Hemodialysis Lecture Part 1

HEMODIALYSIS
LECTURE
PART 1
Mrs Edz Sandoval RN, MAN

UB-CNM, Clinical Instructor
LETS WATCH FIRST…
Anatomy of the
Principles Virtual Tour
Kidneys
Causes of ARF Management

History
and CRF for CRF
Access Equipment
• Temporary Advantages and • Hemodialysis
• Permanent Disadvantages Machine
• Water System
Dialyzer
DIALYSIS DEPT. JON
VIRTUAL TOUR
VIRTUAL TOUR
VIRTUAL TOUR
VIRTUAL TOUR
VIRTUAL TOUR
VIRTUAL TOUR
VIRTUAL TOUR
A DAY IN THE DIALYSIS CENTER
Kidney is pear bean
shape.
Approximately the size
of the fist.
Weighs is about six
ounces.
Kidneys
FUNCTION OF THE KIDNEYS
 Washes away the toxins from the body
 Maintenance of fluids and electrolytes

balance
 Endocrine and metabolic function
 Production of Erythropoietin, which control

red cell production in the bone marrow
FUNCTION OF THE KIDNEYS
 A – controlling ACID-base balance
 W – controlling WATER balance
 E – maintaining ELECTROLYTE balance
 T – removing TOXINS and wastes products
 B – controlling BLOOD PRESSURE
 E – producing the hormone ERYTHROPOIETIN
 D – activating vitamin D
 NOTE:
Healthy Adult 1200 ml of excreted per day.

Urine output will fall if the kidneys are
grossly damaged.
LETS UNDERSTAND DIALYSIS
FIRST.
CAUSES OF ACUTE RENAL
FAILURE
1. Pre Renal
Most occurring inside the kidney, Severe
synthetic hypertension, Sudden
Cardiovascular collapse( hemorrhage,
anaphylaxis, acute MI)
2. Renal Causes
Due to drug poisoning, and drug induced (pain
killer, antibiotic)
3. Post renal causes
Due to stone obstructing the urethra or both
catheters.
CAUSES OF CHRONIC RENAL
FAILURE
Diabetic Nephropathy
GLOMERONEPHRITIS
PYELONEPHRITIS
POLYCYSTIC KIDNEYS
MANAGEMENT FOR CRF
 Renal Transplantation
 Dialysis:
Hemodialysis
Peritoneal Dialysis
A. Continuous Ambulatory Peritoneal
Dialysis (COPD)
B. Continuous Intermittent Peritoneal
Dialysis (CIPD)
C. Continuous Cyclic Peritoneal Dialysis
(CCPD)
HEMODIALYSIS
Is a method for removing waste products such as

creatinine and urea, as well as free water from the
blood when the kidneys are in renal failure
 The principle of hemodialysis involves
diffusion of solutes across a semipermeable
membrane.
 Hemodialysis utilizes counter current flow,

where the dialysate is flowing in the opposite
direction to blood flow in the extracorporeal
circuit.
PRINCIPLES OF HEMODIALYSIS:
 Diffusion is the movement of particles
from an area of greater concentration to
one of lesser concentration
 Osmosis is the movement of fluids across
a semipermeable membrane from an area
of lesser concentration of particles to an
area of greater concentration of particles
 Ultrafiltration is the movement of fluid
across a semipermeable membrane as a
result of an artificially created pressure
gradient
 Fluid removal (ultrafiltration) is achieved by
altering the hydrostatic pressure of the
dialysate compartment, causing free water
and some dissolved solutes to move across
the membrane along a created pressure
gradient.
 The dialysis solution that is used is a
sterilized solution of mineral ions. Urea and
other waste products, potassium, and
phosphate diffuse into the dialysis solution.
However, concentrations of sodium and
chloride are similar to those of normal
plasma to prevent loss. Sodium bicarbonate
is added in a higher concentration than
plasma to correct blood acidity. A small
amount of glucose is also commonly used.
HISTORY
DR. WILLEM KOLFF
Dr. Kolff was the first to construct a working dialyzer in
1943. The first successfully treated patient was a 67-year-old
woman in uremic coma who regained consciousness after 11
hours of hemodialysis with Kolff’s dialyzer in 1945
Dr. Nils Alwall Alwall dialyzer
DR. NILS ALWALL
Encased a modified version of this
kidney inside a stainless steel canister,
to which a negative pressure could be
applied, in this way effecting the first
truly practical application of
hemodialysis
DR. BELDING H. SCRIBNER
In 1962, when
Scribner started
the world’s first
outpatient dialysis
facility, the
Seattle Artificial
Kidney Center,
later renamed the
Northwest Kidney
Centers.
SEATTLE ARTIFICIAL KIDNEY
CENTER
ACCESS
In hemodialysis, three primary methods are
used to gain access to the blood: an
intravenous catheter, an arteriovenous
(AV) fistula and a synthetic graft. The type
of access is influenced by factors such as
the expected time course of a patient's
renal failure and the condition of his or her
vasculature. Patients may have multiple
accesses, usually because an AV fistula or
graft is maturing and a catheter is still
being used. The creation of All these three
major types of vascular accesses requires
surgery.
TEMPORARY ACCESS
AV SHUNTS
A short piece of
silicone elastomer
tubing. This
formed the basis
of the so-called
Scribner shunt.
INTRA JUGULAR
SUBCLAVIAN CATHETER
FEMORAL CATHETER
PERMANENT ACCESS
 AV (arteriovenous) fistulas are
recognized as the preferred
access method. To create a
fistula, a vascular surgeon joins
an artery and a vein together
through anastomosis. Since this
bypasses the capillaries, blood
flows rapidly through the fistula.
One can feel this by placing one's
finger over a mature fistula. This
is called feeling for "thrill" and
produces a distinct 'buzzing'
feeling over the fistula. One can
also listen through a stethoscope
for the sound of the blood
"whooshing" through the fistula,
a sound called bruit.
AV FISTULA (OUTSIDE VIEW)
AV FISTULAS HAVE A MUCH
BETTER ACCESS PATENCY AND
SURVIVAL THAN DO VENOUS
CATHETERS OR GRAFTS. THEY
ALSO PRODUCE BETTER PATIENT
SURVIVAL AND HAVE FAR FEWER
COMPLICATIONS COMPARED TO
GRAFTS OR VENOUS CATHETERS
GRAFTS
AV (arteriovenous) grafts
are much like fistulas in
most respects, except
that an artificial vessel is
used to join the artery
and vein. The graft usually
is made of a synthetic
material
ADVANTAGES OF
HEMODIALYSIS
 Low mortality rate
 Better control of blood pressure and
abdominal cramps
 Less diet restriction
 Better solute clearance effect for the daily
hemodialysis: better tolerance and fewer
complications with more frequent dialysis
Click icon to add picture
DISADVANTAGES
OF HEMODIALYSIS
 Restricts independence, as people
undergoing this procedure cannot travel
around because of supplies’ availability
 Requires reliable technology such as high
water quality and electricity
 Requires more supplies like dialysis machines
 The procedure is complicated and requires
that care givers have more knowledge
 Requires time to set up and clean dialysis
machines, and expense with machines and
associated staff
EQUIPMENT
HEMO DIALYSIS MACHINES
HEMO DIALYSIS MACHINES
FUNCTION OF HEMODIALYSIS
MACHINES
Hemodialysis machine mixed

electrolytes balance bath called dialysate
bath
The machine pump blood from the

patient to the dialyzer and back to the
patient body at a prescribed rate.
 Perform ultra filtration rate
Monitor and guard important parameters

to assure patients safety
WATER SYSTEM
 An extensive
water purification system
is absolutely critical for
hemodialysis. Since
dialysis patients are
exposed to vast quantities
of water, which is mixed
with dialysate concentrate
to form the dialysate,
even trace mineral
contaminants or bacterial
endotoxins can filter into
the patient's blood
Any procedure or method used to alter the
chemical composition of a water supply
Water purity used in hemodialysis should

satisfy specific needs and standards to
prevent toxicity either in the acute or
chronic complication
No WATER No dialysis can be perform
SOURCES OF WATER
Ground water Surface water
It is the rain water It is rain the
that percolates water that goes
down through the down to the
porous upper crust ocean, lakes,
of the earth. river, and man
made reservoirs.
And contain less
mineral
contamination.
WATER TREATMENT
ANY PROCEDURE OR METHOD USED TO
ALTER THE CHEMICAL COMPOSITION OF A
SAFET Y SUPPLY
WATER PURIT Y USED IN HEMODIALYIS

SHOULD SATISFY SPECIFIC NEEDS AND
STANDARD TO PREVENT TOXICIT Y EITHER
IN THE ACUTE OR CHRONIC CONDITIONS
DIALYZER
The dialyzer is the piece of

equipment that actually
filters the blood. Almost all
dialyzers in use today are
of the hollow-fiber variety
DIALYSATE BATH
 An electrolytes balance solution that

“bathes” around the dialyzer fibers
 Carries away the toxin and fluid removed

from the blood
 Prevent the removal of essential electrolytes

TYPES OF DIALYZATE BATH
Acetate Bicarbonate
Is a buffer used for acid
base correction in dialysis
patients
Rarely used anymore

Two separate concentrates are used
“A” Acidified contains most of Na,

CA, MG, K,& CL
“B” It contain sodium and
bicarbonate
ADVANTAGE OF BICARBONATE
 Doctors choice of treatment
 Less patient complication

DISADVANTAGE
 Susceptible to bacteria infection.
 Liquid bicarb is not stable after 24 hrs.

END OF PART 1

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HEMODIALYSIS

Mrs Edz Sandoval RN, MAN

Causes of ARF Management

 Maintenance of fluids and electrolytes

 Endocrine and metabolic function

 Production of Erythropoietin, which control

Healthy Adult 1200 ml of excreted per day.

Is a method for removing waste products such as

 Hemodialysis utilizes counter current flow,

Hemodialysis machine mixed

The machine pump blood from the

 Perform ultra filtration rate

Monitor and guard important parameters

Water purity used in hemodialysis should

WATER PURIT Y USED IN HEMODIALYIS

The dialyzer is the piece of

 An electrolytes balance solution that

 Carries away the toxin and fluid removed

 Prevent the removal of essential electrolytes

Rarely used anymore

“A” Acidified contains most of Na,

 Doctors choice of treatment

 Less patient complication

 Susceptible to bacteria infection.

 Liquid bicarb is not stable after 24 hrs.

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