Renal dialysis

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Renal dialysis

  1. 1. Remove waste products Fluid control BP control RBC production Keeping bones healthy
  2. 2. We may feel sick, sleepy, confused or nauseous. (waste products) We will feel tired and pale. (RBC) We may have ankle swellings & start to feel breathless. (extra fluid) We may have bad breath & loss of appetite. (waste products)
  3. 3. PRESENTED BY ANU ISSAC
  4. 4. • First form of dialysis practised by Romans. • 1854- the term dialysis was used for the first time by Thomas Graham. • 1913- first article on hemodialysis- ‘Artificial kidney’ • 1920’s- first dialysis performed by George Hass • 1948- first successful dialysis in Mount Sinai hospital by Willem Kolff
  5. 5.  Dialysis is the movement of fluid and molecules across a semipermeable membrane from one compartment to another.  Clinically, dialysis is a technique in which substances move from the blood through a semipermeable membrane and into a dialysis solution (dialysate)
  6. 6.  Hemodialysis  Peritoneal Dialysis
  7. 7. OSMOSIS
  8. 8. DIFFUSION
  9. 9. Ultrafiltration
  10. 10. 1. blood 6. dialysate 7. body 2. access 3. tx w/ heparin 4. dialyser 5. solute exchange 4-6 hours
  11. 11. Cleanses the blood of accumulated waste products Removes the by-products of protein metabolism (urea, creatinine & uric acid) Removes excessive fluids Maintains or restores the buffer system of the body Maintains or restores electrolyte levels
  12. 12.  Removal of solutes and water from the blood across a semipermeable membrane
  13. 13. Selective filter for removing toxic or unwanted solutes from the blood
  14. 14. Rectangular cross section, parallel plate dialyser.
  15. 15. CIRCULAR CROSS SECTION; HOLLOW FIBER DIALYSER
  16. 16. Organic cellulose derivatives Synthetic membranes
  17. 17. DIALYSATE  The fluid that is pumped through the dialyser on the opposite side of the semi permeable membrane to the patients blood.  Correct the chemical composition of uremic blood to normal physiological levels.
  18. 18. SOLUTE CONCENTRATION SODIUM (mmol/L) 135- 143 POTASSIUM(mmol/L) 0-4 CHLORIDE 100- 111 CALCIUM 1.25 – 1.75 MAGNESIUM 0.75- 1.5 BICARBONATE 30- 35 GLUCOSE 0- 25 gm
  19. 19. Sodium chloride ; Na+ 176 gm ; 82 mEq/L Potassium chloride ; K+ 5.50 gm ; 2.0 mEq/L Calcium chloride ; Ca + 8.00 gm ; 3.0 meq/L Magnesium chloride ; Mg ++, Cl - 2.75 gm ; 0.75 mEq/L, 88.0 mEq/L Acetic acid 9.0 gm ; 4.0 mEq/L Purified water 1 liter
  20. 20. Sodium chloride 235 gms Sodium bicarbonte 600 gms Na + 55 mmoles HCO3- 35 mmoles Cl- 20 mmoles
  21. 21.  Na + - 137 mEq/L  K + - 2 mEq/L  Ca ++ - 3.0 mEq/L  Mg ++ - 0.75 mEq/L  Cl ‾ - 108 mEq/L  HCo3‾ 35 mEq/L  CH3COO‾ 4 mEq/L
  22. 22.  Filtration  Activated carbon filters (adsorption)  Water softners  Reverse osmosis (RO)  De ionization  Ultraviolet light exposure
  23. 23.  The removal of air  The removal of any chemicals
  24. 24.  PERMANENT VASCULAR ACCESS Arterio venous fistula’s (AVF’s) Arterio venous grafts (AVG’s) Shunts
  25. 25. Advantages Disadvantages  less danger of clotting and bleeding  can be used indefinitely  decreased incidence of infection  no external dressing required  freedom of movement  cannot be used immediately after insertion  venipuncture is required for dialysis  infiltration of needles → hematoma  aneurysm in the fistula  Arterial steal syndrome  Congestive heart failure
  26. 26. Advantages Disadvantages  less danger of clotting and bleeding  can be used indefinitely  decreased incidence of infection  no external dressing required  freedom of movement  cannot be used immediately after insertion  venipuncture is required for dialysis  infiltration of needles → hematoma  aneurysm in the fistula  Arterial steal syndrome  Congestive heart failure
  27. 27. Access is formed by the surgical insertion of 2 silastic cannulas into an artery or vein in the forearm or leg to form an external blood path.
  28. 28. Advantages Disadvantages  can be used immediately after insertion  no venipuncture necessary for dialysis  external danger of disconnecting or dislodging the shunt  risk of hemorrhage, infection or clotting  skin erosion around the catheter site
  29. 29.  Rope ladder puncture  Area puncture  Button hole puncture
  30. 30. Thrombosis Stenosis of fistula Aneurysm Steal syndrome Infection
  31. 31.  Subclavian vein  Internal jugular vein  Femoral vein
  32. 32.  for acute dialysis  In the patient who is imminently awaiting a kidney transplant  for maturation of AV access  Limited availability of vessels  Patients undergoing plasmapheresis  For continuos renal replacement therapies  Patients on peritoneal dialysis requiring temporary hemodialysis because of peritonitis.
  33. 33.  may be inserted for short term or temporary use in acute renal failure  usually filled w/ heparin & capped to maintain patency between dialysis treatments  may be left in place for up to 6 wks if complications do not occur
  34. 34.  may be inserted for short term or temporary use in acute renal failure  client should not sit up more than 45 or lean forward, or the catheter may kink & occlude.  an IV infusion pump w/ microdrip tubing should be used if a heparin infusion through the catheter is prescribed
  35. 35.  Weight  Blood volume monitoring  Blood pressure  Temperature and pulse  Serum biochemistry and hematology
  36. 36.  Kt / V – 1.2  URR – 65%  Albumin - >35 g/L  Potassium – 3.5 – 6.5 mmol/L  Phosphate - < 1.8 mmol/L  Calcium – b/w 2.2 and 2.6 mmol/L  Hb - > 10 g/L
  37. 37.  URR( urea reduction ratio) = 100 (1- Ct/Co) Ct= post dialysis urea Co= pre dialysis urea
  38. 38.  ETO  Gamma irradiation  Steam sterilization  Electron or e-beam sterilization
  39. 39.  Hypotension Muscle cramps  Loss of blood  Hepatitis  Sepsis  Disequilibrium syndrome  Vascular steal  Dialyser Reaction  Hemolysis Air embolism
  40. 40. PERITONEAL DIALYSIS Adequate Patient Care in the Most Biocompatible Way
  41. 41. • Sodium 132- 142 Potassium 0- 4 Calcium 2.5- 3.5 Magnesium 0.5- 1.5 Lactate 35- 40 Chloride 101- 107 pH 5.0- 5.8 Dextrose 1.5- 4.25 gm/dL
  42. 42.  Inflow (fill) – 10 minutes  Dwell ( equilibration) – 20 minutes to 8 or more hours  Drain - 15 to 30 minutes
  43. 43. Automated peritoneal dialysis (APD) Continuous ambulatory peritoneal dialysis (CAPD)
  44. 44.  Continuous cycling peritoneal dialysis ( CCPD)  Nocturnal intermittent peritoneal dialysis (NIPD)  Intermittent peritoneal dialysis (IPD)  Tidal peritoneal dialysis (TPD)
  45. 45.  Requires a peritoneal cycling machine called a cycler  Can be done as intermittent peritoneal dialysis, continuous cycling peritoneal dialysis, or nightly peritoneal dialysis
  46. 46. 1. The dialysate is instilled into the peritoneal cavity through an implant catheter attached to a transferline, which is attached to a bag of dialysate. 2. Once the fluid has been instilled completely into the peritoneal cavity, the empty bag and transferline are folded up and worn in a cloth pouch beneath the clothing. Thus, the patient is free to ambulate and resume his normal daily activities.
  47. 47. 3. When it is time to drain off the effluent, the bag is unfolded, placed on the floor and drainage is achieved by gravity. A new bag of dialysate is then attached to the transferline and the process is repeated. Usually the solution exchange procedure takes about 15 minutes.
  48. 48. o FREEDOM FROM DIALYSIS MACHINE o CONTROL OVER DAILY ACTIVITIES o OPPURTUNITIES TO AVOID DIETARY RESTRICTIONS
  49. 49.  History of multiple abdominal surgeries.  Recurrent hernias  Obesity  Pre –existing vertebral disease  Severe obstructive pulmonary disease
  50. 50.  Exit site infection  Peritonitis  Abdominal pain  Outflow problems  Hernias  Lower back problems  Bleeding  Pulmonary complications  Protein loss  Carbohydrate and lipid abnormalities  Encapsulating sclerosing peritonitis & loss of ultrfiltration
  51. 51. Venous access therapies [venovenous] Arterial access therapies [arteriovenous]
  52. 52.  Venous access therapies o Continuous venovenous ultrafiltration (CVVU) o Continuous venovenous hemofiltration (CVVH) o Continuous venevenous hemodialysis (CVVHD)
  53. 53. ARTERIAL ACCESS THERAPIES  SLOW CONTINUOUS ULTRFILTRATION (SCUF)  CONTINUOUS ARTERIOVENOUS HEMOFILTRATION (CAVH)  CONTINUOUS ARTERIOVENOUS HEMODIALYSIS (CAVHD)
  54. 54. 1) Fluid volume excess related to fluid accumulation/ inadequate dialysis 2) Risk for fluid volume deficit related to rapid removal of fluid during treatment 3) Risk for altered tissue perfusion related to risk of vascular access clotting/ disconnection 4) Risk for infection related to presence of access site and invasive procedure 5) Body image disturbance related to presence of access site.
  55. 55.  Pain/discomfort related to dialysis process.  Altered thought process related to dialysis diaequilibrium syndrome  Ineffective individual/ family coping related to diagnosis of chronic illness  Noncompliance to prescribed treatment regimen
  56. 56. a)Imbalanced nutrition, less than body requirement related to protein loss in the dialysate b)Risk for infection realted to presence of peritoneal dialysis catheter. c) risk for imbalanced fluid volume related to hypertonicity of the dialysate or inadequate exchange. d) activity intolerance to related to fatigue e) risk for complications related to the disease condition and dialysis procedure
  57. 57. 1) TUCKER MARTIN SUSAN, CANOBBIO. M. MARY, PAQUETTE VARGO ELEANOR WELLS FYFE MARJORIE, PATIENT CARE STANDARDS, COLLOBORATIVE PRACTICE PLANNING GUIDES, 6TH EDITION, 1996, MOSBY PUBLICATIONS, USA, PAGE NO:- 690-696. 2) THOMAS NICOLA, RENAL NURSING, THIRD EDITION (2008). BALLIERE TINDALL, ELSEVIER PUBLICATIONS, CHINA, PAGE NO: 181-244. 3) KALLENBACH Z. JUDITH, GUTCH F.C, STONER H.MARTHA., COREA L. ANNA, REVIEW OF HEMODIALYSIS FOR NURSES AND DIALYSIS PERSONNEL, SEVENTH EDITION, 2005, ELSEVIER PUBLICATION ,MISSOURI, PAGE NO: 61- 136. 4) LEWIS. L SHARON,HEITKEMPER McLEAN, MARGARET, DIRKSEN RUFF SHANNON, O’BRIEN GRABER PATRICIA, BUCHER LINDA, LEWIS MEDICAL AND SURGICAL NURSING, ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEM, 7TH EDITION, 2011, ELSEVIER PUBLICATIONS, India, PAGE NO: 1216-1223. 5) NISSENSON R. ALLEN, FINE N. RICHARD, HANDBOOK OF DIALYSIS THERAPY, 4TH EDITION (2008), ELSEVIER PUBLICATIONS, PHILADELPHIA. 6) MASSRY G. SHAUL, GLASSOCK J. RICHARD, TEXTBOOK OF NEPHROLOGY, VOLUME 2 , 3RD EDITION, 1995, WILLIAM AND WILKINS PUBLICATIONS, USA, PAGE NO: 1510- 1600.

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