It is the process of removing waste from the blood. Ppt would help to learn especially for Nursing students. Hemodialysis, Peritoneal dialysis, Renal transplantation

2. Meaning
 Is a process of removing waste and excess
water from blood and is used primarily
artificial replacement for lost kidney function
in people with renal failure

3. GOAL
 To remove end products of protein metabolism
 Maintain concentration of electrolyte
 Correct acidosis
 Remove excess fluid

4. Principles
Ultra filtration
 Refers to removal of fluid from blood using
osmotic and hydrostatic pressure
 Osmosis
Is the movement of fluids across a
semipermeable membrane from an area of
lower concentration of particle to higher
concentration of particles

5. Diffusion
Is the process
of passage of
articles from
area of higher
concentration
to area of
lower
concentration

6.  TYPES
 Hemodialysis
 Peritoneal dialysis

7.  HEMODIALYSIS
A process for removing metabolic waste
products or toxic substance from blood
stream.

8. Hemodialysis access
Acute dialysis catheter
 Are non cuffed, non tunneled catheter
 Used for immediate vascular access
 Inserted in internal jugular vein or femoral vein
 Maintain occlusive dressing over the catheter
insertion
 Assess the insertion site for Hematoma, bleeding,
Catheter dislodgement

9. Subclavian vein catheter Femoral vein catheter
The catheter usually filled
with Heparin and copped to
maintain patency between
dialysis treatment
The catheter should not
uncapped
The catheter may be left in
place for up to 6 weeks if no
complications occurs
Assess the extremity for
circulation, temperature, and
pulse
Prevent Pulling or
disconnecting of the catheter
when giving care
Because the groin is not a
clean site, meticulous
perineal care is required
Use an Iv infusion pump or
controller which microdrip
tubing if heparin infusion

10. Internal Arterio venous fistula
 Is a connection of artery and vein
 Last longer
 Radio cephalic, brachiocephalic, brachio
basilic

11.  A permanent choice for client With CRF
requiring dialysis
 The fistula is created surgically by
anastomosis of a large artery and large vein in
the arm
 The flow of arterial blood into venous system
cause in the vein to become engorged (
Matured or developed)

12.  Maturity is takes about 4-6 weeks,
depending on the client ability to do hand
flexing exercise such as ball squeezing,
which help fistula mature
 Fistula is require to be mature before it can
be used because the engorged vein is
punctured with large bore needle for
dialysis
 Subclavian or femoral catheters, peritoneal
dialysis or external arterio venous shunt
can be used for dialysis while fistula is
maturing or developing.

13. Advantages Disadvantages
• Fistula is internal, the risk
of cloting and bleeding
low
• It can used indefinitely
• Decreased incidence of
infection because of
internal
• Once healing has
occurred, no external
dressing is required
• The fistula allows freedom
of movement
• Can not used immediately
after insertion so
planning ahead for an
alternate access for
dialysis is important
• Needle insertion through
the skin is required for
dialysis
• Infiltration of the needles
during dialysis can occur
and cause hematomas
• An aneurysm can form in
the fistula
• CHF can occur from the
increased blood flow in

14.  Arterial steal syndrome can develop in a client
with an internal arteriovenous fistula. In this
complication, too much blood is diverted to
the vein and arterial perfusion to the hand is
compromised

15. Arterio venous graft
 The internal graft may be used for chronic
dialysis client who do not have adequate blood
vessels for the creation of a fistula

16.  An arterial graft made of Gore- Tex or a bovine
(cow) carotid artery is used to create an
artificial vein for blood flow.
 The procedure involves the anastomosis of an
artery and vein using artificial graft
 The graft can be used 2 weeks after insertion
 Complication of graft including clotting,
aneurysm and infection

17. Advantages Disadvantages
• Graft is internal, the risk of
cloting and bleeding low
• It can used indefinitely
• Decreased incidence of
infection because of internal
• Once healing has occurred,
no external dressing is
required
• The graft allows freedom of
movement
• Can not used immediately
after insertion
• Needle insertion through the
skin is required for dialysis
• Infiltration of the needles
during dialysis can occur and
cause hematomas
• An aneurysm can form in the
AV graft
• CHF can occur from the
increased blood flow in the
venous system
• Arterial steal syndrome can
develop

18.  Teach the client that the extremity should not be used for
monitoring BP, Drawing blood, placing IV lines or
administering injections
 Teach the client with an arteiovenous fistula hand fixing
exercise such as ball squeezing to promote graft maturity
 Note the temperature and capillary refill of the extremity
 Palpate pulse below fistula or graft, and monitor for hand
swelling as indication of ischemia
 Monitor for clotting
› Complains of tingling or discomfort in the extremity
› Inability to palpate a thrill or auscultate a bruit over the fistula or
graft
 Monitor for infection

19.  Monitor lung and heart sound for sign of CHF
 Notify the physician immediately if the sign of
clotting, infection or arterial steal syndrome
occure
 To ensure the Patency, palpate for a thrill or
auscultate for a bruit over the fistula or graft.
Notify the physician if a thrill or bruit is
absent

20.  Two Silastic cannulas are surgically inserted
into an artery and vein in the forearm or leg to
form an external blood path
 The cannulas are connected to From a U
shape blood flows from the client’s artery
through the shunt into the vein

21. ADVANTAGES DISADVANTAGES
The external AV shunt
use immediately
No venipuncture is
necessary
Disconnection or
dislodgment of the
external shunt
Risk for Hemorrhage,
infection or clotting
Potential for skin erosion
around the catheter site

22.  Avoid getting shunt wet
 Wrap a dressing completely around the shunt and
keep it dry and intact
 Keep cannula clamps at the bed side or attached
the arteriovenous disconnection
 Teach the client that shunt extremity should not
use for monitoring BP, Drawing blood, Placing Iv
line and drug admini.
 Monitor skin integrity
 Auscultate bruit and palpate thrill although a
bruit not be heard with the shunt

23.  Fibrin – white flecks noted in the tubing
 Separation of Serum and cell
 Thrill Absent on palpation
 Coolness of the tubing or extremity
 Tingling sensation at site or in extremity

24. Hemodialysis Apparatus
Dialyzer
 Referred to as artificial kidney
 Remove excess waste and fluid from blood
 Made up of thin fibrous material fibers from a
semipermeble membrane which allows small
particles and liquid to pass through

25. Dialysate
The fluid and solute in a dialysis process that flow
through dialyzer do not pass through the
membrane and discarding along with removal
toxic substance
Composition : sodium chloride
Sodium bicarbonate
Sodium acetate
calcium chloride
Potassium chloride

27.  Tubing
 machine

29. COMPLICATION
 Low blood pressure
 Muscle cramps
 Itching
 Anemia
 Access site complication
 Febrile reaction
 Hemolysis

30.  Introduction of air into circulatory system
› Dyspnea, tachypnea, Chest Pain
› Hypotension
› Reduce oxygen saturation
› Cyanosis
› Anxiety
› Changes of sensorium

31.  Interventions
 Stop the hemodialysis
 Turn the client on the left side, with head
down
 Notify physician
 Administer oxygen
 Vital signs

32.  A rapid changes in the composition of the
extracellular fluid occurs during hemodialysis
 Solute are removed from the blood the faster than
from CSF and brain; fluid is pulled into the brain
causing cerebral edema
› Nausea, vomiting, Headache, Hypertension,
Restlessness and agitation , Muscle cramps, confusion,
Seizure

33.  Slow or stop the dialysis
 Notify the physician
 Prepare the administre IV hypertonic saline
solution, albumin, or manitol if prescribed

34.  An aluminium Toxicity from dialysate water
sources containing aluminum; also can occur
from ingestion of aluminum containing antacid
(phosphorus binders)
› Progressive neurological Impairment
› Mental Cloudiness
› Speech disturbance
› Muscle incoordination, bone pain, Seizure

35.  Monitor for the sign of encephalopathy
 Notify physician
 Administering aluminum Chelating agents as
prescribed so that the aluminum is released
and dialyzed from the body

36. NURSING CARE
Weight and volume status : assess BP, weight
Remove restrictive clothing or jewelry from
arm
Avoid pressure on vascular site
Hand hygiene
Review laboratory records
Hold the medication

37. PERITONEAL DIALYSIS
The process uses the patient peritoneum in
abdomen as a membrane across which fluid
and dissolved substance are exchanged
from blood

38.  Peritoneal membrane is large and porous,
allowing solutes and fluid to move via osmosis
from an area of higher concentration to lower
concentration in the dialyzing fluid.
 The peritoneal cavity reach in capillaries
therefore it provides a ready access to the
blood supply.

39. Indication
 Patient who are not willing and unable to
undergo to hemodialysis
 ARF
 CRF

40.  Peritonitis
 Recent abdominal surgery
 Abdominal Adhesion
 Other GI problems Such as Diverticulities

41. Procedure
 preparation of patient
• Explain the procedure
• Baseline data's are recorded
• Patient is encourage to empty bowel and
bladder
• Broad spectrum antibiotic

42.  A siliconized rubber catheter such as Tenckhoff
Catheter is surgically inserted into the client’s
Peritoneal cavity to allow infusion of dialysis fluid
 The preferred Insertion site is 3 to 5 cm below
Umbilicus this area is relatively avascular and has
less fascial resistance
 The catheter is tunneled under the skin, through
the fat and muscle tissue to the peritoneum; it is
stablize with inflatable Darcon cuffs in the muscle
and under skin

43.  Over a period of 1 to 2 weeks following
insertion, fibroblast and blood vessels grow
around the cuffs, fixing the catheter in place
and providing an extra barrier against
dialysate leakage and bacterial invasion
 If the client is scheduled fro transplant surgery
the peritoneal catheter may either be removed
of left in place if the need for dialysis is
suspected post transplantation.

45.  Preparing equipment (Dialysate solution)
 The Solution is sterile
 All Dialysis solution are prescribed by the
physician; the solution contain electrolytes
and minerals and has a specific osmolarity,
specific glucose concentration and other
medication additives as prescribed
 The higher the glucose concentration, the
greater the hypertonicity and the amount of
fluid removed during a peritoneal dialysis
exchange

46.  The higher glucose concentration, the grater
the hyper tonicity and the amount of fluid
removed during peritoneal dialysis exchange
 Increasing the glucose concentration increases
the concentration of active particles that cause
osmosis, increase the rate of ultra filtration
and increases the amount of fluid removed
 Heparin is added to prevent clotting
 Insulin may added – if client is DM

47.  Performing exchange
1. Infusion (fill)- dialysate infused by gravity
in to peritoneum
5-10 min is usually required to infuse
2. Dwell- time allow to diffusion and osmosis
3. Drainage- drain from peritoneal cavity by
gravity

48. TYPES
Continuous ambulatory peritoneal dialysis
(CAPD)
1.5 – 3 liter of diaysate fluid instilled in the
abdomen and left place for a prescribed
period of time
 Solution drain by gravity flow
 Use four dialysis cycle every 24 hours

49. Automated peritoneal dialysis
 Use of peritoneal cycling machine
 This method can be performed as
continuous and cyclic

50. COMPLICATION
• Fever , abdominal tenderness
• nauseaPeritonitis
• Displacement, obstruction, fluid
leakage
• Incomplete healing
Catheter
related
• Pain
• Hypotension
• Over hydration
Dialysis
related

52.  Kidney transplantation involves
transplanting a kidney from living donor or
deceased donor to recipient who have no
longer has renal function

53.  A living donor is a person who is alive at the
time of donation and may or may be related
to recipient
 A deceased or cadaveric transplant comes
from someone who has died and donated his
or her organ

54.  Native kidney not usually removed
 Transplant kidney is placed in the patient
iliac fossa anterior to iliac crest because it
allow for easier access to the blood supply
needed to perfuse kidney

55.  Preoperative MGT
 Complete physical examination of the donor
and recipient
 Assess the bladder neck function
 Patient must free from infection
 Psychosocial evaluation
 Hemodiaysis perform before prior to
transplantation
 Consent
 Dietary restriction

56. Postoperative management
Assessing patient for transplant rejection:
oliguria, edema, fever, increase BP, Weight
Preventing infection:
Monitoring urinary function
Monitoring complication

57. Contraindication
 Malignancy
 Active or chronic infection
 Sever irreversible disease
 HIV
 Hepatitis B and c
 Diabetes and HTN