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RENAL NURSING

WITH EMPHASIS ON
HEMODIAYSIS

MODULE I
HISTORY OF
HEMODIALYSIS
By:
CAMILLE M. ESPINOSA, RN, CNN

Today

HEMODIALYSIS
Aprocedureforremovingmetabolicwasteproductsor
toxic
substancesfromthebloodstream.
Thepatient'sbloodisshuntedfromthebodythrougha
machinefor
DIFFUSIONandULTRAFILTRATIONand
thenreturnedtothe patient'scirculation.
Requires
accesstothepatient'sbloodstream,amechanismfor
thetransportofthebloodtoandfrom
thedialyzer,andadialyzer.

DEFINITION OF TERMS
SEMI PERMEABLE MEMBRANE
A type of membrane which allows certain particles to pass through
while others cannot.
DIALYSATE
The material that passes through a membrane during dialysis
DELIVERY SYSTEM
The dialysis machine has two systems
the e x t r a c o r p o re a l (outside the body) circuit T h e
extracorporeal circuit is the tubing, blood pump, h e p a r i n (blood
thinner) pump, k i d n e y, and monitors for blood flow, blood
pressure, and air bubbles.
The dialysate delivery system of the machine mixes the bath with
purified water and checks to be sure it is safe

highlights

1961: THOMAS
GRAHAM
Professor of Chemistry at Andersons

University in Glasgow, Scotland.


He formulated the law of diffusion of
Gases known as GRAHAMS LAW
He described the idea of SELECTIVE

DIFFUSION(separation of substances
across a semipermeable membrane)
Which gave rise to the term DIALYSIS
(this term was first used by Graham on
1854)
DIALYSIS comes from the greek word

mean loosening from someone else

The First Hemodialysis


1913: JOHN ABEL, LEONARD ROWNTREE and BERNARD TURNER

Experiment
VIVIDIFUSSION APARRATUS
made up
Out of collodian tubes
housed in a glass cylinder
In which dialysate is
circulated.
The removal of diffusible
substances from circulating
blood of living animals by
Dialysis

HIRUDIN

1913:The First Hemodialysis Experiment


(VIVIDDIFFUSION APPARATUS)

The removal of diffusible

substances from
circulating blood of living
animals by Dialysis

1926:The First Human


Experiment
Dr. GEORGE HAAS who

first attempt to dialyze a


human with uremic
GOAL: to remove toxic
nitrogenous susbstances
from the blood
Collodion membranes

were constructed similar


to that of Abel and et al.

He

used a VENOVENOUS
approach whereby blood was
removed from the body and
passed through the collodian
membrane, exposed to a
dialyzing solution and then
reinfused into the bloodstream

HIRUDIN
Allergic reactions to impurities in

HIRUDIN led him to abandon his


experiments.

1928: Discovery of
HEPARIN
By Dr.

WILLIAM
HENRY
HOWELL
Anticoagulan
t
Warfarin,

1943:Dr. WILLEM JOHAN


KOLFF

-Dutch doctor
-father of dialysis
- (1943) invented
the suitable dialyzer
called the
Rotating
Drum Device

1943: DRUM KIDNEY MACHINE


From JUNKYARD SCRAPS to the FIRST ARTIFICIAL KIDNEY

disadvantages
Need more
blood
transfusion
s
Minor operations
has to be
performed
Treatment offered only for
acute renal failure which
required treatment time of
approximately 6 hours

1948: KOLF-BRIGHAM ARTIFICIAL


KIDNEY
Kolf redesigned his device together

with DR. CARL WALTERS and DR.


JOHN MERRILL at the PETER BRENT
BRIGHAM hospital in Boston.
The Kolf-Brigham artificial kidney

was constructed of stainless steel


and had a Plexiglas hood.
The volume of dialyzer clearance

could be modified by adjusting the


number of wraps of cellulose
tubing.
Treatment time lasted to 8-10

hours.

1950 to 53: KOREAN WAR


These dialyzers

would be used to
treat acute renal
failure in injured
soldiers during the
war.
Kolf would later

develop a disposable
coil dialyzer known
as TWIN COIL
DIALYZER

1954: DR. JOSEPH MURRAY- first


organ transplant doctor
Noble prize in

Physiology or
Medicine in 1990
Transplant were

possible in unrelated
donors if drugs were
taken to supress the
bodys immune
reaction.

CADAVERIC TRANSPLANT
Successful cadaveric

transplantsbegan in the
1960s.
Long term graft survival

would have to wait until


the 1970s and 1980s
when the
immunosupresants
CYCLOSPORINE
(Sandimmune) and
TACROLIMUS (Prograf)
were introduced.

1960: Dr. Beiding SCRIBNER and


Dr. George Quinton
Introduced external

AV shunt
AV shunt consisted

of a small plate that


sat outide the body,
usually on the
forearm

A Teflon tube was placed

in both the patients


artery and vein.
The tubes were

connected to the
bloodlines of the dialysis
machine during
treatment
When not in use for a

dialysis treatment, the


loops would be
connected externally
with a U shaped device
allowing continuous flow
to maintain patency

1966: Dr. Michael BRESCIA and Dr.


James CIMINO
Created the first permanent

internal vascular access, the AVF


AVF is a surgical connection

between an artery and vein


Continues to remain the access

of choice for hemodialysis


patients today
Had fewer complications and the

problem of accidental
dislodgement and bleeding was
not a concern

1964: Home
Hemodialysis
Belding in Seattle

and Dr. Merril in


Boston initiated the
first Home
hemodialysis as a
treatment of
modality in the US
A single patient
dialysis machine was
developed for use in
the home.

1964: Nocturnal Home


Hemo
The Model A was built by the

Milton Roy Company in St.


Petersburg, Florida in 1964. It
was designed to perform
nocturnal home HD.
The wooden veneer was used to

give it a furniture look for home


use.
The Model A had automatic hot

water (90 C) disinfection,


automatic alarms, solid-state
(diode) logic, and acoustic tile
inside to reduce noise.

1972: Social Security Amendment


Pres. Richard Nixon signed SS Amendments

which extended Medical Coverage to those with


CKD
The amendment was originally intended for
those under the age of 65 but was lated revised
to include those aged 65 and older.
The federal funding allowed dialysis to be made
available to patients without regard to age or
comorbities.
As a result of this landamark legislation, a
proliferation of outpatient dialysis centers was
seen across the country.

1989: The Federal Food and


Drug Administration
approved the
use of Epoietin Alfa
Anemia was generally treated with frequent and

multiple blood transfusions.


Anabolic steroids, such as Nandrolone Decanoate,
were also use to ammeliorate the anemia
associated with CKD. These steroids were usually
administered weekly by IM injection.
The introduction of recombinant human
Erythropoietin diminished or in most cases
precluded, the need to administer BT and anabolic
steroids.

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