1. HEMO-
DIALYSIS
MACHINE
P R E S E N T E D B Y : G H I N A J O U N Y
H A S S A N E Z Z E D I N E
O M A R N A S S E R
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2. Objectives
•Introduction
•Kidney function
•Kidney failure
•Definition of hemodialysis
•Principle of hemodialysis
•Function of hemodialysis
•Dialysis machine
•What does dialysis machine do?
•Types of dialysis
•Principle of dialysis machine
•Difference between diffusion and convection
•Require of hemodialysis
•Ingredient of dialysate solution
•Dialyzer
•Dialysate preparation
•Procedure
•Parts and function
•Dialysis access
•Risks
•Advantages
•Disadvantages
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3. Introduction:
Dialysis patients are all too familiar with the routine of their
treatments: Go to the clinic, get weighed, have their temperature
and blood pressure taken, get stuck with needles (unless the patient
has a catheter access), have tubes connected from their access to
the dialyzer and then sit in the chair until it is time to go home.
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5. Kidney failure
Kidney failure, or renal failure, occurs when the kidneys fail to function
adequately.
1- Acute renal failure (ARF) occurs when a rapid loss of renal function results
in poor urine production, electrolyte disturbance, and fluid balance
disturbance
2- Chronic renal failure (CRF) or chronic kidney disease (CKD) occurs when a
progressive loss of kidney function occurs over a period of months to years
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6. Definition of hemodialysis
Hemo=blood dialysis=diffusion
1. Hemodialysis (HD) refers to the process of using an artificial kidney to clear urea, metabolic waste
products, toxins, and excess fluid from the blood. The term dialysis refers to the net movement of solutes
and water across a semipermeable membrane along a concentration gradient.
2. Semi membrane is one that allows the passage of certain smaller molecules of such crystalloids as UREA,
but prevents passage of larger molecules such as PROTEINS and RED BLOOD CELLS.
3. Hemodialysis is the extracorporeal exchange of water and solutes between blood and an artificial
solution termed dialysate, across manufactured semipermeable.
4. Hemodialysis is a process of purifying the blood of a person whose kidneys are not working normally.
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7. Principles of hemodialysis
Schematic representation of solute
transport across the semi-permeable
dialysis membrane. The plasma
concentration of urea and creatinine is
high resulting in diffusive movement
down concentration gradients into the
dialysate. The reverse is true of
bicarbonate resulting in net movement
from the dialysate into the plasma
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8. Function of hemodialysis:
Cleanses the blood of accumulated waste products.
Removes the by-products of protein metabolism such as urea, creatinine,
and uric acid.
Removes excessive fluids.
Maintains or restores the buffer system of the body.
Maintains or restores electrolyte levels.
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9. Dialysis machine
Dialysis is a treatment for people whose kidneys are failing.
When you have kidney failure, your kidneys don’t filter
blood the way they should. As a result, wastes and toxins
build up in your bloodstream. Dialysis does the work of your
kidneys, removing waste products and excess fluid from the
blood.
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11. What does my dialysis machine do?
The dialysis machine mixes and monitors the dialysate. Dialysate is
the fluid that helps remove the unwanted waste products from your
blood. It also helps get your electrolytes and minerals to their proper
levels in your body. The machine also monitors the flow of your
blood while it is outside of your body. You may hear an alarm go off
from time to time. This is how the machine lets us know that
something needs to be checked.
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12. Types of dialysis
There are two different kinds of dialysis used in medicine: Hemodialysis and
peritoneal dialysis. The methods for performing dialysis may be different, but
the goal of the treatment is the same, that is, to remove waste products. These
wastes are composed mainly of nitrogen in the form of urea, uric acid, and
creatinine.
1- Hemodialysis
2-Peritoneal dialysis
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15. Diffusion
The toxins and wastes in the blood are removed by diffusion- that is, they move from an area of
higher concentration the in blood to an area of lower concentration in dialysate. The semi
permeable membrane impedes the diffusion of large molecules, such as red blood cells and
proteins.
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16. Osmosis
Excess water is removed from the blood by osmosis, in which water moves from an area of
higher concentration (the blood) to an area of lower solute concentration (the dialysate bath).
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19. Requires of hemodialysis:
The delivery of hemodialysis is technically demanding and requires:
1. access to the patient's vasculature(Av fistula ,Av graft, jugular ,femoral or sub clavien catheter
(temporary or intermittent)
2. a hemodialyzer
3. an extracorporeal blood circuit
4. a dialysis delivery system to formulate and deliver the dialysate, control blood flow in the
extracorporeal circuit, deliver anticoagulant, and monitor the integrity and safety of the entire
dialysis process
5. physiologic monitoring equipment
6. a source of purified water
7. a specifically trained and dedicated nursing and professional staff.
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21. Dialyzer
Hollow fibers
During hemodialysis, your blood goes through a filter, called a dialyzer, outside your
body. A dialyzer is sometimes called an “artificial kidney”. Dialyzer is a filter is
composed into many, very thin, hollow fibers.
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22. Dialysate
preparation:
Water ultra-pure
(7 Bar)
Water machine
connector
PRV : pressure
reducing valve
(0,4 bar)
Heater exchanger
Heater
sleeve gaz separation
Mixing chamber
Duplex pump
Note : Always we measure the pressure.
-we have two mixing chambers: first mix water with acid and the second mix
water and acid with base.
-heater exchange and heater: warm the water.
-Sleeve: for air bubble. 22
24. Procedure (cont.)
1. Two tubes are connected via your hemodialysis access. Blood flows from your body into the
machine through 1 of the tubes.
2. A pressure monitors and pump work together to keep the flow at the right rate.
3. Heparin solution is used to prevent blood clotting.
4. Your blood enters the dialyzer, where it is filtered.
5. Dialysate solution enters the dialyzer. It draws the waste out of your blood.
6. Used dialysate solution is pumped out of the machine and discarded.
7. Your blood goes through another pressure monitor and an air trap to make sure it’s safe to go
back into your body.
8. Your cleaned blood returns to your body through the second tube attached to your access site.
9. Always we measure the pressure.
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25. Parts and function:
S.NO Parts Functions
1 Dialysis machine blood pump
and tubing
A blood pump simply pumps the blood from the body into the
machine through specially made tubes.
2 Syringe The syringe contains a drug called heparin which prevents the
blood from clotting in the tube.
3 dialyzer The dialyzer is a large canister containing thousands of small
fibers through which patient blood is passed. The dialyzer is the
key part of a dialysis machine where the cleaning of blood takes
place.
4 Air leakage detector The detector is settled in the venous blood line and detects as
well as in the purpose of avoiding air embolus.
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26. Parts and function (cont.)
S.NO Parts Function
5 Alarms in order to protect the patient from any errors in functioning. The
things that are monitored with alarms include:
• Blood pressure within the machine
• Blood pressure of the patient
• Blood flow
• Temperature
• Dialysate mixture
6 Pressure monitor • Arterial pressure monitor: Detects the pressure between the
blood access and the blood pump.
• Venous pressure monitor: It normally detects positive pressures. If
If the venous pressure goes low, it probably due to
disconnection/low blood flows in the circuit
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27. Parts and function (cont.)
S.NO Parts Function
7 Data interface Dialysis machines can include USB, and a variety of serial interfaces
interfaces to legacy hospital information systems. Wireless
interfaces (such as Wi-Fi) may also be included for direct
connection to the hospital wireless networks.
8 Valves Several valves with electronic actuation are needed in the machine
machine to allow variable mixing ratios
9 sensors Dialysis machines require many different types of sensors to
monitor various parameters. Blood pressure at various points in
the extracorporeal circuit, dialysate pressure, temperature, O2
saturation, motor speed, dialyzer membrane pressure gradient,
and air are all monitored for proper values during dialysis
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28. Dialysis access
•Provides location for easy access to patient’s body for dialysis .
•Three types of dialysis access:
AV fistula
1.Catheter
1.AV graft
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29. Dialysis access (cont.)
1- AV Fistula
Vein cross-cut, attached end to side to artery
High-pressure flow dilates and thickens vein
Best alternative:
Lowest infection risk
Longest lasting with least thromboses
Drawbacks
Takes 2-4 months to mature
Only about 50% ever mature
Goal for all dialysis patient
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30. Dialysis access (cont.)
2-AV graft:
Tube made of biocompatible material attached end to side to artery and vein
Often required in patients with vascular disease, occluded distal veins
Advantages
Ready to use when swelling resolves(~2weeks)
Able to use in most patients
Disadvantages
High stenosisthrombosis rate
Moderate infectious risks
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31. Dialysis access (cont.)
3-Catheter (IJ most common)
Tunneled under skin to reduce communication from skin flora
with blood
Advantages
Ready for use immediately
Disadvantages
High infectious risk
High thrombosis risk
AW increased mortality
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32. Risks:
1- Anemia : due to the procedure associated blood losses and mild effect on oxygen transporting
function.
2- Hematocrit : measure of red blood cells.
3- Cramps, nausea, vomiting, and headaches
4- Hypotension
5- Infection
6-Infection diseases: ex hepatitis
7-sleeps problems.
8-bone diseases.
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33. Advantages:
Low mortality rate
Better control of blood pressure and abdominal cramps
Better solute clearance effect for daily hemodialysis: better tolerance and fewer
complications with more frequent dialysis.
Patients usually only have three treatments per week; giving them four days off
No equipment or supplies have to be kept at home
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35. Disadvantages:
Travel to a dialysis center may be required three times a week
Access sites run the risk for infection
Strict renal diet and fluid restrictions are required
Some patients experience discomforts such as headaches, nausea, leg cramps,
tiredness, and weakness
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