Haemodialysis is a medical procedure that removes waste and fluid from the blood using an artificial kidney machine and dialyzer. It was pioneered by Dr. Willem Kolff in 1943. Conditions like acute renal failure and chronic renal failure can necessitate haemodialysis when they lead to acid-base imbalances, electrolyte abnormalities, fluid overload, or uremia. The goals of haemodialysis are solute clearance and fluid removal through diffusion and ultrafiltration across a semi-permeable membrane. It requires a dialyzer, dialysis solution, blood tubing, and a machine. Access points like arteriovenous fistulas and catheters are used to connect the patient's blood to the

1. By
PRADEEP.S
BSC (N), MBA

2. DEFINITION
 A medical procedure to remove fluid and waste
products from the blood and to correct electrolyte
imbalances. This is accomplished using a machine
and a dialyzer, also referred to as an "artificial kidney."

3. Dr. WILLEM KOLFF
 FATHER OF DIALYSIS
 HE WAS THE FIRST TO CONSTRUCT A WORKING
DIALYSER IN 1943

4. CONDITIONS WHICH LEADS TO
HAEMODIALYSIS
1. ARF
a. Decreased renal blood flow
b. Damage to kidneys
c. Hydronephrosis
2. CRF
a. DM (40%)
b. Hypertension (25%)
c. Glomerulonephritis

5. INDICATIONS
 Acid base imbalance ( pH< 7.1)
 Electrolyte imbalance ( K+ > 6.5 mEq/ L)
 Intoxication (Alcohol or drug intoxication)
 Overload of fluids ( pulmonary oedema)
 Uremic syndrome (↑ed level of urea & CR)

6. GOAL OF HAEMODIALYSIS
1. Solute clearance
2. Fluid removal

7. PRINCIPLES OF HAEMODIALYSIS
1. DIFFUSION : Passive movement of solute across a
semipermeable membrane
2. ULTRAFILTRATION : Solute + fluid removal across
semipermeable membrane down a pressure gradient

9. ULTRAFILTRATION

10. HAEMODIALYSIS APPARATUS
a. Dialyser
b. Dialysis solution ( dialysate)
c. Tubings for transport of blood
d. Dialysis Machine

11. DIALYSER

12. DIALYSATE
A solution used in dialysis to draw fluids and
toxins out of the blood stream and supply electrolytes
and other chemicals to the blood stream.
Contents of dialysate
Na+ : 137 mEq/L
K+ : 2 mEq/L
Ca++ : 7 mg/dl
Mg++ : 0.75 mEq/L
Cl- : 108 mEq/L
HCO3-- : 35 mEq/L

13. TUBINGS OF DIALYSIS

14. HAEMODIALYSIS MACHINE

15. ACCESS 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

16. AVF

17. AVG

18. Cuffed tunnelled dialysis catheter

19. Internal jugular vein

20. Femoral vein

21. Assessment of patient before
dialysis
1. Weight
2. Serum biochemistry , serology and haematology
3. Blood pressure
4. Temperature and pulse
5. Assessing Hepatitis B vaccination status
BEFORE HD
 Take consent
 Verification of physician’s order

22. Process of dialysis

23. Process of dialysis

24. Process of dialysis

25. Effect of dialysis
Blood result of CRF pt Content of dialysate Post dialysis values
1. CR – 8mg/dl CR- 0 mg/dl (8+0)/2 = 4 mg/dl
2. Urea – 100 mg/dl Urea - 0 mg/dl (100+0)/2 = 50 mg/dl
3. Na+ - 137 mEq/L Na+ - 137 mEq/ L (137+137)/2 = 137 mEq/L
4. K+ - 8 mEq/L K+ - 2 mEq/L (8+2)/2 = 5 mEq/L
5. HCO3- 18 mEq/L HCO3- 35 mEq/L (18+35)/2= 26.5mEq/L

26. Complications of haemodialysis
1. Hypotension
2. Muscle cramps
3. Loss of blood
4. Air embolism
5. Hypoglycemia
6. Dialyser reaction
7. Disequilibrium syndrome
8. Haemolysis
9. Sepsis
10. Vascular steal

27. Post dialysis care
 Needle site care
 Monitoring of post HD vitals
 Collection of sample for post HD investigations
 Administration of medication such as Inj. Espogen
 Measurement of weight
 Diet education & fixing next appointment

28. THANK
YOU……...