample. The kidney filtration rate can be estimated by
measuring serum creatinine, a waste product. The level of blood urea
nitrogen (BUN) can also indicate how well the kidneys are
functioning, although many other factors can alter this level.
Creatinine clearance a more accurate test can be approximated from
a blood sample, using a formula that relates the serum creatinine
level to a person's age, weight, and sex; determining it exactly
requires a 24-hour urine collection.
60
Kidney Diagnosis
Computed tomography (CT) is more expensive than
ultrasound scanning and intravenous urography but has
some advantages.
61
Kidney Diagnosis
Angiography, which involves injecting a radiopaque
substance into an artery, is the most invasive of all
kidney imaging procedures and is reserved for special
situations, such as when a doctor must evaluate the blood
supply to the kidneys.
62
Kidney Diagnosis
Tissue and Cell Sampling
A kidney biopsy, in which a tissue sample is removed and examined
under a microscope, may be performed so that a doctor can establish
a diagnosis and observe the progress of treatment.
A needle biopsy, in which the needle is inserted through the skin, is
often part of the evaluation of kidney failure, and biopsies of a
transplanted kidney are performed frequently to look for signs of
rejection.
For a biopsy of a person's own (native) kidney, the person lies face
down, and a local anesthetic is injected into the skin and muscles of
the back over the kidney.
63
Kidney Diagnosis
Tissue and Cell Sampling
The biopsy needle is inserted and tissue is removed for
microscopic examination.
For a biopsy of a transplanted kidney, the needle is inserted
directly through the abdominal wall.
Ultrasound is used to help guide the needle to an abnormality.
64
65
Principles Of Hemodialysis
66
What is Hemodialysis?
Hemodialysis Means The cleaning of the Blood.
Hemo Means Blood & Dialysis means cleaning.
Hemodialysis is a process of
dialysis which requires the
transport of blood and a dialysate fluid on either side of a SemiPermeable membrane, to effect the diffusion of toxic metabolites
& transport of water across the membrane to waste.
The Hemodialysis process consists of two part
67
Diffusion
Higher concentration
Lower concentration
Balance concentration
68
Diffusion
Apart from removing waste products,Diffusion also
assists in maintaining the bodys essential mineral salts.
The blood with higher mineral salt concentration is
removed while blood with lower concentration is
corrected with the transfer from the dialysate.
Diffusion is dependent on concentration Gradient &
Temp.
69
Convection
SemiPermeable
Membrane
Blood
Dialysate
Blood
Dialysate
70
Semipermeable
membrane
Ultrafiltration
Flow
direction
Negative
Direction
High
Concentration
Low
concentration
71
About Dialyser
72
The Artificial Kidney contains a chamber which is divided by a thin semipermeable membrane.
Waste products such as urea & creatinine are small in size & will pass
through the membrane and be removed.
Waste products are removed from the blood through three chemical
process: Diffusion,Convection & Ultrfiltration.
73
About Dialyser
Dialyser is the Filtering unit of the Hemodialysis treatment.
The Dialyser possess 4 ports as follows:-
1.
2.
3.
4.
74
Dialysate Solution
There are five important Compounds in Dialysate solution
1. Sodium chloride.
2. Sodium Bicarbonate or Sodium Acetate.
3. Calcium Chloride
4. Potassium chloride
5. Magnesium Chloride.
There are two types of dialysis solution commonly used
1. Acetate Dialysis
2. Bicarbonate Dialysis.
75
Acetate Dialysis
The Acetate is Physiologically compatible with blood & is
Metabolized to Bicarbonate in the liver without incident in stable
Patient.Acetate is mixed with water in a proportioning system in
ratio of 1part of acetate with 34 Part of water to form a Dialysate.
Advantage of Acetate:Many patients have been treated with this type of dialysis for
many years with few problems.
76
Acetate Dialysis
Disadvantage of Acetate: Patient serum Bicarbonate may decrease early during dialysis;
usually it then corrects after a period of time.
Acetate accumulation contributes to Cardiovascular instability
& Hypo tension, as well as Nausea,vomiting & Post dialysis
Fatigue.
Not Suited for rapid,high-efficiency dialysis or High-flux
dialysis.
77
Bicarbonate Dialysis
To over come the Patient problem in Acetate Dialysis, Bicarbonate dialysis
has been introduced. Calcium & Magnesium will not remain in a solution
with bicarbonate because of the low Hydrogen ion content. To solve this
two separate concentrates are used.
A (acidified) concentrate chemical contains most of sodium,calcium,
magnesium, & Potassium, chloride & Small amount of acetic acid to maintain
low pH.
B (Bicarbonate) Contains Sodium Bicarbonate. Some system includes part
of the sodium chloride to raise the conductivity to monitor the concentrate.
Advantage of Bicarbonate:Solves the patient problems in acetate.
78
Bicarbonate Dialysis
Disadvantage of Bicarbonate: Delivery system is more complex, since it must mix & monitor
three liquids instead of only two.
B concentrate is not stable,if mixed with another container.
not cleaned
79
Principle of Hemodialysis
80
Extracorporeal circuit
Arterial Circuit.
Blood from the artery
Venous pressure
Venous line clamp.
Blood/Saline detector.
Blood to the Venous.
81
Dialysate Circuit
Fresh Dialysate Circuit
RO treated water mixed with A& B
Concentrated solution (34:1:1.83) ratio.
Dialysate Heated to blood temp 37C.
Degassing & Flow Balancing circuit.
Dialysate Measuring & Monitoring.
Bypass circuit incase of dialysate alarm.
If No Dialysate alarm Dialysate will pass
through the Venous Dialysate port in the dilayser.
83
84
Degassing
Mixing.
85
86
Closed System.
87
To Patient
Flow
controller
Post-Pump 500ml/min
Dialyser
From Patient
In open system, Pre-pump will run with the feed back from the flow
meter(A) which was controlled by Flow controller circuit. Post-pump
will run with the feed back from the flow meter (B) which was
controlled by Flow controller circuit, but post-pump may run faster
than Pre-pump based on the UF Goal set by the Patient.
88
Flow
controller
Post-Pump
510ml/min
Dialyser
From Patient
Flow meter
(B)
10ml
In open system, Pre-pump will run with the feed back from the flow
meter(A) which was controlled by Flow controller circuit. Post-pump
will run with the feed back from the flow meter (B) which was
controlled by Flow controller circuit, but post-pump will run faster
than Pre-pump to get the 10ml from the patient.
89
Flow
controller
Post-Pump 500ml/min
Dialyser
From Patient
In open system, if the Pre-pump faster than post pump due some
failure. Then there is a risk of reverse ultra-filtration.
So the open system will have high Failure rate in UF accuracy. UF
REMOVAL INACCURATE IN OPEN SYSTEM.
90
Balancing
Chamber
Fresh Dialysate to BC
Dialyser
From Patient
500ml/min
91
Spend Dialysate to
Drain
To Patient
Balancing
Chamber
Fresh Dialysate to
BC
Dialyse
500ml/min
r
From Patient
(10ml/min)
To Drain
UF Pump
92
Balancing
Chamber
Fresh Dialysate to BC
Dialyser
From Patient
93
Negative pressure pump is used to remove the Spent Dialysate from the dilayser.
Negative pump is controlled & monitored by the flow control circuit considering the
calculation of UF target .
Finally before Draining, Spent dialysate fluid will be passed through the Blood Leak
sensor to check for any blood leakage from the dialyser.
94
Once the Blood leaks, the Blood leak detector will detect the blood in the Dialysate
and Blood leak alarm will be triggered.
Once Blood is triggered, following will happen in the machine:1) Blood pump stopped, 2) Venous line clamped, 3) Dialysate flow will bypass the
dialyser to avoid further blood leak into the machine.
95
Extracorporeal circuit
Arterial Circuit.
Blood from the artery
Extracorporeal circuit
Arterial Circuit.
Blood from the artery
97
Extracorporeal circuit
Arterial Circuit.
Blood from the artery
Extracorporeal circuit
Venous Circuit
Venous Blood port.
Air detector
Venous pressure
Venous line clamp.
Blood/Saline detector.
Extracorporeal circuit
Venous Circuit
Venous Blood port.
Air detector
Venous pressure
Venous line clamp.
Blood/Saline detector.
Venous
pressure
depend on the venous
line of the Patient.
Monitor
High/low
alarm limit.
100
Extracorporeal circuit
Venous Circuit
Venous Blood port.
Air detector
Venous pressure
Venous line clamp.
Blood/Saline detector.
101
Extracorporeal circuit
Venous Circuit
Venous Blood port.
Air detector
Venous pressure
Venous line clamp.
Blood/Saline detector.
Blood to the Venous.
To Prepare the Fresh Dialysate as per the Patient requirement & feed into
Dialyser with proper flow.
To remove the Target Volume of fluid from the patient by determining the
necessary pressure to be applied onto the semipermeable membrane.
Drain the Spend dialysate from the Dialyzer & Blood leak in the spend
Dialysate is Monitor
Monitor
Blood pump
1.Display.
2. Alarm LED.
3. Operation LED.
4. Pressure connector.
5. Clamping piece.
6. Blood pump cover.
7. Rotor.
8. Sensor.
9. Start/Stop.
10 & 11 Key.
Heparin pump
1. Slide Carriage.
2. Bolus.
3. Rate.
4. Time Key.
5. Syringe Holder.
6. Stop-watch time Indicator
7. Start/Stop key.
8 & 9 Key.
10. Power.
11. Display.
12. Alarm.
Air detector
1. Key
2. Venous Pressure connector.
3. Holder( Venous chamber)
Concentratesis.
Mixing Ratio
Common Methods:
Fistula
Internal Graft
Subclavian
Patient Preparation.
Check Pre-weight.
Disposables
Dialysate concentrate.
Transducer Protector.
Syringe.
Heparin Solution.
Alcohol Swab.
Temperature.
Conductivity.
UF Target.
Arterial Pressure.
Venous Pressure.
Air detector.
Heparin Infusion
Start Self test to ensure the proper functioning of the machine, during
self test all the parameters are tested.
Treatment Sequence
During Prime Mode Patient Blood lines & Dialyser are primed with
saline solution until the Patient circuit is clean & free from the
Disinfectant & Air.
Check the Pre-weight of the Patient. Based on the dry weight, UF Goal
will be calculated.
Now stop the blood pump & Clamp both the Arterial & Venous blood
line.
Treatment Sequence
Once both the Artery & Venous Blood lines are connected to the
patient, open the clamps in the blood line.
Treatment Sequence
Treatment Sequence
Blood from the Dialyser pass through the Venous Blood port Via
Venous blood line to the Patient Venous Fistula needle.
Finally venous blood tube is inserted into the venous clamp &
Optical detector will detects the colour change. (Saline-BloodSaline).
Blood is circulated from & to the body for four hours to do the
Hemodialysis.
Treatment Sequence
Once Blood reaches the Optical detector of the venous clamp
Dialysis Starts led will flash.
Check all the Treatment Parameters Settings & Alarm Windows
for all the alarms.
Switch UF function.
Treatment time start counting down.
TMP
Blood leak.
Conductivity.
Temperature.
Air Detector.
Flow Alarm.
Water Alarm.
Power Failure.
Blood count.
ECG.
Blood Iron.
Hepatitis Status.
HIV Test.
Clamp Artery Fistula line, Disconnect Artery blood line & run the blood pump
slowly return the blood back to the venous fistula.
Once air reached the air detector, blood pump will be stopped.
Remove Venous chamber from the Air detector.
Bypass Air detector alarm & run the blood pump to pump the blood until end of
venous blood line.
Ensure there is no Air when blood is return back to the patient.
Disconnect the Blood tubes & Dialyzer from the Machine.
Check Patient Post weight.
Rinse & Disinfect the blood tube & Dialyzer using Dialyzer reprocessing unit.
Cleaning program
Machine need to be Rinsed as per manufacture
recommendation after each Hemodialysis treatment.
Ensure the Dwell time of the chemicals used for
disinfections are as per Manufacture recommendation.
Check the machine drain free from the disinfectant
used before connecting to the Patient.
Cleaning program
Cleaning program
Cleaning program
Dialyser reprocessor
Defibrillator
Weighing scale
NIBP
Stethoscope
Oxygen cylinder
Maintenance
Hemodilaysis Training
Maintenance
Block Diagram.
Daily Maintenance.
Test Equipment.
Hemodilaysis Training
Block Diagram
Electronic Circuits
Hemodilaysis Training
Hydraulic Circuit
Block Diagram
Hemodilaysis Training
Hemodilaysis Training
Hemodilaysis Training
Hemodilaysis Training
Hemodilaysis Training
Filling Program
Hemodilaysis Training
Hemodilaysis Training
Daily Maintenance
Start of operation.
Rinsing
Self test.
Visual Inspection.
End of Operation.
Disinfection & Cleaning.
Hemodilaysis Training
Test Equipment
Test Equipment required to test HDU Machine.
Syringe (50CC)
Safety Analyzer.
Hemodilaysis Training
Hemodilaysis Training
Trouble Shooting
Inlet Water Flow
Display
Conductivity
Indicators
Temperature
Blood leak
Pressure
Air detector
Hemodilaysis Training
Flow
Power fail
Blood pump
UF
Safety
Electrical safety:Type of Protection:- Safety class 1
Degree of protection against electrical shock:- Type B.
Safety test need to carry out after Maintenance.
Ensure that machine is installed as per the Manufacture
Operating conditions.
Water Quality to the machine
Electrical supply.
Drain height.
Water inflow pressure.
Water inflow temperature.
Water inflow rate.
Operating Temperature.
Hemodilaysis Training
Safety
Ensure Hepatitis & HIV patients are treated in a
Isolated area & a separate machine is used with a
caution Label. Take a special precaution before using
the machine.
Hemodialysis Machine should be used only by a well
trained personnel.
Machine should not be tested when Patient is
connected.
Use only treated water which complies to the
Standards.
Hemodilaysis Training
Safety
Label the Patient name in the Dialyzer& Blood
tubing.
After each Hemodialysis treatment rinse the
machine.
The Content of opened bicarbonate concentrate
container cannot be store.
Dont Mix the Bicarbonate concentrate from one
container to another.
Pass the Self test before connecting to the patient.
At the end of the day Chemical disinfections need to
be done as per Manufacture recommendation.
Hemodilaysis Training
Safety
In case power failure for long time & no power back
up return the blood back to Patient.
Do not remove the blood line from the venous line
clamp during treatment.
Check for the machine Drain & the Patient circuit is
free from the Disinfectant before connecting to the
patient.
Check the Blood segment size in the blood module.
Hemodilaysis Training
Safety
Connect the correct concentrate container to the
correct concentrate tubes (A & B).
Check the Mixing ratio is as per your concentrate
manufacture specification.
Dont switch off the machine immediately after
dialysis.
Before start dialysis conform your conductivity
reading using your external Meter.
Send the dialysate sample to the lab for Bacteria
growth every month.
Every Six month do the RO water sampling for the
recommended standards.
Hemodilaysis Training
Q&A
Hemodilaysis Training
THANK YOU
157