its the chapter of dialysis

1. INTRODUCTION
 Dialysis is a technique in which substances move
from the blood through a semi permeable membrane
and into a dialysis solution (dialysate).
 It is used to correct fluid & electrolyte imbalances
and to remove waste products in renal failure.

2. Dialysis
 (from Greek dialusis,"", meaning dissolution, dia,
meaning through, and lysis, meaning loosening or
splitting)
 is a process for removing waste and excess
water from the blood and is used primarily as an
artificial replacement for lost kidney
function in people with kidney failure.

3. Purpose of
Dialysis
1. Used to remove fluid and uremic waste
products from the body when the kidneys
cannot do so.
2.It may also be used to treat patients with
edema that does not respond to treatment,
hepatic coma, hyperkalemia,
hypercalcemia, hypertension, and uremia.

4. Indications for
Dialysis
 The need for dialysis may be acute or chronic.
1. Acute dialysis is indicated
A.when there is a high and rising level of serum
potassium, fluid overload, or impending pulmonary
edema, increasing acidosis, pericarditis, and severe
confusion.
B.to remove certain medications or other toxins
(poisoning or medication overdose) from the blood.
2. Chronic or maintenance dialysis is indicated in
chronic renal failure, known as end-stage renal
disease (ESRD

5. Two main types of dialysis
1. HEMODIALYSIS
 most commonly used method of dialysis for patients
who are acutely ill and require short-term dialysis
(days to weeks)
 Indicated for patients with ESRD who require
long-term or permanent therapy.
 Patients receiving hemodialysis must undergo
treatment for the rest of their lives or until they
undergo a successful kidney transplant.
 Treatments usually occur three times a week for
at least 3 to 4 hours per treatment (some
patients undergo short-daily hemodialysis; )

6. HEMODIALYSIS

7. Hemodialysis
 removes wastes and water by
circulating blood outside the
body
 The anticoagulant heparin is
administered to keep blood from
clotting in the dialysis circuit
 The cleansed blood is then
returned via the circuit back to
the body
 By the end of the dialysis
treatment, many waste products
have been removed, the
electrolyte balance has been
restored to normal, and the
buffer system has been
replenished.

8. Equipment for
HEMODIALYSIS
 Dialyzers (artificial kidneys)
are either flat-plate dialyzers
or hollow-fiber artificial
kidneys that contain
thousands of tiny cellophane
tubules that act as
semipermeable membranes.
 Dialysate - a solution with
minerals (potassium and
calcium) flows in the opposite
direction with the blood
circulating around the tubules

9. GENERAL PRINCIPLES OF DIALYSIS
 DIFFUSION : It is the movement of solutes from an
area of greater concentration to an area of lesser
concentration.
 OSMOSIS : It is the movement of fluid from an area
of lesser to an area of higher concentration.
 ULTRA FILTRATION : (water and fluid removal)
results when there is an osmotic gradient or
pressure gradient across the membrane.

10. 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 the blood, loaded with toxins and
nitrogenous wastes, is diverted from the patient to a dialyzer, in which
is cleansed and then returned to the patient.
 DIFFUSION : It is the movement of solutes from an area of greater
concentration to an area of lesser concentration.
 OSMOSIS : It is the movement of fluid from an area of lesser to an area
of higher concentration.
 ULTRA FILTRATION : (water and fluid removal) results when there is an
osmotic gradient or pressure gradient across the membrane

11. Vascular Access
 Access to the patient’s vascular system
must be established to allow blood to be
removed, cleansed, and returned to the
patient’s vascular system at rates
between 200 and 800 mL/minute.
 SUBCLAVIAN, INTERNAL,
JUGULAR, AND FEMORAL
CATHETERS
 FISTULA - A more permanent access is
created surgically (usually in the
forearm) by joining (anastomosing) an
artery to a vein, either side to side or end
to side. The fistula takes 4 to 6 weeks to
mature before it is ready for use
 GRAFT - An arteriovenous graft can be
created subcutaneously when the
patient’s vessels are not suitable for a
fistula; usually placed in the forearm,
upper arm, or upper thigh.

12. Complications of Hemodialysis
 During dialysis ( hypotension, arrhythmias,
exsanguination, seizures, fever)
 Between treatments
(Hypertension/Hypotension, Edema,
Pulmonary edema, Hyperkalemia, Bleeding,
Clotting of access
 Long term : Hyperparathyroidism, CHF, AV
access failure, pulmonary edema, neuropathy,
anemia, GI bleeding,

13. Complications of Dialysis:
 Hypovolemic Shock – result of rapid removal or
ultrafiltration of fluid from the intravascular
compartment
 Dialysis-disequilibrium syndrome – caused by rapid,
efficient dialysis resulting in shifts in water, pH and
osmolarity between fluid and blood.

14. PERITONEAL DIALYSIS
2. Peritoneal dialysis removes toxins from the blood of
a patient with acute or chronic renal failure who
doesn’t respond to other treatments.
In PD, the patients peritoneal membrane is used as
a semi permeable dialyzing membrane.
More time is needed for the same effect to be
obtained than the hemodialysis.

16. PROCEDURE AND PROCESS
 The surgical insertion of a siliconized rubber (Sillastic)
catheter into the abdominal cavity is required to allow the
infusion of dialyzing fluid (dialysate) is infused according
to the physician Order.
 1 to 2L of dialysate is infused by gravity (fill) into the
peritoneal space over a 10 to 20 minutes period, according
to the client’s tolerance.
 The fluid dwells in the cavity for a specified time ordered
by the physician. The fluid then flows out of the body
(drain)by gravity into a drainage bag.
 The peritoneal outflow contains the dialysate in addition
to the excess water, electrolytes, and nitrogenous waste
products that have accumulated in the body.

17. Three phases (PD)
The three phases of the PD cycle are:
 Inflow
 Dwell
 Drain

18.  PD occurs through diffusion and osmosis across the
Semipermeable peritoneal membrane and adjacent
capillaries.
 The peritoneal membrane is large and porous.
it allows solutes, which carry fluid with them to move
by an osmotic gradient from an area of higher
concentra-tion in the body (blood) to an area of
lower concentration in the dialyzing fluid.

19. AUTOMATED PERITONEAL DIALYSIS
 An automated device called a cycler is used to
deliver the dialysate for APD. The automated cycler
times & controls the fills, dwell & drain phases. The
machine cycles 4 or more exchanges per night with
1-2 hours per exchange.

20. CONTINUOUS AMBULATORY PERITONEAL
DIALYSIS
 Instillation of 2 litres of dialysate fluid into peritoneal
cavity
 Leave for equillibration period
 Drain the dilysate fluid back from peritoneal cavity

21. Complications of CAPD
PERITONITIS-the major complication of PD. The most common cause of
peritonitis is contamination of the connection site during an exchange.
The infection of peritoneum is manifested by cloudy dialysate outflow
(effluent), fever, rebound abdominal tenderness, abdominal pain, general
malaise, nausea, and vomiting.
. Cloudy or opaque effluent is the earliest sign of peritonitis. The best
treatment of peritonitis is prevention.
. The nurse must maintain meticulous sterile technique when caring for
the PD catheter and when hooking up or clamping off dialysate bags.

22. Complications of CAPD
Pain- pain during inflow of dialysate is common during the
first few exchanges because of peritoneal irritation;
however, it disappear after a week or two. Cold dialysate
aggravates discomfort. Thus the dialysate bags should be
warmed before instillation by use of a heating pad to wrap
the bag or use of warming chamber.
Microwave oven are not recommended for the warming of
dialysate because of their unpredictable warming patterns
and temperatures.
Exit Site and Tunnel infections- the normal exit site
from a PD catheter should be clean, dry, and with
out pain or evidence of inflammation.

23. Insufficient flow of the Dialysate- Constipation is the primary
cause of inflow or outflow problems. To prevent constipation, the
physician orders a bowel preparation before placing the PD
catheter. The nurse ensures that the drainage bag is lower than the
client abdomen. The nurse inspects the connection tubing and PD
system for kinking or twisting and rechecks to make sure that
clamps are open.
Dialysate Leakage- when dialysis is initiated, small volumes of
dialysate are used. It may take clients 1 to 2 weeks to tolerate
a full 2-L exchange without leakage around the catheter site.
Other Complication- The nurse notes any change in the color of
the outflow.

24. The outflow is recorded accurately after each exchange.
Visual inspection of the outflow bag and daily weights
may be sufficient to note the adequacy of the return.
If drainage return is brown, a bowel perforation must be
suspected.
If drainage return is the same color as urine and has the
same glucose concentration, a possible bladder
perforation should be investigated.
If drainage is cloudy or opaque, an infection is
suspected.