Sunteți pe pagina 1din 57

c  




 
  
 
c   
c  
 g    
  
     

  
 

 
     
      


 
      
  

 


      
    
 
   !"   


 
  

      

 # 
   
  
The main functions of dialysis are to:
6 u$ $   $ $ $%&'$& $($
)* $
 
 $)* $
$ $$
$$
 $ 
 

6 +  $ $$ $ $ $$  $$


  

6, - $$ $ $ 


 $.,'$/$


6 0$ $
$$ $$ $  $ $ $
 $* 1 $ $ $  2$$$


 c  
½ Hemodialysis
ƥ Most common and efficient method of
dialysis

ƥ Used for acute ill patient


& require short term dialysis and for
patients with ESRD who require long
term, permanent therapy or until
kidney transplant is done
ƥ The blood travels from the body to the
machine through tubes inserted into a
vein in your arm, leg, or neck through
the artificial kidney called Ơdialyzerơ to
excrete waste products and regulate
electrolytes

ƥ Treatments are usually 3x a week for


at least 3-4 hours per permanent
treatment
ërinciples of Hemodialysis

(   * /


    
 
      
    
    

 
% 3    )*   
      
       

  1
2  
    1
 
 2
 &
 
   
    
      
+     
  
 
 
 

÷  

   
-    
 
Hemodialysis machine is required
to pump the blood at requisite flow
The machine also monitors the
flow parameters and the pressures in
the circuit
The amount of ultrafiltration (
removal of excess fluid from the
body) can be programmed into the
machine and current day machines
will precisely remove the fluid to the
last milliliter
D c       
which acts as the semipermiable
membrane
lood is pulled from the patient and
carried into the filter
nce inside, the blood travels
through many tiny tubules called hollow
fibers
ater and solutes can pass across
the semi-permeable membrane between
the blood and the fluid that surrounds
the hollow fibers ½ny fluid or solutes
that enters the filter canister will be
drained out as waste
[ ¦     

 

  

 
      
 
       

 
       
 

  
    
 
  
 


 

 
   
    
    

 

 
         
  
      
      
   


        
 
          
      

  
 

x  x 

       



 
    
ƥ ½lthough they have similarities
between nephron and dialyzer, they
also have difference like the some
electrolytes and water are not
reabsorbed
ƥ ½ny filtrate that enter the dialyzer will
be removed via drainage tubule
ƥ This would only be controlled by
adjusting the dialysis solution and
ultrafiltration rates
   
 
¦ 
   
6    
6÷   © 
 6
6u      6
6u   
   

6  ©  6


6u   6

6u  u

 

6Ô  

 *   
 
6Ô  ë 

ë ë    *
6½ u  
 
ë 
Ñ c     is a
solution that is composed
of electrolytes, buffer
such as lactate and
acetate, and the most
common is bicarbonate
 lood Tubing Sets and
Needle
   which allow
blood to be removed,
cleansed, and returned to the
patientƞs vascular system at
rates between 200-800ml/min
Types of vascular ½ccess:

( 4 
  0 
5 

g
   
    

 
   
   0 

    (6 g 

       
            
% (  g 
      
  

      


    g 
  
 7
 8   

 
     

$(6$   
    $

$ 
  $ $ 
¦   

gor Hemodialysis
efore Hemodialysis:

~+       %&'     


      


 

   '  1&4+ .(6)
 * 2

~9  
    1'3+     (6
g 
# 2          9 

    
~9      
    
 
 1
   
 
2

~+
   
  
   
During Hemodialysis
ƥ Monitor VS especially closely monitor
ë every 30 mins
ƥ ½dministration of Heparin to prevent
blood clot Contact of patient's blood with the
dialysis membrane and the tubing leads to activation
of the coagulation cascade
ƥ T may be done as ordered
ƥ atch for major complications such as:
 ½therosclerotic CVD
 Heart gailure : Coronary Heart
Disease, ½nginal pain, Stroke
 ½nemia and gatigue
efore Hemodialysis:

~+       %&'        


   


 
   
'  1&4+ .(6)
 * 2

~9 
   1'3+     (6
g 
# 2      9 
   

~9      
  
 

~+
   
  
   
ther complications
[ .       
  
'   6      +   
::      
[ , 
 
    
 

* 
[ )*    
  
  

[    
 
 /   
[ ( 
 
[ 
   ; 
   
    


       
 

'   6    <3
½ssessment
ƥ ½ssess venous site for swelling or
redness

ƥ Check for audible bruit sign and


palpable thrill in the ½V fistula and
graft

ƥ ½ssess client knowledge regarding


hemodialysis
ërotect the Vascular acess
ƥ ërotect from damage
ƥ ½ssess for patency
ƥ Do not use extremity for ë
taking or venopuncture
ƥ Instruct to avoid tight dressing,
restraints or jewelry over vascular
access
ƥ Clean with soap and water
(<)u+= g 
       
     
 
         
   + 
           
½fter Hemodialysis

ƥ Monitor VS especially ë

ƥ eight patient

ƥ Must obtain Lab Examination


and serum electrolytes
Diet
•
  
     
         

  
  

ƥ Low soduim, ërotein, K,


phosporus
ƥ High in calcuim
ëharmacologic Treatment
[ ,  $4
  $ $ 
[ )#$4$  
[ %
$  $ 
[ 
 $ 
 $ $
 
[ ,  $ >$
 $  $

$$$


[   >$ $* $

[ 4
$  $ $
*  >$ $ $  $
  $$ $$ $$  $
$
 
[ 0 $ 
 >$  $ $ $$ $
  $ $  $$ $
$


 ëeritoneal Dialysis
ƥ a sterile solution containing glucose
is run through a tube into the
peritoneal cavity, the abdominal
body cavity around the intestine,
where the peritoneal membrane acts
as a semipermiable membrane
ƥ ë     is primarily
performed at home by patients and
their family members
ƥ Used if unable or unwilling to
receive hemodialysis
ƥ Has slower rate of fluid electrolyte
and metabolic changes
Types of ëD
[   (
  1(,2    
    

   (    
  
           0  
   8?      +  


     
 +    
 
 
 
  '    
[   
 1,2      0 
   


[ ' 
0  1'0,2     
  , + ;       

    
   0   

  ,
Type Length of grequency of
procedure procedure
C½ëD 3-6 hours, 4 times/day
plus
30 minutes
to drain
CCëD 9-12 Every night
hours
NIëD 12 + 36-42
hours hours/week
ërinciples

ƥ Diffusion
ƥ smosis
½s waste product moves from higher
concentration(peritoneal blood) to
lower concentration (peritoneal
cavity) across a semipermiable
membrane(peritoneal membrane)
ëeritoneal Catheter
[ %           

 

    1  * 
 7@

2  
  8 

 
 
[ +           
[ +   

      
 (
            
      
ërepare the client
ƥ ½ssess patientƞs anxiety and
provide support and instruction
ƥ btain VS, weight, serum
electrolytes are recorded
ƥ EMëTY bladder and bowel to
reduce risk of puncturing internal
organs
ƥ It is important to keep this access
clean and dry to prevent infection
ëreparing Equipment
[ 9 $ $$
   $
 1 $ $   $ $
 2  $ $
[ .   $
$ 
[ ,  $
 $ $
$   $$
 $
 $
[ (  $$ $$  $ 
[ 0
$ $
$$ $ $ $

 $ $ 
$ $ $A" $$
0
$ $$
 $ 
ëerforming the Exchange
´ ½n Exchange is defined as the
infusion, dwell and drainage of the
dialysate
´ The dialysate is infused by gravity ½
period of about 5-10 mins is usually
required to infuse 2L of fluid
´ The prescribed dwell or equilibrium,
time allows diffusion osmosis to
occur
´ Diffusion of small molecules such
as urea and creatinine, peaks in
1st  - mins of the dwell time
´ ½t the end of the dwell time,
     of the
exchange begins
´ The tube is unclamped and the
solution drains from the peritoneal
cavity by gravity through a closed
system
´ Drainage is usually completed in -
 Ñ  
´ Drainage fluid is normally   
     and should NT
be cloudy
´ loody drainage may be seen in the
   after the new
insertion of catheter but should 
occur ½gTER that time
´ Entire Exchange (infusion, dwell
time, drainage) takes -    
depending on the prescribed dwell
time
´ The removal of   
during ëD is achieved by using a
      with a high
dextrose concentration that creates
an   
   
ƥ ëeritonitis
ƥ Leakage
ƥ leeding
ƥ Long term complications:
ùHypertriglyceridemia,
ù½bdominal hernia due to
intra abdominal pressure
ùLow back pain and anorexia
from fluid in the abdomen
 
 
ë        !
6       
M  
6      "   
  
6    
6    
      
 
 
6      
  
6       # 
   

c 

       


       c
   


   c   
  c


  
    
 
    
½     
  
c   
½ 

  
        
 
 
 !"# 

 
 

  


$ 
 
    
 
        c
  
  
   
      
 
      


      
À   



 
 

    
  
  

 
  
À    
  
    


    c    

  
À 
    



  


 !
     


 
 !   
 

   

 
 !   
  
 




 
 
   
 

 ! 
  % & 


 
  c