Hemodialysis and peritoneal dialysis

1. DIALYSIS
ANEEZ. K
IST YEAR MSC. NURSING
EMS CON

2. Definition
Dialysis is the movement of fluid and molecules across a
semipermeable membrane from one compartment to another.
Clinically dialysis is a technique in which substances move from
the blood through a semipermeable membrane and in to a
dialysis solution called dialysate.

3. Historical Evolution in the Field Of
Dialysis
 It was the romans first used a form of dialysis therapy
by using hot bath to patients to remove urea.

4.  1854 the first time the term dialysis was used by
Thomas Graham
 1889 BW Richardson First referred the use of
collodion membrane in the dialysis of blood .This
help the living animals were dialysed in
experimental conditions.

5.  1914 Hess & McGuigan were experimenting with
dialysis in a pharmacology lab in Chicago. As a result
they were able to transfer sugar from tissue to blood
and from the blood across a collodion membrane.
 1920s the first dialysis performed on human was
carried out by George Hass. He used hirudin as an
anticoagulant and later a crude form of heparin. He
was honoured as a pioneer of dialysis.

6.  1923 Heinrich Necheles was discovered
contemporary dialyser.
 In mid 1930s purification of the heparin occur.
 1937 an American scientist, William Thalhimer use first
synthetic membrane.

7.  In 1945 William Kolff first clinical experience was gained
on a 29 year old women with chronic nephritis. The
blood urea was kept stable for 26 days but after 12
sessions of dialysis her blood urea began to increase
and she subsequently died.
 After the world war Kolff technique was wildly used.

8.  In 1950s Allis Chalmers Corporation was one of the first companies to
produce dialysis machine commercially.
 In the late 1950s Fredrik Kiil of Norway made more modification in the
field of dialyser.
 In 1960s the forerunner of today’s capillary – flow dialyser was
produced by Richard Stewart.
 Belding Scribner was introduced the shunt to provide vascular
access in dialysis.

9.  Followed by this invention hemodialysis started.
 In late 1970s and early 1980s the continuous ambulatory
peritoneal dialysis as the first choice of home treatment.
 The innovations in the field of dialysis is reaching up to
the satellite dialysing unit nowadays. And the patient
surveillance rate also increase.

10. Principles of Dialysis
 Diffusion: Diffusion is the movement of solutes from an area of
greater concentration to an area of lower concentration.

11.  Osmosis: Osmosis is the movement of fluid from an
area of lesser concentration to an area of greater
concentration of solutes.

12.  Ultra filtration: Ultra filtration that is solution move
when there is an osmotic gradient or pressure
gradient across the membrane.

13. INDICATION OF DIALYSIS
 Renal failure
 Severe electrolyte and/or fluid abnormalities
 Acidosis
 Drug overdose
 Poisoning

14. TYPES OF DIALYSIS
 HEMODIALYSIS
 PERITONEAL DIALYSIS

15. HEMODIALYSIS
 HEMODIALYSIS APPARATUS
Blood circuit
Dialysis solution circuit
Dialyser

16. BLOOD CIRCUTE

17. DIALYSIS SOLUTION CIRCUTE
 Water Purification System
RO + Acetic Acid + NaHCO3 + KHCO3

18. REVERSE OSMOSIS

19. DIALYSER

20. VASCULAR ACCESS
 Intravenous Catheter
Non-tunnelled or Temporary Catheter
Tunnelled or Permanent Catheter or
Prem Cath
 AV fistula
 AV graft

21. INTRAVENOUS CATHETERS

22. Replacement therapies of HD
 HEMOFILTRATION
 HEMODIAFILTRATION
 INTESTINAL DIALYSIS
 PLASMAFERESIS

23. PERITONEAL DIALYSIS
 Fill phase
 Dwell phase
 Drain phase

24. Complications of Peritoneal Dialysis
Peritonitis
Catheter Infection
Cuff erosion
Abdominal hernias
Abdominal distension
Hypotension

25. Hyperglycaemia
Hypernatremia/ Hypernatremia
Hyperkalaemia/Hypokalaemia
Hypoalbuminemia
Abdominal wall and pericatheer leak
Genital edema
Respiratory complications
Back pain
Dyslipidaemia

26. Psychosocial Issues in ESRD Patients
Psychological problems like,
Depression
Dementia/ Delirium
Anxiety and behaviour disorders

27. Psychosocial Issues like,
Marital relationship
Sexual dysfunction
Socioeconomic issues
Rehabilitation
Quality of life
Altered body image
Awareness of early death
Non adherence to the medical and nursing care

28. BIBLIOGRAPHY
 John T. Daugirdas, Peter G. Blake, Todd S. Ing “Handbook of Dialysis”(2007),4th edition,
Wolters Kluwer (India) publication, page no: 59-88
 Allen R. Nissenson, Richrad N. Fine “Handbook of Dialysis Therapy” (2009), 4th edition,
Elsevier Publications, page no: 703-710, 1221-1225
 Nicola Thomas “Renal Nursing” (2008), 3rd edition, Elsevier Publication, page no: 73-78, 181-
232
 Lewis, Dirksen, Heitkemper, Bucher “Medical – Surgical Nursing Assessment and
Management of Clinical Problems” (2011), 9th edition, Elsevier Publications, page no: 1183-
1188
 Lippincott “Manual of Nursing Practice” (2009), 10th edition, Wolters Kluwer (India)
publication, page no: 785-788
 http://en.wikipedia.org/wiki/Dialysis
 http://www.ncbi.nlm.nih.gov/pubmed/22916962