Dialysis is a method of removing waste and toxins from the blood when the kidneys fail. There are two main types: hemodialysis which uses a machine to filter blood outside the body through a semipermeable membrane, and peritoneal dialysis which uses the peritoneal membrane in the abdomen. Hemodialysis treatments typically last 4 hours and occur 3 times per week to cleanse the blood and maintain electrolyte and fluid balance for patients with kidney failure. Access points for hemodialysis include catheters, arteriovenous shunts, and arteriovenous fistulas or grafts.

1. DIALYSIS
Done by:
J.Manasia

2. Dialysis…
 a method of removing toxic substances
(impurities or wastes) from the blood when
the kidneys are unable to do so.
 most frequently used for patients who have
kidney failure, but may also be used to
quickly remove drugs or poisons in acute
situations. This technique can be life
saving in people with acute or chronic
kidney failure.

3. Dialysis: Methods
 Hemodialysis
 Peritoneal Dialysis

4. Hemodialysis…
 A dialysis process
which requires a
machine to
transport the blood
and dialysing fluid
on either side of a
semi-permeable
membrane to effect
the removal of toxic
metabolites and
excess water

5. How Hemodialysis Works?

6. Hemodialysis: Functions
 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

7. Hemodialysis: Access
Subclavian and femoral
catheter
External arteriovenous shunt
Internal arteriovenous fistual
Internal arteriovenous graft

8. Subclavian (vein)
Catheter…
 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

9. Femoral (vein) Catheter…
 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

10. External AV Shunt
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.

11. External AV Shunt…
Advantages Disadvantages
 can be used  external danger of
immediately after disconnecting or
insertion dislodging the shunt
 no venipuncture  risk of hemorrhage,
necessary for dialysis infection or clotting
 skin erosion around
the catheter site

12. Internal AV Fistula
 for chronic dialysis
clients
 created surgically by
anastomosis of a large
artery & a large vein in
the arm
 Maturity: veins
become engorged due
to the flow of arterial
blood into the venous
system; takes 1-2 wks.
 Maturity is required
before the fistula can
be used

13. Internal AV Fistula…
Advantages Disadvantages
 less danger of clotting  cannot be used
and bleeding immediately after insertion
 venipuncture is required
 can be used
for dialysis
indefinitely  infiltration of needles →
 decreased incidence hematoma
of infection  aneurysm in the fistula
 no external dressing  Arterial steal syndrome
required

14. Internal AV Graft
 for chronic dialysis clients who
do not have adequate blood
vessels for the creation of a
fistula
 Gore-Tex or a bovine (cow)
carotid artery as artificial vein
for blood flow
 Procedure involves the
anastomosis of the graft to the
artery, a tunneling under the
skin, and anastomosis to a
vein.
 can be used 2 wks after
insertion
 Complications: clotting,
aneurysms and infection

15. Internal AV Graft…
Advantages Disadvantages
 less danger of clotting  cannot be used
and bleeding immediately after insertion
 venipuncture is required
 can be used
for dialysis
indefinitely  infiltration of needles →
 decreased incidence hematoma
of infection  aneurysm in the fistula
 no external dressing  Arterial steal syndrome
required

16. How long do hemodialysis
treatments last?
Usually, each hemodialysis treatment lasts about four hours
and is done three times per week.