Hemodialysis-Avin's Therapy Presentation

8/7/2019 Hemodialysis-Avin's Therapy Presentation

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HEMODIALYSIS

Prepared by, Avinder Kaur Mann

Group 13


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W HAT IT DOES?y It removes was t es from th e blood.y

It removes excess fluid from th e blood andit keeps elec t roly t es well balanced.


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y

W h at sor t of th ings are excre t ed by th e kidney?y Urea - 30 g/day y Crea t inine - 2 g/day y Salt - 15 g/day y Uric Acid - 0.7 g/day y W at er - 1500 mL/day y Unknown

y Kidney failurey accumula t ion of was t ey acidosis, edema, h yper t ension, coma


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Actively Secreted Substancesy H ydroxybenzoa t esy H ippura t esy Neu t rot ransmi tt ers (dopamine)y Bile pigmen t sy Uric acidy An t ibio t icsy

Morph

iney Sacch arin


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Reabsorbed Substancesy Glucosey Amino acidsy

Ph

osph

atey Sulfat e

y Lact at ey Succina t ey Cit rat e


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F iltration and Reabsorption of W ater by the Kidneys

L/day mL/min

Filtration 170 120Resorption 168.5 119

UrineExcretion 1.5 1


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W hat does this mean in terms of

dialysis?

y Purpose - removal of was t es from th e body y Kidney sh ould be th e ideal model for h emodialysisy W at er re t en t ion / removaly Salt ret en t ion / removaly Pro t ein re t en t ion


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HOW IT W OR KS?y D ialysis works on th e principles of th e diffusion and

osmosis of salu t es and fluids across a semi permeable

membrane.y Blood flows by one side of a semi-permeable

membrane and a dialysa t e or fluid flows by th eopposi t e side.


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Mechanisms of solute clearancey D iffusive t ranspor t

y Blood from th e pa t ien t flowing wi th in th e dialysisappara t us in t erfacing wi th dialysa t e fluid via poreslocat ed wi th in eac h fiber of th e dialysis membrane

y Convec t ive t ranspor ty In th is mec h anism, solu t es are effec t ively dragged along

with fluid as i t moves across th e membrane depending

upon th eir size rela t ive t o th e size of th e membranepores.


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Diffusion (true dialysis)

y movemen t due t o concen t rat ion gradien ty If concen t rat ion is h igh er in th e blood and th e species

can passth

rough

th

e membrane,transpor

toccurs un

tilth e concen t rat ions are equal

y Slowy If dialysa t e concen t rat ion is h igh er, th e flow goes t oward

th e blood


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Convection

y Massive movemen t of f luid across membraney Fluid carries dissolved or suspended species th at can

pass th roug h th e membraney Usually as a resul t of fluid pressure (bo th posi t ive and

suc t ion pressure)y Principal means of wa t er and elec t roly t e removal

(ul t rafilt rat ion)y

Can also remove wa t er by adding glucose t o dialysa t e(osmo t ic gradien t )


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FUNC TION S OF BU TTON S OF HEMODIALYSISMAC HIN E


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y Cont ain th ousands of h ollow fibers similar inst ruc t ure t o a h umancapillary

y Types of membranesy Cellulosey Subst it ut ed cellulosey Synth et ic

Hollow fiber dialyzers


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Types of vascular accessy AV fist ulay AV graf ty Cen t ral venous ca th et ers


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C linical Indications to Start Dialysisy Pericardi t is or pleuri t isy Progressive uremic encep h alopa th y or neuropa th y, with signs suc h as

confusion, as t erixis, myoclonus, wris t or foo t drop, or, in severe cases,seizures

y A clinically significan t bleeding dia th esis a tt ribu t able t o uremiay Fluid overload refrac t ory t o diure t icsy Persis t en t me t abolic dis t urbances th at are refrac t ory t o medical

th erapy; th ese include h yperkalemia, me t abolic acidosis,h ypercalcemia, and h yperp h osph at emia

y Persis t en t nausea and vomi t ingy Hypertension poorly responsive to antihypertensive

medicationsy Weight loss or signs of malnutrition


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P ossible Indications For Early Dialysisy Most nep h rologis t s agree th at delaying ini t iat ion of dialysis

un t il one or more of th ese complica t ions is presen t may pu t th e pa t ien t at unnecessary jeopardy

y An impor t an t goal of dialysis is t o en h ance th e quali t y of life as well as t o prolong survival

y It is th erefore impor t an t t o consider less acu t e indica t ionsfor dialysis

y Est ima t ion of GFR (


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C omplications during dialysisCommon Less common but serious

y H ypot ension (20-50%)y Muscle cramps (5-20%)y Nausea (5-15%)y H eadac h e (5%)y It ch ing (5%)y

Ch

est

pain/back pain (2-5%)y Fever and c h ills (


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Intradialytic hypotensiony Th ere are t wo clinical pa tt erns of dialysis-associa t ed

h ypo t ensiony Episodic h ypo t ension, w h ich t ypically occurs during th e latt er

st ages of dialysis; th is is associa t ed wi th vomi t ing, musclecramps, and o th er vagal symp t oms (suc h as yawning).

y Ch ronic persis t en t h ypot ension, w h ich may occur in long-t erm pa t ien t s in wh om predialysis sys t olic blood pressures of less th an 100 mm H g are frequen t ly observed.


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Serious complications of dialysis

y Arrh y th miasy Especially common in pa t ien t s on D igoxin

y In t racranial bleedingy Underlying cerebrovasculardisease combined wi th th e use of h eparin

y H emolysisy Port wine appearance t o blood in re t urn linesy Sudden back/c h est painy

Associated wi

thobs

truc

tion of blood line and problems wi

th th

edialysis solu t ionsy Air embolism

y Ent ers cerebral venous sys t em in sea t ed pa t ien t sy Ent ers rig ht vent ricle in recumben t pa t ien t s

Hemodialysis-Avin's Therapy Presentation

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