Hemodialysis and peritoneal dialysis are two types of dialysis used to replicate kidney function for patients with kidney failure. Hemodialysis uses a machine to filter waste from the blood outside of the body through a semipermeable membrane, while peritoneal dialysis introduces fluid into the abdomen to draw waste from the blood vessels within. Both aim to control fluid balance and remove toxins when the kidneys are unable to do so, helping to correct conditions like fluid overload, electrolyte imbalances, and metabolic acidosis. Key differences between the two include that hemodialysis requires vascular access while peritoneal dialysis uses a permanent catheter, and that hemodialysis is done at a center several times a week

1. Prepared by,
Gayathri R
2nd yr MSc (N)
UCON

2. INTRODUCTION
Dialysis attempt to reproduce kidney function by allowing wastes and
abnormally concentrated substances to pass from a person’s blood by
allowing wastes and abnormally concentrated substances to pass from
a person’s blood across a semipermeable membrane for excretion from
the body. Specifically dialysis is used to remove excessive amounts of
drugs and toxins in poisonings of intentional and accidental nature, to
correct fluid imbalance, and acid base imbalances and to remove
metabolic waste when renal shutdown occurs either suddenly or in
patients with chronic end stage kidney disease.

3. DEFINITION
Dialysis is procedure for cleaning and filtering the blood. It
substitute for kidney function when the kidneys cannot
remove the nitrogenous waste products and maintain
adequate fluid, electrolyte and acid base balance.
[Barbara K Timby]

4. It’s defined as exchange of fluid across a semipermeable
membrane. Dialysis is not limited to filtration of kidneys and
removal of nitrogenous waste from the blood but implies
addition or removal of excess water, electrolytes and
dialyzable poison from the blood.
[ S N Chung]

5. INDICATIONS
• Acute renal failure
• Chronic renal failure
• Poisoning
• Severe metabolic acidosis
• Hyperkalemia irrespective of its causes
• Fluid overload or acute pulmonary edema

6. TYPES
• Hemodialysis (through the artificial kidney)
• Peritoneal dialysis (through the peritoneal cavity)

7. HEMODIALYSIS
Hemodialysis is an efficient modality for correction of fluid and
electrolyte abnormalities due to acute kidney injury or chronic renal
failure. However, it is expensive to institute, requires expertise and
skilled nursing is not available at most centers. It is not suited for
patients with hemodynamic instability, bleeding tendency and in very
young children where vascular access might be difficult.

8. Indications

9. Indications of dialysis in acute renal failure (ARF)
• Severe fluid overload
• Refractory hypertension
• Uncontrollable hyperkalaemia
• Nausea, vomiting, poor appetite, gastritis with haemorrhage
• Lethargy, malaise, somnolence, stupor, coma, delirium, asterixis, tremor,
seizures,
• Pericarditis (risk of haemorrhage or tamponade)
• Bleeding diathesis (epistaxis, gastrointestinal (GI) bleeding and etc.)
• Severe metabolic acidosis
• Blood urea nitrogen (BUN) > 70–100 mg/dl

10. Indications of dialysis in chronic renal failure (CRF)
• Pericarditis
• Fluid overload or pulmonary edema refractory to diuretics
• Accelerated hypertension poorly responsive to
antihypertensive
• Progressive uremic encephalopathy or neuropathy such as
confusion, asterixis, myoclonus, wrist or foot drop, seizures
• Bleeding diathesis attributable to uremia

11. Equipments & other requirements
Vascular access using central venous catheter
• Temporary access: It is established by percutaneous insertion
of catheter into a large vein such as the internal jugular or
femoral, subclavian vein is less preferred.
• Permanent access: Construction of Arteriovenous fistula
permits repeated access for months to years.

12. Arteriovenous (AV) fistula

13. AV graft

14. Central venous catheter

15. Dialysate circuit in hemodialysis machine

16. • Pediatric dialyzer with tubings
• Dialysate fluid

17. Procedure of Hemodialysis

18. Risks
• Hypotension
• Muscle cramps
• Itching
• Sleep problems
• Anemia
• Bone diseases
• Hypertension
• Fluid overload

19. Risks
• Pericarditis
• Hyperkalemia
• Access site complications
• Amyloidosis
• Depression

20. Complications during dialysis
• Hypotension
• Muscle cramps
• Nausea, Vomiting
• Chest pain and Back pain
• Fever and Chills
• Disequilibrium syndrome
• Dialyzer reaction
• Arrhythmia
• Cardiac tamponade
• Intracranial bleeding
• Seizures
• Hemolysis
• Neutropenia; compliment
activation

21. Other Complications
• Catheter lumen thrombosis
• Infections
• Pneumothorax
• Hemothorax
• Air embolism
• Arrhythmia
• Thrombosis
• Nerve injury

22. Nursing management
• Patient care
• Patient monitoring
• Physical examination
• Fistula checking
• Proper administration
• Management of catheter infection
• Client teaching

23. Common medications used
DRUG USE ADMINISTRATION TIME
Oral
calcium phosphate
binder
To counter high phosphate levels in blood
when the kidney are no longer able to control
serum levels.
Taken with or immediately after meals. Can
be taken with a meal before hemodialysis.
Erythropoietin (EPO) For chronic anemia to stimulate red blood cell
production in the bone marrow.
Given IV or SQ during or at the end of
hemodialysis treatment. Monitor predialysis
hematocrit to determine the amount of
erythropoietin.
Iron To produce red blood cells. The parenteral form can be taken with a
meal before hemodialysis.
Antihypertensive
agent
To regulate hypertension. Morning dose is held and given after
hemodialysis.
Sodium heparin To prevent clotting in the extracorporeal
circuit.
Given during hemodialysis by dialysis nurse.

24. PERITONEAL DIALYSIS
Peritoneal dialysis (PD) is a treatment for kidney failure. A
special sterile fluid is introduced into the abdomen through a
permanent tube that is placed in the peritoneal cavity. The
fluid circulates through abdomen to draw impurities from
surrounding blood vessels in the peritoneum, which is then
drained from the body.

25. Indications
• Patient with acute kidney injury with severe or persistent
hyperkalaemia (>7meq/l)
• Fluid overload (Pulmonary oedema, Severe hypertension)
• Uremic encephalopathy
• Severe metabolic acidosis (total CO2 10-12mEq/L)
• Hyponatremia and Hypernatremia

26. Materials required
• Peritoneal dialysis catheter

27. Peritoneal dialysis solution

28. Other materials required
• Sterile set
• Surgical blade number 15
• Normal saline
• Suture
• Povidone iodine; Chlorhexidine

29. Procedure

30. Types
Continuous ambulatory PD Automated peritoneal dialysis

31. Types
• Intermittent peritoneal dialysis
• Continuous cycling peritoneal dialysis
• Nightly peritoneal dialysis

32. Benefits of PD
• Painless and no bleeding
• Home based therapy
• Gentler and works more like the natural kidney

33. Signs and symptoms monitoring during dialysis
FLUID OVERLOAD FLUID UNDERLOAD PERITONITIS
Hypertension
Pitting edema of feet, ankles
and hands
Crackles in lung field
Shortness of breath
Jugular vein distention
Pulmonary edema
Fatigue
Ascites
Hypotension
Tachycardia
Muscle cramps (Legs)
Abdominal pain during exchange
Nausea
Vomiting
Cloudy outflow fluid (effluent)
Systemic infection symptoms

34. Risks
• Nausea
• Trouble sleeping
• Poor appetite
• Loss of energy
• Hiccups
• Dry, itchy skin
• Weight loss irregular menstrual periods
• Muscle cramping, especially at night
• Swelling anemia (low blood count)
• Trouble breathing

35. Nursing management
• Predialysis care
• Intra dialysis care
• Post dialysis care
• Client and family teaching

36. Complications
• Bleeding after catheter insertion
• Perforation of gut
• Abdominal pain
• Leakage around catheter
• Difficult drainage
• Pulmonary complications
• Peritonitis
• Metabolic problems

37. Disadvantages
• Infections
• Weight gain
• Hernia
• Inadequate dialysis

38. DIFFERENCE B/W HEMO & PERITONEAL DIALYSIS
HEMODIALYSIS PERITONEAL DIALYSIS
Advantages
Effective removal of waste product.
Care given by trained professional.
Regular contact with other patients.
Rapid correction of electrolyte imbalance.
No equipment to store at home.
Treatment usually occurs only three times a week.
Schedule flexibility, easier to travel.
Few risks of dialysis associated cramps.
Clinic visits limited to 1-2 times a month.
Patient or family involved in care.
No need for needles or vascular access.
Steady state therapy, gentler ultrafiltration.
Disadvantages
Vascular access surgery required.
Use of large needles.
Schedule inflexibility.
Must travel to center three times a week.
Cramping with ultrafiltration.
Risk of bacteremia.
Permanent external catheter; problems.
No off days.
Risk of peritonitis.
Risk of weight gain from glucose in dialysate.
Must store dialysis equipment and supplies at home.
Need for self-monitoring care.

39. CONCLUSION
In medicine, dialysis is the process of removing
excess water, solutes, and toxins from the blood in people
whose kidneys can no longer perform these functions
naturally. This is referred to as therapy. Dialysis is used in
patients with rapidly developing loss of kidney function,
called acute kidney injury (previously called acute renal
failure), or slowly worsening kidney function, called Stage
5 chronic kidney disease, (previously called chronic kidney
failure and end-stage renal disease and end-stage kidney
disease).

40. REFERENCE
• Ignativicius ,Work man. Text book of medical surgical nursing, Elsevier
publishers, 5th edn.
• Barbara K Timby, Nancy E Smith. Introductory medical surgical nursing,
Lippincott publishers, 9th edn.
• Beverly George Gay, Cynthia. Clinical medical surgical nursing, Saunders
publishers, 1st edn.
• Rakesh Lodha, SK Kabra. Pediatric procedures, CBS publishers, 1st edn.
• OP Ghai. Essentials of pediatric nursing, CBS publishers, 7th edn.
• Medline plus.com
• www.mayoclinic.com

41. Keeping your kidneys always healthy…
Thank you…