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Dialysis is an artificial process for removing waste products and excess fluids from the body, a process that is needed when the kidneys are not functioning properly. Dialysis usually requires the effort of a team of people. A doctor completes a dialysis prescription, manages complications, and monitors the medical care. A nurse monitors the persons general well-being and mental health and educates the person about dialysis and what needs to be done to maintain the best possible health.Dialysis
Chronic indications for dialysis: Symptomatic renal failure Low glomerular filtration rate (GFR) (RRT often recommended to commence at a GFR of less than 10-15 mls/min/1.73m2). In diabetics, dialysis is started earlier. Difficulty in medically controlling fluid overload, serum potassium, and/or serum phosphorus when the GFR is very lowChronic Indications
Acidemia from metabolic acidosis in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload Electrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI Intoxication, that is, acute poisoning with a dialyzable substance. These substances can be represented by the mnemonic SLIME: salicylic acid, lithium, isopropanol, Magnesium- containing laxatives, and ethylene glycol Overload of fluid not expected to respond to treatment with diuretics Uremia complications, such as pericarditis, encephalopathy, or gastrointestinal bleeding.Indications for dialysis in thepatient with acute kidney injury
Peritoneal dialysis Intermittent hemodialysis Hemofiltration Continuous renal replacement therapy Hemodiafiltration• Decision of modality determined by catabolic rate, hemodynamic stability, and whether primary goal is fluid or solute removalTypes
In peritoneal dialysis, the peritoneum acts as semi permeable membrane as it has a large surface area and a rich network of blood vessels. A fluid (dialysate) is infused through a catheter inserted through the abdominal wall into the peritoneal space within the abdomen. The dialysate must be left in the abdomen for a sufficient time to allow waste products from the bloodstream to pass slowly into it. Then the dialysate is drained out, discardedPD
Manual intermittent peritoneal dialysis is the simplest technique. In manual intermittent peritoneal dialysis, bags containing dialysate are warmed to body temperature and infused into the peritoneal (abdominal) cavity, 60 to 90 minutes and then is drained out in about 10 to 20 minutes. This process is then repeated. The entire treatment can take 12 to 24 hours.Various techniques are used forperitoneal dialysis
Automated cycler intermittent peritoneal dialysis -This technique uses a machine (cycler) to do automated exchanges of dialysate continuous ambulatory peritoneal dialysis, the dialysate is kept in the abdomen for much longer intervals Continuous cycler-assisted peritoneal dialysis uses an automated cycler to perform short exchanges at night during sleep, whereas longer exchanges are performed manually
Bleeding Unintentional perforation of an internal organ during placement of the catheter Removal of the catheter from the bodyInfection Unsterile techniques during dialysisLow level of albumin (a protein) in Loss of protein in fluid removedthe blood during dialysisConstipation Intake of inadequate fiber or use of calcium salts to treat high phosphate levels in the blood, causing the intestine to widen, which possibly interferes with dialysate flow in and out of the abdomenPossible Complications ofPeritoneal Dialysis
Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Since the 1960s, when hemodialysis first became a practical treatment for kidney failure, In recent years, more compact and simpler dialysis machines have made home dialysis increasingly attractive.Introduction to hemodialysis
Hemodialysis is usually needed when you have only 10 to 15 percent of your kidney function left. Hemodialysis can help take over your kidneys job by controlling your blood pressure and maintaining the proper balance of fluid and various chemicals — such as potassium and sodium — in the bodyIntro cont.
In hemodialysis, blood is removed from the body and pumped by a machine outside the body into a dialyzer (artificial kidney). The dialyzer filters metabolic waste products from the blood and then returns the purified blood to the person. The total amount of fluid returned can be adjusted. Hemodialysis requires repeated access to the bloodstream.Procedure
Doctors can achieve temporary access by inserting a large intravenous catheter in a big vein, usually one near the neck. An artificial connection between an artery and a vein (an arteriovenous fistula) is surgically created to make long-term access easier In this procedure, typically the radial artery in the forearm is joined with the cephalic vein. When a fistula cannot be created, an artery and a vein may be surgically connected to each other using a synthetic connector (graft)AV Fistulas/Graft
Heparin, a drug that prevents clotting, is given during hemodialysis to prevent blood from clotting in the dialyzer. Inside the dialyzer, a porous artificial membrane separates the blood from a fluid (the dialysate). Fluid, waste products, and electrolytes in the blood filter through the membrane into the dialysate. Blood cells and large proteins are unable to filter through the small pores of the membrane and so remain in the bloodCont…
Dialyzers have different sizes and degrees of efficiency. Dialysis treatment time is usually about 3 to 4 hours. Most people who have chronic kidney failure need hemodialysis 3 times a week.Dialysis
Fever Bacteria or fever-causing substances (pyrogens) in the bloodstream Overheated dialysateLife-threatening allergic reaction Allergy to a substance in the(anaphylaxis) dialyzer or blood tubingLow blood pressure Removal of too much fluid or excessive fluid gain between dialysisAir embolus Air entering blood in the machine Possible Complications of Hemodialysis
Abnormal heart rhythms Abnormal levels of potassium and other substances in the blood Low blood pressureBleeding in the intestine, brain, Use of heparin to prevent clottingeyes, or abdomen in the machineInfection Bacteria entering the bloodstream through a dialysis catheter or through a needle inserted into veinsComplication
Diet:For those undergoing hemodialysis, daily consumption of sodium and potassium is even more restricted. Foods high in phosphorus also may have to be limited. Daily fluid intake is limited for people who have very little urine output or a persistently low or decreasing sodium concentration in the blood. Daily weighing is important to monitor weight gain. Multivitamins required.Special Considerations
Medical considerations: Erytheopoeitin-Rbc Production Phosphate binders-to remove excess dietary phosphates Vitamin D/Calcitrol-to maintain excess PTH Psychosocial Considerations: People undergoing dialysis may experience losses in every aspect of their life and become depressed and anxious. Dialysis sessions may interfere with work, school, or leisure activities.
Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, "dragging" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost from the blood during this process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during the treatment. Hemodiafiltration is the combining of hemodialysis and hemofiltration in one process.Hemofiltration