Hemodialysis is a process used to remove waste and excess fluid from the blood of patients with kidney failure. During hemodialysis, blood is pumped out of the body and into a dialyzer, where it passes through a semi-permeable membrane that removes toxins and fluid before returning clean blood to the body. Key aspects of hemodialysis include diffusion of wastes out of the blood, osmosis which removes excess water, and ultrafiltration of water under pressure. Patients typically require hemodialysis treatments lasting 4 hours, 3 times per week, either at a dialysis center or at home. Lifestyle management and monitoring for complications are important for patients on chronic hemodialysis

1. HEMODIALYSIS
PRESENTED BY
DR.SHALI B.S
PROFESSOR
MAMATA COLLEGE OF NURSING.KHAMMAM

2. INTRODUCTION
Dialysis is used to remove fluid and uremic waste products from the
body when the kidneys cannot do so. It may also be usedto treat
patients with edema that does not respond to treatment,hepatic coma,
hyperkalemia, hypercalcemia, hypertension, anduremia. Methods of
therapy include hemodialysis, continuous renal replacement therapy
(CRRT; discussed later), and various forms of peritoneal dialysis.

3. MEANING
Hemodialysis is a process of cleansing the blood of accumulated waste
products. It is used for patients with end-stage renal failure or for
acutely ill patients who require short-term dialysis.
• A dialyzer (once referred to as an artificial kidney) serves as a
synthetic semipermeable membrane, replacing the renal glomeruli
and tubules as the filter for the impaired kidneys.

4. Principles of Hemodialysis
The objectives of hemodialysis are to extract toxic nitrogenous
substances from the blood and to remove excess water. In
hemodialysis, the blood, laden with toxins and nitrogenous wastes, is
diverted from the patient to a machine, a dialyzer, in which the blood
is cleansed and then returned to the patient.
• Diffusion
• Osmosis
• Ultrafiltration.

5. Diffusion: The toxins and wastes in the blood are removed by
diffusion—that is, they move from an area of higher concentration in
the blood to an area of lower concentration in the dialysate. The
semipermeable membrane impedes the diffusion of large molecules,
such as red blood cells and proteins.

6. • Osmosis: Excess water is removed from the blood by osmosis, in
which water moves from an area of higher solute concentration (the
blood) to an area of lower solute concentration (the dialysate bath).
• Ultrafiltration is defined as water moving under high pressure to an
area of lower pressure.

8. Procedure
• The patient's access is prepared and cannulated.
• Heparin is administered (unless contraindicated).
• Heparinized blood flows through a semipermeable dialyzer in one direction,
and dialysis solution surrounds the membranes and flows in the opposite
direction.
• Dialysis solution consists of highly purified water to which sodium,
potassium, calcium, magnesium, chloride, and dextrose have been added.
Bicarbonate or acetate is also added to achieve the proper pH balance.
• Through the process of diffusion, solute in the form of electrolytes,
metabolic waste products, and acidic base components can be removed or
added to the blood.
• Excess water is removed from the blood (ultrafiltration).
• The blood is then returned to the body through the patient's access.

9. Requirements for Hemodialysis
• Access to the patient's circulation
• Dialysis machine and dialyzer with semipermeable membrane
• Appropriate dialysate bath
• Time approximately 4 hours, three times weekly
• Place dialysis center or home (if feasible)

10. Methods of Circulatory Access
• Arteriovenous fistula (AVF) creation of a vascular communication by
suturing a vein directly to an artery
• Usually, radial artery and cephalic vein are anastomosed in nondominant arm;
vessels in the upper arm may also be used.
• After the procedure, the superficial venous system of the arm dilates.
• By means of two large-bore needles inserted into the dilated venous system,
blood may be obtained and passed through the dialyzer. The arterial end is
used for arterial flow and the distal end for reinfusion of dialyzed blood.
• Healing of AVF requires several weeks; a central vein catheter is used .

11. • Arteriovenous graft arteriovenous connection consisting of a tube
graft made from autologous saphenous vein or from
polytetrafluoroethylene. Ready to use in 2 to 3 weeks.
• Central vein catheters direct cannulation of veins (subclavian, internal
jugular, or femoral); may be used as temporary or permanent dialysis
access.

12. Monitoring During Hemodialysis
• Involves constant monitoring of hemodynamic status, electrolyte, and
acid–base balance as well as maintenance of sterility and a closed
system.
• Usually performed by a specially trained nurse who is familiar with
the protocol and equipment being used.

13. Lifestyle Management for Chronic Hemodialysis
• Dietary management involves restriction or adjustment of protein,
sodium, potassium, or fluid intake.
• Ongoing health care monitoring includes careful adjustment of
medications that are normally excreted by the kidney or are dialyzable.
• Surveillance for complications.
• Arteriosclerotic cardiovascular disease, heart failure, disturbance of lipid
metabolism (hypertriglyceridemia), coronary heart disease, stroke
• Intercurrent infection
• Anemia and fatigue
• Gastric ulcers and other problems
• Bone problems (renal osteodystrophy, aseptic necrosis of hip)—from
disturbed calcium metabolism
• Hypertension
• Psychosocial problems: depression, suicide, sexual dysfunction

14. • REHABILITATION
• Encouragement: Patients, families, and staff need encouragement to adopt
a positive attitude toward rehabilitation.
• Education: Patients need to understand their disease. They need to learn
strategies for successful adaptation to dialysis and how to maximize
functional status, among many other subjects. Parents, staff, and
employers require education about the many positive life options of
dialysis patients.
• Exercise: Exercise is critical to rehabilitation, just as with heartndisease.
Many levels of activity to fit the different abilities of renal patients are
helpful, from vigorous workouts to stretching exercises.
• Employment: The primary goal is to allow dialysis patients to keep their
current jobs whenever possible. If not possible, vocational rehabilitation
counseling should be used.
• Evaluation: Systematic evaluation of rehabilitation outcomes is necessary
to identify and measure which interventions have made an impact.

15. Complications of Vascular Access
• Infection
• Catheter clotting
• Central vein thrombosis or stricture
• Stenosis or thrombosis
• Ischemia of the hand (steal syndrome)
• Aneurysm or pseudoaneurysm

16. REFERENCES
1.Sandra MN. The Lippincott manual of nursing practice. 7th ed.
Lippincott: Jaypee brothers; 2003. P. 770-73.
2. Rochelle LB, Maribeth. American association of critical care nurses,
procedure manual for critical care. Philadelphia: WB Saunders
company; 1993. P. 555-58