DIALYSIS

• Dialysis is used to remove fluid and uremic waste products from

the body when the kidneys cannot do so.
• It may also be used to treat patients with edema that does not
respond to treatment, hepatic coma, hyperkalemia,
hypercalcemia, hypertension, and uremia.
• The need for dialysis may be acute or chronic
TYPES

• hemodialysis,
• continuous renal replacement therapy (CRRT),
• peritoneal dialysis.
• Acute dialysis is indicated when there is a high and rising level
of serum potassium, fluid overload, or impending pulmonary
edema, increasing acidosis, pericarditis, and severe confusion. It
may also be used to remove certain medications or other toxins
(poisoning or medication overdose) from the blood.
• Chronic or maintenance dialysis is indicated in chronic renal failure, known as end-stage
renal disease (ESRD)
• It is indicated in presence of uremic signs and symptoms affecting all body systems
(nausea and vomiting, severe anorexia, increasing lethargy, mental confusion),
hyperkalemia, fluid overload not responsive to diuretics and fluid restriction, and a
general lack of well-being.
HEMODIALYSIS

• It is used for patients who are acutely ill and require short-term
dialysis (days to weeks) and for patients with ESRD who
require long-term or permanent therapy.
• A dialyzer (once referred to as an artificial kidney) serves as a
synthetic semipermeable membrane, replacing the renal
glomeruli and tubules as the filter for the impaired kidneys.
• For patients with chronic renal failure, hemodialysis prevents death,
although it does not cure renal disease and does not compensate for the
loss of endocrine or metabolic activities of the kidneys.
• Patients receiving hemodialysis must undergo treatment for the rest of
their lives or until they undergo a successful kidney transplant.
• Treatments usually occur three times a week for at least 3 to 4 hours per
treatment
PRINCIPLES OF HEMODIALYSIS

• The objectives of hemodialysis are to extract toxic nitrogenous

substances from the blood and to remove excess water.
• In hemodialysis, the blood, laden with toxins and nitrogenous
wastes, is diverted from the patient to a machine, a dialyzer, in
which the blood is cleansed and then returned to the patient.
• The principles include:
i. Diffusion: The toxins and wastes in the blood are removed by
diffusion—that is, they move from an area of higher
concentration in the blood to an area of lower concentration in
the dialysate
• The dialysate is a solution made up of all the important
electrolytes in their ideal extracellular concentrations.
•
ii. Osmosis: Excess water is removed from the blood by osmosis, in which
water moves from an area of higher solute concentration (the blood) to an
area of lower solute concentration (the dialysate bath)
• iii. Ultrafiltration: defined as water moving under high pressure to an
area of lower pressure. This process is much more efficient at water
removal than osmosis.
• Ultrafiltration is accomplished by applying negative pressure or a
suctioning force to the dialysis membrane. It helps achieve fluid balance.
• The body’s buffer system is maintained using a dialysate bath made up of
bicarbonate (most common) or acetate, which is metabolized to form
bicarbonate.
• The anticoagulant heparin is administered to keep blood from clotting in
the dialysis circuit.
• By the end of the dialysis treatment, many waste products have been
removed, the electrolyte balance has been restored to normal, and the
buffer system has been replenished.
EQUIPMENT

• Dialyzer
• dialysate
VASCULAR ACCESS

• Access to the patient’s vascular system must be established to allow blood to be removed, cleansed,
and returned to the patient’s vascular system at rates between 200 and 800 mL/minute.
• They include: SUBCLAVIAN, INTERNAL, JUGULAR, AND FEMORAL access.
• Double lumen catheters are used to allow effective in and ouflow of blood.
• Complications include: hematoma, pneumothorax, infection, thrombosis of the subclavian vein,
and inadequate flow
OTHER ACCESS

• FISTULA A more permanent access, is created surgically

(usually in the forearm) by joining (anastomosing) an artery to a
vein, either side to side or end to side.
• The arterial segment of the fistula is used for arterial flow and
the venous segment for reinfusion of the dialyzed blood.
• The fistula takes 4 to 6 weeks to mature before it is ready for
use.
• GRAFT: An arteriovenous graft can be created by
subcutaneously interposing a biologic, semibiologic, or
synthetic graft material between an artery and vein
COMPLICATIONS

• Hypotension may occur during the treatment as fluid is removed. Nausea and vomiting,
diaphoresis, tachycardia, and dizziness are common signs of hypotension.
• Painful muscle cramping may occur, usually late in dialysis as fluid and electrolytes
rapidly leave the extracellular space.
• Exsanguination may occur if blood lines separate or dialysis needles accidentally become
dislodged.
• Dysrhythmias may result from electrolyte and pH changes or from removal of
antiarrhythmic medications during dialysis.
• Air embolism is rare but can occur if air enters the vascular system.
• Chest pain may occur in patients with anemia or arteriosclerotic heart disease.
• Dialysis disequilibrium results from cerebral fluid shifts. Signs and symptoms include
headache, nausea and vomiting, restlessness, decreased level of consciousness, and
seizures. It is more likely to occur in acute renal failure or when blood urea nitrogen levels
are very high (exceeding 150 mg/dL).
• Early-morning or late-afternoon dialysis may be a risk factor for
developing sleep abnormalities.
• atherosclerotic cardiovascular disease.
• Disturbances of lipid metabolism (hypertriglyceridemia) appear
to be accentuated by hemodialysis.
• Heart failure, coronary heart disease and anginal pain, stroke,
and peripheral vascular insufficiency
• Gastric ulcers and other gastrointestinal problems occur from
the physiologic stress of chronic illness, medication, and related
problems.
• Disturbed calcium metabolism leads to renal osteodystrophy
that produces bone pain and fractures
• fluid overload associated with heart failure, malnutrition,
infection, neuropathy, and pruritus.