2. Remove waste products
Fluid control
BP control
RBC production
Keeping bones healthy

3. 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)

4. PRESENTED BY
ANU ISSAC

5. • 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

6.  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)

8.  Hemodialysis
 Peritoneal Dialysis

9. OSMOSIS

10. DIFFUSION

11. Ultrafiltration

13. 1. blood
6. dialysate
7. body
2. access
3. tx w/ heparin
4. dialyser
5. solute exchange
4-6 hours

14. 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

15.  Removal of solutes and water from the blood across a
semipermeable membrane

16. Selective filter for removing toxic or unwanted solutes
from the blood

17. Rectangular cross section, parallel plate dialyser.

18. CIRCULAR CROSS SECTION; HOLLOW FIBER
DIALYSER

19. Organic cellulose derivatives
Synthetic membranes

20. 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.

21. 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

22. 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

23. Sodium chloride 235 gms
Sodium bicarbonte 600 gms
Na + 55 mmoles
HCO3- 35 mmoles
Cl- 20 mmoles

24.  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

25.  Filtration
 Activated carbon filters (adsorption)
 Water softners
 Reverse osmosis (RO)
 De ionization
 Ultraviolet light exposure

26.  The removal of air
 The removal of any chemicals

27.  PERMANENT VASCULAR ACCESS
Arterio venous fistula’s (AVF’s)
Arterio venous grafts (AVG’s)
Shunts

29. 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

31. 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

32. 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.

33. 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

34.  Rope ladder puncture
 Area puncture
 Button hole puncture

35. Thrombosis
Stenosis of fistula
Aneurysm
Steal syndrome
Infection

36.  Subclavian vein
 Internal jugular vein
 Femoral vein

37.  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.

38.  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

39.  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

41.  Weight
 Blood volume monitoring
 Blood pressure
 Temperature and pulse
 Serum biochemistry and hematology

42.  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

43.  URR( urea reduction ratio) = 100 (1- Ct/Co)
Ct= post dialysis urea
Co= pre dialysis urea

45.  ETO
 Gamma irradiation
 Steam sterilization
 Electron or e-beam sterilization

46.  Hypotension
Muscle cramps
 Loss of blood
 Hepatitis
 Sepsis
 Disequilibrium syndrome
 Vascular steal
 Dialyser Reaction
 Hemolysis
Air embolism

50. PERITONEAL DIALYSIS
Adequate Patient Care in the Most Biocompatible Way

53. •
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

54.  Inflow (fill) – 10 minutes
 Dwell ( equilibration) – 20 minutes to 8 or more
hours
 Drain - 15 to 30 minutes

55. Automated peritoneal dialysis (APD)
Continuous ambulatory peritoneal dialysis (CAPD)

56.  Continuous cycling peritoneal dialysis ( CCPD)
 Nocturnal intermittent peritoneal dialysis (NIPD)
 Intermittent peritoneal dialysis (IPD)
 Tidal peritoneal dialysis (TPD)

57.  Requires a peritoneal
cycling machine called
a cycler
 Can be done as
intermittent peritoneal
dialysis, continuous
cycling peritoneal
dialysis, or nightly
peritoneal dialysis

59. 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.

60. 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.

61. o FREEDOM FROM DIALYSIS MACHINE
o CONTROL OVER DAILY ACTIVITIES
o OPPURTUNITIES TO AVOID DIETARY
RESTRICTIONS

62.  History of multiple abdominal surgeries.
 Recurrent hernias
 Obesity
 Pre –existing vertebral disease
 Severe obstructive pulmonary disease

63.  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

64. Venous access therapies [venovenous]
Arterial access therapies [arteriovenous]

65.  Venous access therapies
o Continuous venovenous ultrafiltration
(CVVU)
o Continuous venovenous hemofiltration
(CVVH)
o Continuous venevenous hemodialysis
(CVVHD)

66. ARTERIAL ACCESS THERAPIES
 SLOW CONTINUOUS ULTRFILTRATION
(SCUF)
 CONTINUOUS ARTERIOVENOUS
HEMOFILTRATION (CAVH)
 CONTINUOUS ARTERIOVENOUS
HEMODIALYSIS (CAVHD)

67. 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.

68.  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

69. 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

70. 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.