The document summarizes the key components and functions of a hemodialysis apparatus. It discusses the blood circuit and dialysate circuit, which meet at the dialyzer. It describes the components that pump blood and dialysate, monitor parameters like temperature, conductivity and pressure, and control ultrafiltration. Emergencies related to clinical issues from improper dialysate or power failure are also briefly outlined.
During hemodialysis, a hemodialyzer, or artificial kidney, is used to filter fluids and wastes from a dialysis patient's blood. Reuse of a hemodialyzer means that the same hemodialyzer (filter) is used more than once for the same patient. When dialyzers are reused, they are cleaned and disinfected after each treatment.
During hemodialysis, a hemodialyzer, or artificial kidney, is used to filter fluids and wastes from a dialysis patient's blood. Reuse of a hemodialyzer means that the same hemodialyzer (filter) is used more than once for the same patient. When dialyzers are reused, they are cleaned and disinfected after each treatment.
he water to be used for the preparation of haemodialysis fluids needs treatment to achieve the appropriate quality. The water treatment is provided by a water pre-treatment system which may include various components such as sediment filters, water softeners, carbon tanks, micro-filters, ultraviolet disinfection units, reverse osmosis units, ultrafilters and storage tanks. The components of the system will be determined by the quality of feed water and the ability of the overall system to produce and maintain appropriate water quality.
he water to be used for the preparation of haemodialysis fluids needs treatment to achieve the appropriate quality. The water treatment is provided by a water pre-treatment system which may include various components such as sediment filters, water softeners, carbon tanks, micro-filters, ultraviolet disinfection units, reverse osmosis units, ultrafilters and storage tanks. The components of the system will be determined by the quality of feed water and the ability of the overall system to produce and maintain appropriate water quality.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Introduction
•The process of hemodialysis pumps the patients’ blood
against dialysate that may be generated by the dialysis
machine or at a central location
•Dialysis machines are essentially composed of pumps,
monitors, and alarms that allow safe proportioning of dialysate
•Knowledge of the components of a dialysate circuit
are important for patient safety and care
3.
4. The systems Approach
● The HD machine cannot be isolated from the rest
● It is a part of an assembly
■ The HD machine
■ The extracorporeal circuit
■ The dialyzer
■ The water treatment system
■ Dialysate concentrate supply
■ The data network
Polaschegg HD, Contrib Nephrol 2002.137;227-235
5. Ideal Dialysis Machine
● The utilitarian philosopher's ‘ideal’:
■ Achieve minimum required dialysis dose
■ Achieve accuracy in controlled values
■ Achieve quality while controlling costs
■ The ‘ideal’ machine does not exist and will never exist
6. Hemodialysis apparatus
• Hemodialysis apparatus can be divided into 2 circuits
• Blood circuit
• Dialysis solution circuit
• The two circuits meet at the dialyser
9. Blood pump
Blood is pumped in the circuit @ 200-600 ml/min
The blood pump has 2 rollers compressing the tubing,
forcing the blood along the tube
adaptable to different sized tubing if required clinically
can be operated manually in case of power loss
calibrated to measure blood flow based on the
internal diameter of the tubing BFR= RPM x tubing
volume (π.r2 x length)
10. Excessively Negative
Arterial pressure
• Low BP
• Catheter /needle malposition
• Kink/Clot
• Suction/spasm of vessel wall
• Stenosis in AVF
• Long small bore needles
11. The Venous Chamber
1.Allows for determining
Positive pressure on the
blood access site
2.Allows for separation of
air bubbles (excessive air, when
present, may still enter the patient)
12. High venous pressure alarm
• High Qb, narrow needle
• Clot in the venous drip
chamber, needle, venous limb
• Spasm of venous limb of AV access
• Kink in the venous return line
• Needle malposition
Low venous pressure alarm
• Disruption of connections
anywhere downstream from
the blood pump to and
including the venous needle
and access
• Low blood flow (upstream of
blood pump).
13. Venous Pressure
Monitor reading
Height difference
Intra-access
pressure
Venous monitor: Pressures and Heights
Ribitsch W. et al Seminars in Dialysis 2013
➢ The fistula
pressure
➢ Qb, viscosity
➢ Flow
resistance
➢ The height
difference
betweenAVF
and the level in
the venous
chamber
14. ➢In the absence of blood flow
➢Venous pressure reading = Intra access pressure
(when corrected for height difference between the access and the
pressure monitor)
➢ When needle slips out from access but remains at the same
height, the venous pressure will decrease by the amount of the
access pressure
15. ❑Determinants of Venous pressure
• Intra-access pressure
• Qb
• Needle length/gauge/ thickness
• Blood viscosity
• With narrow gauge needles and high Qb, the relatively higher flow
resistance within needle may prevent the venous pressure to fall
low enough to set off the alarm
• The lower limit of the venous pressure alarms are usually set 30-
40 mm below the access pressure
16. Fistulae have much lower pressure than grafts
AVG 60 mm Hg ; AVF 32 mm Hg
Over 90% AVG have access pressures >40
Only 30% AVF have access pressures >40
18. In just 5-7 minutes a patient on HD can lose 40% of blood
Volume from a Venous Needle dislodgement
UK Renal unit Survey [Clinical Directors and Lead renal nurses]
▪ Estimated prevalence/incidence of dislodgement
▪ UK ~ 100/year (0-4 episodes/unit/year)
▪ ~ 1/100,000 haemodialysis sessions
▪ Severity
▪ 1 death (0.6%)
▪ 6.4% Moderate/Severe harm (e.g. hospitalization)
▪ 93.0% No/Mild Harm
19. Dialysate Circuit Outline
The main components of the dialysate circuit
include:
• Deaeration
• Dialysate proportioning and conductivity
• Dialysate formulation
• Monitors, alarms, and conductivity
• Ultrafiltration: Volumetric and flow-sensor control
• Dialysate disinfection and rinsing
20. Dialysis Machine
Dialysate Circuitry
•Once pure product water has been generated,
bicarbonate and acid solutions are mixed with water
to form dialysate solution
•Mixing or proportioning may be done by the individual
machine or centrally in a dialysis unit
•Several components of proportioning ensure safe
dialysate that is monitored by a series of alarms,
pumps, and monitors
•Fluid ultrafiltration occurs by volumetric or flow
sensor controllers
•Disinfection prevents bacterial overgrowth
22. Degassing Dialysate Water
•Treated water inflows into the dialysis machine and
passes through a heat exchanger prior to entering the
heater
•Heating the treated water assists in degassing the cold water
•Water is heated to body temperature (33°–39°C) by stainless
steel heating elements
•Temperature is monitored downstream by a special
temperature monitoring device
23. Deaeration
•Water heated to physiologic temperatures is
subjected to negative pressure to remove any air
•Air in the water can interfere with dialysate flow and
cause “air trapping”
•Negative pressure is maintained by a closed loop
composed of a pump, constricting valve, air trap, and
vent
•Heating treated water to 85C followed by cooling
prior to proportioning can also de-gas purified
water
25. Dialysate Proportioning
•Proportioning assures proper mixing of heated and treated
water to produce the appropriate dialysate solution
•Proportioning pumps mix premade fresh dialysate acid (A)
and bicarbonate (B) solution
•Acid solutions contain acid/chloride salts including sodium,
potassium, calcium, magnesium, and acetate
•Bicarbonate solutions are made fresh, since pre-prepared
bicarbonate can release CO2 and encourage bacterial
growth
26. Dialysate Proportioning
•Dialysate solutions are passed through a small filter prior
to and after formation
•Potential problems include:
• Incorrect bicarbonate or acid concentrate
• Inadequate dialysate mixing
• Clogged filters
• Device alarms disarmed by the operator
• Precipitation of calcium or bicarbonate salts
28. Dialysate Modeling
•Sodium
• Sodium modeling can be used to maintain hemodynamic
stability during ultrafiltration. However, some controversy
exists regarding its use due to the increased incidence of
patient thirst, which may lead to more intradialytic weight gain
and fluid retention
• Sodium modeling programs are available on dialysis
machines and allow alteration of sodium concentration over
time
29. Dialysate Monitoring
•pH
• The recommended pH range is 6.8–7.6. Not all machines
have a monitor, but dialysate pH should be monitored each
session
•Temperature
• A heat sensor monitors dialysate temperature near the dialyzer
and provides a short feedback loop for changes. Temperature
should be between 35– 42C
• Low temperatures can cause shivering
• High temperatures can cause protein denaturing or hemolysis
30. Dialysate Monitoring
•Conductivity
• Conductivity is the amount of electrical current
conducted through a dialysate and reflects electrolyte
concentration
• A constant voltage is applied across two electrodes 1 cm
apart in the dialysate flow. If the concentration of electrolytes
changes, the voltage will change
• Conductivity should be between 12–16mS/cm (millisiemens
per centimeter). The greater the number of ions, the greater
the conductivity of the dialysate
• Conductivity can be affected by temperature, or
concentration of acid to base
• Alarms will stop dialysate flow if conductivity is out of limits
32. Alarms—Conductivity
•Conductivity alarms can occur in the following:
• An empty concentrate jug
• Change in electrolyte concentration of dialysate
• Abnormal water inlet pressure
• Water leaks or puddles beneath the mixing chamber
• Concentration line connector unplugged
•The conductivity settings should never be adjusted while
the patient is on the dialysis machine
33. Alarms—Temperature and Pressure
Monitors
• Temperature Monitor
• A malfunctioning heating element can cause abnormal dialysate
temperatures
• Cool temperatures (<35C) will result in shivering
• Warm temperature (>42C) can cause protein denaturing or hemolysis
(>45C)
• Pressure Monitor
• The pressure range is –400 to +350 mmHg with an accuracy of ± 10%
• Alarm limits are set at ± 10% of the pressure setting
• Pressure in the dialysate compartment should not exceed that in the blood
compartment or there is an increased risk of blood contamination by
unsterile dialysate secondary to dialyzer membrane rupture and back
filtration
• Ultrafiltration (UF) is controlled by transmembrane pressure (TMP)
• TMP = PBO – PDO
34. Blood Leak Monitor
•Blood should not cross the blood/dialysate membrane
•Leakage of blood into the dialysate circuit is detected by the
blood leak monitor, which is usually located downstream
from dialyzer
•Infrared or photoelectric cells detect decreases in light
from source
•Red blood cells scatter light and trigger alarm, which
deactivates the blood pump
36. Volumetric-based Ultrafiltration
•Ultrafiltration is the process of removing fluid from the patient in
a controlled fashion, during which volume is accurately
measured
•Most dialysis machines use volumetric-based control,
which uses a balancing chamber(s) composed of 2
compartments separated by a flexible membrane
•One side of the membrane allows fresh dialysate in, while
the other allows spent or used dialysate out
37. Volumetric-based Ultrafiltration
•Valves are connected on the inlet and outlet and allows fluid to
enter one side of the chamber, which pushes an equal amount
of fluid out of the other side of the chamber
•One chamber fills with used dialysate and pushes fresh
dialysate to the dialyzer, while the other chamber is filling with
fresh dialysate and pushes used dialysate to the drain
• One pump moves proportioned dialysis to the balance
chambers; a second pump pulls dialysate from the dialyzer
and pushes it to the balance chambers
38. Ultrafiltration Pump
•The UF pump or the fluid removal pump removes fluid from
the closed loop, which results in fluid removal from the
dialyzer membrane
•Most UF pumps are piston type and placed in the used
dialysate flow path by negative pressure
•When the UF pump is off, there is no pressure gradient
between the blood and dialysate and no fluid is removed from
the patient
40. Ultrafiltration: Flow Control
•Flow-control UF has flow sensors on the inlet and outlet
side of the dialyzer that allow control of dialysate flow
•A post-dialyzer UF pump removes fluid at an UF rate
calculated by the dialysis machine
44. Dialysate Disinfection and Rinsing
•Dialysis machines should be disinfected according to the
manufacturer’s recommendations, usually daily
•The dialysate circuit should be exposed to disinfectant
•Reused bicarbonate/acid containers should be disinfected between use
•Disinfectants and rinse solutions include:
Formaldehyde
Hypochlorite (bleach)
Peracetic acid
•Machines should be rinsed between chemicals and before a dialysis
session
•Dead space is needed between dialysate effluent line and drain
•Some dialysis machines incorporate a bacterial and endotoxin-retentive
ultrafilter that prevents bacterial contamination. This is termed
“ultrapure dialysate”
45. Emergencies—Clinical
32
• Dialysis machine proportioning problems can result in severe serum
electrolyte abnormalities. Some of these emergencies include:
• High or low serum sodium, potassium, calcium or magnesium
• High or low plasma osmolarity due to hyper- or hypo-osmolar dialysate
• Clinical emergencies can occur if significant levels of contaminants are in the
dialysate
• Copper or cupraphane may be released from heating element or dialyzer
and can cause severe hemolysis
• Chloramines and nitrates can cause severe hemolysis
• Fluoride can cause severe pruritis, nausea, and ventricular tachycardia or
fatal ventricular fibrillation
• Aluminum can cause bone disease, anemia, and fatal progressive
neurologic deterioration commonly known as dialysis encephalopathy
syndrome
• Lead, copper, zinc, and aluminum can leach from metal pipes and cause
anemia
46. Emergencies—Power
33
•Power Failure
• In the event of loss of power, the system is no longer safe for
dialysis patients. Blood should be returned manually to
patients and patients taken off the machine if power is not
restored in 15–30 minutes