Haemodialysis is a medical procedure that uses a machine and dialyzer, also called an artificial kidney, to remove fluid, waste, and correct electrolyte imbalances from the blood of patients with kidney failure. The dialyzer contains bundles of capillary tubes through which the patient's blood circulates, while a dialysis solution circulates on the outside of the tubes, allowing diffusion and ultrafiltration to take place. Common complications of haemodialysis include hypotension, cramps, nausea and vomiting, and headaches. More serious potential complications include disequilibrium syndrome and dialyzer reactions such as anaphylaxis.

1. Procedure & Complication
of Haemodialysis
Angel Das Y.L
No:17

2. Haemodialysis
Medical procedure to remove fluid
& waste products from blood & to correct electrolyte
imbalance.
done using a haemodialysis machine & dialyzer
also called as ‘artificial kidney.’

3. Indications For Dialysis
 Acidosis ( pH< 7.1)
 Electrolyte imbalance ( K+ > 6.5 mEq/ L)
 GFR <10ml/min
 Overload of fluids ( pulmonary oedema)
 Uremic symptoms (↑ed level of nitrogenous waste products)

4. Principle Of Haemodialysis
1. DIFFUSION : Passive movement of solute
across a semipermeable membrane
2. ULTRAFILTRATION : Solute + fluid removal
across semipermeable membrane down a
pressure gradient

5. Haemodialysis Apparatus
a. Dialyzer
b. Dialysate
c. Blood delivery system

6. Dialyzer(Artificial Kidney)
 Plastic chamber – contains bundles of capillary
tube through which blood circulates while
dialysis solution travels outside the bundle in
opposite counter current direction.
 Diffusion & ultrafiltration happens here.

7.  Membranes using in dialyser
-Cellulose
-Substituted Cellulose-
cellulose acetate
-Cellulosynthetic-Cellosyn/
Hemophan
-Synthetics-polyacrylonitrile,
polysulfone,polymethyl methacrylate

8. Dialysate
 Solution used in dialysis which has same solute concentration as those in plasma.
 Water used in the dialysate is purified by reverse osmosis.
 Contents of dialysate
Na+ - 136-140mmol/L
K+ - 0-4mmol/L
Mg2+ -0.25-0.75mmol/L
HCO3- 27-40mmol/L(buffer)
Dextrose- 0-5.5mmol/L

9. Blood Delivery system
 Blood Pump – moves blood from access
site through the dialyzer &
back to the patient
 Blood flow Rate – 250-500 ml/min

10. Acess for Haemodialysis
1. Arterio venous fistula ( AVF )
2. Arterio venous graft ( AVG )
3. Cuffed tunneled dialysis catheter
4. Temporary access sites
a. Internal jugular vein
b. Femoral Vein
c. Subclavian Vein

11. Arterio-Venous Fistula
o Takes 6 weeks for development(arterialization
of vein)
o Both the dialysis needles are inserted into
the native vein
Types
 Radiocephalic (first choice)
 Brachiocephalic (second choice)
 Brachiobasilic (third choice)
o Subcutaneous anastomosis of an artery to an
adjacent native vein

12. Arterio Venous Graft

13. Procedure
 Blood Flow Rate- 300-500 ml/min
 Dialysate - 500-800ml/min
Usually done – 3 times a week & each
dialysis lasts for 4 hours.

14. Complications Of Haemodialysis
 Hypotension (25-55%)
 Cramps (5-20%)
 Nausea and vomiting (5-15%)
 Headache (5%)
 Chest pain (2-5%)
 Back pain (2-5%)
 Itching (5%)
 Fever and chills (<1%)

15. Hypotension
 Causes
Volume Related
Inadequate Vasoconstriction
Cardiac Factors
Large weight gain
Short dialysis
High dialysis solution
temperature
Antihypertensives
Eating during treatment
Diastolic dysfunction
Arrhythmia

16. Muscle Cramps
 Predisposing Factors
Hypotension
Hypovolemia
High filtration Rate
Leads to vasoconstriction cause
muscle hypoperfusion leading to
muscle cramps
Low sodium dialysis
solution

17.  Nausea & Vomitting
due to hypotension
 Headache
Common
 Chestpain & Back pain
 Itching
precipitated by dialysis. May be due to hypersensitivity reaction
to dialyzer
 Fever & Chills

18. Less Common But Serious Complications
 Disequilibrium Syndrome
set of systemic & neurologic symptoms with characteristics
electroencephalographic findings occur either during / following dialysis
• Early Manifestation- Nausea , Vomitting, Restlessness & headache
• Serious Manifestation- Seizure ,Obtundation, Coma
o Cause
Acute increase in brain water content

19.  Dialyzer reactions
can be Anaphylactic type (type A) & nonspecific type (type B)
 Arrhythmia
common in patients receiving digitalis & those with coronary artery
disease
 Cadiac Tamponade
recurrent hypotension – sign of impending cardiac tamponade
 Hemolysis
its a medical emergency. Can be due to obstruction/narrowing in the
blood line & if there is any problem with dialysis solution

20. Thank you