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Remove waste products
Fluid control
BP control
RBC production
Keeping bones healthy
We may feel sick, sleepy, confused or
nauseous. (waste products)
We will feel tired and pale. (RBC)
We may have ankle swellings & start to feel
breathless. (extra fluid)
We may have bad breath & loss of appetite.
(waste products)
PRESENTED BY
ANU ISSAC
• First form of dialysis practised by Romans.
• 1854- the term dialysis was used for the first time by
Thomas Graham.
• 1913- first article on hemodialysis- ‘Artificial kidney’
• 1920’s- first dialysis performed by George Hass
• 1948- first successful dialysis in Mount Sinai hospital by
Willem Kolff
 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 into a dialysis solution (dialysate)
 Hemodialysis
 Peritoneal Dialysis
OSMOSIS
DIFFUSION
Ultrafiltration
1. blood
6. dialysate
7. body
2. access
3. tx w/ heparin
4. dialyser
5. solute exchange
4-6 hours
Cleanses the blood of accumulated waste
products
Removes the by-products of protein
metabolism (urea, creatinine & uric acid)
Removes excessive fluids
Maintains or restores the buffer system of the
body
Maintains or restores electrolyte levels
 Removal of solutes and water from the blood across a
semipermeable membrane
Selective filter for removing toxic or unwanted solutes
from the blood
Rectangular cross section, parallel plate dialyser.
CIRCULAR CROSS SECTION; HOLLOW FIBER
DIALYSER
Organic cellulose derivatives
Synthetic membranes
DIALYSATE
 The fluid that is pumped through the
dialyser on the opposite side of the semi
permeable membrane to the patients
blood.
 Correct the chemical composition of
uremic blood to normal physiological
levels.
SOLUTE CONCENTRATION
SODIUM (mmol/L) 135- 143
POTASSIUM(mmol/L) 0-4
CHLORIDE 100- 111
CALCIUM 1.25 – 1.75
MAGNESIUM 0.75- 1.5
BICARBONATE 30- 35
GLUCOSE 0- 25 gm
Sodium chloride ; Na+ 176 gm ; 82 mEq/L
Potassium chloride ; K+ 5.50 gm ; 2.0 mEq/L
Calcium chloride ; Ca + 8.00 gm ; 3.0 meq/L
Magnesium chloride ; Mg ++, Cl - 2.75 gm ; 0.75 mEq/L, 88.0 mEq/L
Acetic acid 9.0 gm ; 4.0 mEq/L
Purified water 1 liter
Sodium chloride 235 gms
Sodium bicarbonte 600 gms
Na + 55 mmoles
HCO3- 35 mmoles
Cl- 20 mmoles
 Na + - 137 mEq/L
 K + - 2 mEq/L
 Ca ++ - 3.0 mEq/L
 Mg ++ - 0.75 mEq/L
 Cl ‾ - 108 mEq/L
 HCo3‾ 35 mEq/L
 CH3COO‾ 4 mEq/L
 Filtration
 Activated carbon filters (adsorption)
 Water softners
 Reverse osmosis (RO)
 De ionization
 Ultraviolet light exposure
 The removal of air
 The removal of any chemicals
 PERMANENT VASCULAR ACCESS
Arterio venous fistula’s (AVF’s)
Arterio venous grafts (AVG’s)
Shunts
Advantages Disadvantages
 less danger of clotting
and bleeding
 can be used
indefinitely
 decreased incidence of
infection
 no external dressing
required
 freedom of movement
 cannot be used
immediately after insertion
 venipuncture is required
for dialysis
 infiltration of needles →
hematoma
 aneurysm in the fistula
 Arterial steal syndrome
 Congestive heart failure
Advantages Disadvantages
 less danger of clotting
and bleeding
 can be used
indefinitely
 decreased incidence of
infection
 no external dressing
required
 freedom of movement
 cannot be used
immediately after insertion
 venipuncture is required
for dialysis
 infiltration of needles →
hematoma
 aneurysm in the fistula
 Arterial steal syndrome
 Congestive heart failure
Access is formed by the
surgical insertion of 2
silastic cannulas into
an artery or vein in
the forearm or leg to
form an external
blood path.
Advantages Disadvantages
 can be used
immediately after
insertion
 no venipuncture
necessary for dialysis
 external danger of
disconnecting or
dislodging the shunt
 risk of hemorrhage,
infection or clotting
 skin erosion around
the catheter site
 Rope ladder puncture
 Area puncture
 Button hole puncture
Thrombosis
Stenosis of fistula
Aneurysm
Steal syndrome
Infection
 Subclavian vein
 Internal jugular vein
 Femoral vein
 for acute dialysis
 In the patient who is imminently awaiting a kidney
transplant
 for maturation of AV access
 Limited availability of vessels
 Patients undergoing plasmapheresis
 For continuos renal replacement therapies
 Patients on peritoneal dialysis requiring temporary
hemodialysis because of peritonitis.
 may be inserted for
short term or temporary
use in acute renal
failure
 usually filled w/
heparin & capped to
maintain patency
between dialysis
treatments
 may be left in place for
up to 6 wks if
complications do not
occur
 may be inserted for
short term or temporary
use in acute renal
failure
 client should not sit up
more than 45 or lean
forward, or the catheter
may kink & occlude.
 an IV infusion pump
w/ microdrip tubing
should be used if a
heparin infusion
through the catheter is
prescribed
 Weight
 Blood volume monitoring
 Blood pressure
 Temperature and pulse
 Serum biochemistry and hematology
 Kt / V – 1.2
 URR – 65%
 Albumin - >35 g/L
 Potassium – 3.5 – 6.5 mmol/L
 Phosphate - < 1.8 mmol/L
 Calcium – b/w 2.2 and 2.6 mmol/L
 Hb - > 10 g/L
 URR( urea reduction ratio) = 100 (1- Ct/Co)
Ct= post dialysis urea
Co= pre dialysis urea
 ETO
 Gamma irradiation
 Steam sterilization
 Electron or e-beam sterilization
 Hypotension
Muscle cramps
 Loss of blood
 Hepatitis
 Sepsis
 Disequilibrium syndrome
 Vascular steal
 Dialyser Reaction
 Hemolysis
Air embolism
PERITONEAL DIALYSIS
Adequate Patient Care in the Most Biocompatible Way
•
Sodium 132- 142
Potassium 0- 4
Calcium 2.5- 3.5
Magnesium 0.5- 1.5
Lactate 35- 40
Chloride 101- 107
pH 5.0- 5.8
Dextrose 1.5- 4.25 gm/dL
 Inflow (fill) – 10 minutes
 Dwell ( equilibration) – 20 minutes to 8 or more
hours
 Drain - 15 to 30 minutes
Automated peritoneal dialysis (APD)
Continuous ambulatory peritoneal dialysis (CAPD)
 Continuous cycling peritoneal dialysis ( CCPD)
 Nocturnal intermittent peritoneal dialysis (NIPD)
 Intermittent peritoneal dialysis (IPD)
 Tidal peritoneal dialysis (TPD)
 Requires a peritoneal
cycling machine called
a cycler
 Can be done as
intermittent peritoneal
dialysis, continuous
cycling peritoneal
dialysis, or nightly
peritoneal dialysis
1. The dialysate is instilled into
the peritoneal cavity through an
implant catheter attached to a
transferline, which is attached to
a bag of dialysate.
2. Once the fluid has been
instilled completely into the
peritoneal cavity, the empty
bag and transferline are
folded up and worn in a cloth
pouch beneath the clothing.
Thus, the patient is free to
ambulate and resume his
normal daily activities.
3. When it is time to drain off the effluent, the bag is unfolded, placed on the floor
and drainage is achieved by gravity. A new bag of dialysate is then attached to the
transferline and the process is repeated. Usually the solution exchange procedure
takes about 15 minutes.
o FREEDOM FROM DIALYSIS MACHINE
o CONTROL OVER DAILY ACTIVITIES
o OPPURTUNITIES TO AVOID DIETARY
RESTRICTIONS
 History of multiple abdominal surgeries.
 Recurrent hernias
 Obesity
 Pre –existing vertebral disease
 Severe obstructive pulmonary disease
 Exit site infection
 Peritonitis
 Abdominal pain
 Outflow problems
 Hernias
 Lower back problems
 Bleeding
 Pulmonary complications
 Protein loss
 Carbohydrate and lipid abnormalities
 Encapsulating sclerosing peritonitis & loss of ultrfiltration
Venous access therapies [venovenous]
Arterial access therapies [arteriovenous]
 Venous access therapies
o Continuous venovenous ultrafiltration
(CVVU)
o Continuous venovenous hemofiltration
(CVVH)
o Continuous venevenous hemodialysis
(CVVHD)
ARTERIAL ACCESS THERAPIES
 SLOW CONTINUOUS ULTRFILTRATION
(SCUF)
 CONTINUOUS ARTERIOVENOUS
HEMOFILTRATION (CAVH)
 CONTINUOUS ARTERIOVENOUS
HEMODIALYSIS (CAVHD)
1) Fluid volume excess related to fluid accumulation/
inadequate dialysis
2) Risk for fluid volume deficit related to rapid removal
of fluid during treatment
3) Risk for altered tissue perfusion related to risk of
vascular access clotting/ disconnection
4) Risk for infection related to presence of access site
and invasive procedure
5) Body image disturbance related to presence of access
site.
 Pain/discomfort related to dialysis process.
 Altered thought process related to dialysis
diaequilibrium syndrome
 Ineffective individual/ family coping related to
diagnosis of chronic illness
 Noncompliance to prescribed treatment regimen
a)Imbalanced nutrition, less than body requirement
related to protein loss in the dialysate
b)Risk for infection realted to presence of peritoneal
dialysis catheter.
c) risk for imbalanced fluid volume related to
hypertonicity of the dialysate or inadequate exchange.
d) activity intolerance to related to fatigue
e) risk for complications related to the disease condition
and dialysis procedure
1) TUCKER MARTIN SUSAN, CANOBBIO. M. MARY, PAQUETTE VARGO ELEANOR
WELLS FYFE MARJORIE, PATIENT CARE STANDARDS, COLLOBORATIVE PRACTICE
PLANNING GUIDES, 6TH EDITION, 1996, MOSBY PUBLICATIONS, USA, PAGE NO:-
690-696.
2) THOMAS NICOLA, RENAL NURSING, THIRD EDITION (2008). BALLIERE TINDALL,
ELSEVIER PUBLICATIONS, CHINA, PAGE NO: 181-244.
3) KALLENBACH Z. JUDITH, GUTCH F.C, STONER H.MARTHA., COREA L. ANNA,
REVIEW OF HEMODIALYSIS FOR NURSES AND DIALYSIS PERSONNEL, SEVENTH
EDITION, 2005, ELSEVIER PUBLICATION ,MISSOURI, PAGE NO: 61- 136.
4) LEWIS. L SHARON,HEITKEMPER McLEAN, MARGARET, DIRKSEN RUFF SHANNON,
O’BRIEN GRABER PATRICIA, BUCHER LINDA, LEWIS MEDICAL AND SURGICAL
NURSING, ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEM, 7TH
EDITION, 2011, ELSEVIER PUBLICATIONS, India, PAGE NO: 1216-1223.
5) NISSENSON R. ALLEN, FINE N. RICHARD, HANDBOOK OF DIALYSIS THERAPY, 4TH
EDITION (2008), ELSEVIER PUBLICATIONS, PHILADELPHIA.
6) MASSRY G. SHAUL, GLASSOCK J. RICHARD, TEXTBOOK OF NEPHROLOGY, VOLUME
2 , 3RD EDITION, 1995, WILLIAM AND WILKINS PUBLICATIONS, USA, PAGE NO: 1510-
1600.

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Renal dialysis

  • 1.
  • 2. Remove waste products Fluid control BP control RBC production Keeping bones healthy
  • 3. We may feel sick, sleepy, confused or nauseous. (waste products) We will feel tired and pale. (RBC) We may have ankle swellings & start to feel breathless. (extra fluid) We may have bad breath & loss of appetite. (waste products)
  • 5. • First form of dialysis practised by Romans. • 1854- the term dialysis was used for the first time by Thomas Graham. • 1913- first article on hemodialysis- ‘Artificial kidney’ • 1920’s- first dialysis performed by George Hass • 1948- first successful dialysis in Mount Sinai hospital by Willem Kolff
  • 6.  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 into a dialysis solution (dialysate)
  • 7.
  • 12.
  • 13. 1. blood 6. dialysate 7. body 2. access 3. tx w/ heparin 4. dialyser 5. solute exchange 4-6 hours
  • 14. Cleanses the blood of accumulated waste products Removes the by-products of protein metabolism (urea, creatinine & uric acid) Removes excessive fluids Maintains or restores the buffer system of the body Maintains or restores electrolyte levels
  • 15.  Removal of solutes and water from the blood across a semipermeable membrane
  • 16. Selective filter for removing toxic or unwanted solutes from the blood
  • 17. Rectangular cross section, parallel plate dialyser.
  • 18. CIRCULAR CROSS SECTION; HOLLOW FIBER DIALYSER
  • 20. DIALYSATE  The fluid that is pumped through the dialyser on the opposite side of the semi permeable membrane to the patients blood.  Correct the chemical composition of uremic blood to normal physiological levels.
  • 21. SOLUTE CONCENTRATION SODIUM (mmol/L) 135- 143 POTASSIUM(mmol/L) 0-4 CHLORIDE 100- 111 CALCIUM 1.25 – 1.75 MAGNESIUM 0.75- 1.5 BICARBONATE 30- 35 GLUCOSE 0- 25 gm
  • 22. Sodium chloride ; Na+ 176 gm ; 82 mEq/L Potassium chloride ; K+ 5.50 gm ; 2.0 mEq/L Calcium chloride ; Ca + 8.00 gm ; 3.0 meq/L Magnesium chloride ; Mg ++, Cl - 2.75 gm ; 0.75 mEq/L, 88.0 mEq/L Acetic acid 9.0 gm ; 4.0 mEq/L Purified water 1 liter
  • 23. Sodium chloride 235 gms Sodium bicarbonte 600 gms Na + 55 mmoles HCO3- 35 mmoles Cl- 20 mmoles
  • 24.  Na + - 137 mEq/L  K + - 2 mEq/L  Ca ++ - 3.0 mEq/L  Mg ++ - 0.75 mEq/L  Cl ‾ - 108 mEq/L  HCo3‾ 35 mEq/L  CH3COO‾ 4 mEq/L
  • 25.  Filtration  Activated carbon filters (adsorption)  Water softners  Reverse osmosis (RO)  De ionization  Ultraviolet light exposure
  • 26.  The removal of air  The removal of any chemicals
  • 27.  PERMANENT VASCULAR ACCESS Arterio venous fistula’s (AVF’s) Arterio venous grafts (AVG’s) Shunts
  • 28.
  • 29. Advantages Disadvantages  less danger of clotting and bleeding  can be used indefinitely  decreased incidence of infection  no external dressing required  freedom of movement  cannot be used immediately after insertion  venipuncture is required for dialysis  infiltration of needles → hematoma  aneurysm in the fistula  Arterial steal syndrome  Congestive heart failure
  • 30.
  • 31. Advantages Disadvantages  less danger of clotting and bleeding  can be used indefinitely  decreased incidence of infection  no external dressing required  freedom of movement  cannot be used immediately after insertion  venipuncture is required for dialysis  infiltration of needles → hematoma  aneurysm in the fistula  Arterial steal syndrome  Congestive heart failure
  • 32. Access is formed by the surgical insertion of 2 silastic cannulas into an artery or vein in the forearm or leg to form an external blood path.
  • 33. Advantages Disadvantages  can be used immediately after insertion  no venipuncture necessary for dialysis  external danger of disconnecting or dislodging the shunt  risk of hemorrhage, infection or clotting  skin erosion around the catheter site
  • 34.  Rope ladder puncture  Area puncture  Button hole puncture
  • 36.  Subclavian vein  Internal jugular vein  Femoral vein
  • 37.  for acute dialysis  In the patient who is imminently awaiting a kidney transplant  for maturation of AV access  Limited availability of vessels  Patients undergoing plasmapheresis  For continuos renal replacement therapies  Patients on peritoneal dialysis requiring temporary hemodialysis because of peritonitis.
  • 38.  may be inserted for short term or temporary use in acute renal failure  usually filled w/ heparin & capped to maintain patency between dialysis treatments  may be left in place for up to 6 wks if complications do not occur
  • 39.  may be inserted for short term or temporary use in acute renal failure  client should not sit up more than 45 or lean forward, or the catheter may kink & occlude.  an IV infusion pump w/ microdrip tubing should be used if a heparin infusion through the catheter is prescribed
  • 40.
  • 41.  Weight  Blood volume monitoring  Blood pressure  Temperature and pulse  Serum biochemistry and hematology
  • 42.  Kt / V – 1.2  URR – 65%  Albumin - >35 g/L  Potassium – 3.5 – 6.5 mmol/L  Phosphate - < 1.8 mmol/L  Calcium – b/w 2.2 and 2.6 mmol/L  Hb - > 10 g/L
  • 43.  URR( urea reduction ratio) = 100 (1- Ct/Co) Ct= post dialysis urea Co= pre dialysis urea
  • 44.
  • 45.  ETO  Gamma irradiation  Steam sterilization  Electron or e-beam sterilization
  • 46.  Hypotension Muscle cramps  Loss of blood  Hepatitis  Sepsis  Disequilibrium syndrome  Vascular steal  Dialyser Reaction  Hemolysis Air embolism
  • 47.
  • 48.
  • 49.
  • 50. PERITONEAL DIALYSIS Adequate Patient Care in the Most Biocompatible Way
  • 51.
  • 52.
  • 53. • Sodium 132- 142 Potassium 0- 4 Calcium 2.5- 3.5 Magnesium 0.5- 1.5 Lactate 35- 40 Chloride 101- 107 pH 5.0- 5.8 Dextrose 1.5- 4.25 gm/dL
  • 54.  Inflow (fill) – 10 minutes  Dwell ( equilibration) – 20 minutes to 8 or more hours  Drain - 15 to 30 minutes
  • 55. Automated peritoneal dialysis (APD) Continuous ambulatory peritoneal dialysis (CAPD)
  • 56.  Continuous cycling peritoneal dialysis ( CCPD)  Nocturnal intermittent peritoneal dialysis (NIPD)  Intermittent peritoneal dialysis (IPD)  Tidal peritoneal dialysis (TPD)
  • 57.  Requires a peritoneal cycling machine called a cycler  Can be done as intermittent peritoneal dialysis, continuous cycling peritoneal dialysis, or nightly peritoneal dialysis
  • 58.
  • 59. 1. The dialysate is instilled into the peritoneal cavity through an implant catheter attached to a transferline, which is attached to a bag of dialysate. 2. Once the fluid has been instilled completely into the peritoneal cavity, the empty bag and transferline are folded up and worn in a cloth pouch beneath the clothing. Thus, the patient is free to ambulate and resume his normal daily activities.
  • 60. 3. When it is time to drain off the effluent, the bag is unfolded, placed on the floor and drainage is achieved by gravity. A new bag of dialysate is then attached to the transferline and the process is repeated. Usually the solution exchange procedure takes about 15 minutes.
  • 61. o FREEDOM FROM DIALYSIS MACHINE o CONTROL OVER DAILY ACTIVITIES o OPPURTUNITIES TO AVOID DIETARY RESTRICTIONS
  • 62.  History of multiple abdominal surgeries.  Recurrent hernias  Obesity  Pre –existing vertebral disease  Severe obstructive pulmonary disease
  • 63.  Exit site infection  Peritonitis  Abdominal pain  Outflow problems  Hernias  Lower back problems  Bleeding  Pulmonary complications  Protein loss  Carbohydrate and lipid abnormalities  Encapsulating sclerosing peritonitis & loss of ultrfiltration
  • 64. Venous access therapies [venovenous] Arterial access therapies [arteriovenous]
  • 65.  Venous access therapies o Continuous venovenous ultrafiltration (CVVU) o Continuous venovenous hemofiltration (CVVH) o Continuous venevenous hemodialysis (CVVHD)
  • 66. ARTERIAL ACCESS THERAPIES  SLOW CONTINUOUS ULTRFILTRATION (SCUF)  CONTINUOUS ARTERIOVENOUS HEMOFILTRATION (CAVH)  CONTINUOUS ARTERIOVENOUS HEMODIALYSIS (CAVHD)
  • 67. 1) Fluid volume excess related to fluid accumulation/ inadequate dialysis 2) Risk for fluid volume deficit related to rapid removal of fluid during treatment 3) Risk for altered tissue perfusion related to risk of vascular access clotting/ disconnection 4) Risk for infection related to presence of access site and invasive procedure 5) Body image disturbance related to presence of access site.
  • 68.  Pain/discomfort related to dialysis process.  Altered thought process related to dialysis diaequilibrium syndrome  Ineffective individual/ family coping related to diagnosis of chronic illness  Noncompliance to prescribed treatment regimen
  • 69. a)Imbalanced nutrition, less than body requirement related to protein loss in the dialysate b)Risk for infection realted to presence of peritoneal dialysis catheter. c) risk for imbalanced fluid volume related to hypertonicity of the dialysate or inadequate exchange. d) activity intolerance to related to fatigue e) risk for complications related to the disease condition and dialysis procedure
  • 70. 1) TUCKER MARTIN SUSAN, CANOBBIO. M. MARY, PAQUETTE VARGO ELEANOR WELLS FYFE MARJORIE, PATIENT CARE STANDARDS, COLLOBORATIVE PRACTICE PLANNING GUIDES, 6TH EDITION, 1996, MOSBY PUBLICATIONS, USA, PAGE NO:- 690-696. 2) THOMAS NICOLA, RENAL NURSING, THIRD EDITION (2008). BALLIERE TINDALL, ELSEVIER PUBLICATIONS, CHINA, PAGE NO: 181-244. 3) KALLENBACH Z. JUDITH, GUTCH F.C, STONER H.MARTHA., COREA L. ANNA, REVIEW OF HEMODIALYSIS FOR NURSES AND DIALYSIS PERSONNEL, SEVENTH EDITION, 2005, ELSEVIER PUBLICATION ,MISSOURI, PAGE NO: 61- 136. 4) LEWIS. L SHARON,HEITKEMPER McLEAN, MARGARET, DIRKSEN RUFF SHANNON, O’BRIEN GRABER PATRICIA, BUCHER LINDA, LEWIS MEDICAL AND SURGICAL NURSING, ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEM, 7TH EDITION, 2011, ELSEVIER PUBLICATIONS, India, PAGE NO: 1216-1223. 5) NISSENSON R. ALLEN, FINE N. RICHARD, HANDBOOK OF DIALYSIS THERAPY, 4TH EDITION (2008), ELSEVIER PUBLICATIONS, PHILADELPHIA. 6) MASSRY G. SHAUL, GLASSOCK J. RICHARD, TEXTBOOK OF NEPHROLOGY, VOLUME 2 , 3RD EDITION, 1995, WILLIAM AND WILKINS PUBLICATIONS, USA, PAGE NO: 1510- 1600.