HEMODIALYSIS MACHINE, DIALYSATE CHEMISTRY, &

DIALYSIS WATER TREATMENTEngr. APOLLO M. ARQUIZA

TOPIC OUTLINE

• WHAT IS HEMODIALYSIS MACHINE?• WHAT ARE THE BASIC FUNCTIONS?• BASIC PARTS DEFINITION & HOW IT FUNCTIONS?• WHAT ARE THE TWO TYPES OF DELIVERY SYSTEM?• WHAT IS AN EXTRACORPOREAL CIRCUITS?

DEFINITION

• HEMODIALYSIS – IS A PROCESS OF REMOVING TOXIN FROM THE BLOOD THRU DIFFUSSION,

OSMOSIS, & ULTRAFILTRATION.

• DIALYZER– IT IS A SEMIPERMEABLE MEMBRANE- describes a membrane or tissue that

allows some types of particles to pass through, but not others.– IS A DEVICE USED IN DIALYSIS TO SEPARATE TOXIN AND WATER FROM THE

BLOOD.– IT HAS TWO COMPARTMENT TO SEPARATE BLOOD AND DIALYSATE CALLED

BLOOD AND DIALYSATE COMPARTMENT

• HEMODIALYSIS MACHINES– IT IS A SOPHISTACED ELECTRONICS DEVICE THAT IS USED IN CONJUCTION

WITH A DIALYZER TO PERFORM HEMODIALYSIS PROCEDURE

Diffusion is the natural tendency of molecules to flow from higher concentrations to lower concentrations.

the flow of one constituent of a solution through a membrane while the other constituents are

blocked and unable to pass through the membrane

Osmosis

ARTERIAL

VENOUS

DIALYSATE

DIALYSATEINFLOW

Normal Dialysis

Toxin removal + UF

ARTERIAL

VENOUS

Dialysate Bypass

NO Toxinremoval

ARTERIAL

VENOUS

Dialysate Isolate

NO Toxinremoval

UF ONLY NO UF

Bypass vs Isolate

6-9

BASIC FUNCTIONS OF HEMODIALYSIS MACHINE

• HEMODIALYSIS MACHINE MIXED ELECTROLYTE BALANCE BATH CALLED DIALYSATE BATH

• THE MACHINE PUMP BLOOD FROM THE PATIENT TO THE DIALYZER AND BACK TO THE PATIENT BODY AT A PRESCRIBED RATE

• PERFORMS ACCURATE ULTRAFILTRATION RATE

• MONITOR AND GUARD IMPORTANT PARAMETERS TO ASSURE PATIENT’S SAFETY.

PARTS OF HEMODIALYSIS MACHINES

• I.V. POLE• SIGNAL / STATUS LAMP• MONITOR AND CONTROL PANEL• HEPARIN INFUSION PUMP• BLOOD PUMP • BLOOD PUMP MANUAL HANDLE• BLOODLEAK DETECTOR• VENOUS PRESSURE PORT• ARTERIAL PRESSURE PORT• AIR BUBBLE LEVEL DETECTOR & LINE CLAMP• DIALYSATE BYPASS CONNECTOR• DILYSATE SUPPLY COUPLER (BLUE)• DIALYSATE RETURN COUPLER (RED)• CONCENTRATE SUCTION PORT (ACID)• BICABONATE SUCTION PORT (BICARB)

PARTS OF HEMODIALYSIS MACHINES

• ACID & BICARB RINSE PORT• DIALYZER HOLDER• DISINFECTANT PORT • WATER SUPPLY HOSE• DRAIN HOSE• HYDRAULIC PART CAGE• ELECTRONIC PART CAGE• MAIN POWER SWITCH

Leak Detector

EffluentFrom

Dialyzer

To Heat

X’changer

Photo-resistor

Lamp

2 TYPES OF DELIVERY SYSTEM

• TWO STREAM PROPORTIONING RATIO

TYPES OF DELIVERY SYSTEM

• THREE STREAM PROPORTIONING RATIO

THE EXTRACORPOREAL CIRCUIT

• The area involve in the extracorporeal circuit are the patient blood access, bloodlines, blood pump, arterial pressure, heparin infusion pump, dialyzer blood compartment, venous pressure, blood detector, tube detector, air bubble detector, & tube clamp

THE EXTRACORPOREAL CIRCUIT

• It is a circular path of blood situated or happening outside the body with the flow route from the patient then back to the patient

• WHAT IS DIALYSATE• TYPES OF DIALYSATE• CONSTITUENTS COMPARISON• Dialysate composition• Proportioning ratio• Estimating conductivity

• AN ELECTROLYTE-BALANCED SOLUTION THAT “BATHES” AROUND THE DIALYZER FIBERS

• CARRIES AWAY TOXINS AND FLUID REMOVED FROM THE BLOOD• ELECTROLYTE LEVELS MAY DIFFER FROM BLOOD LEVELS CAUSING

ADJUSTMENT OF THESE ELECTROLYTES IN THE PATIENT• PREVENTS THE REMOVAL OF ESSENTIAL ELECTROLYTE• PRESSURE ARE APPLIED IN THE DIALYSATE COMPARTMENT

CAUSING REMOVAL OF FLUID

2 TYPES OF BATH

• ACETATE BATH – IS A BUFFER USED FOR ACID/BASE CORRECTION IN DIALYSIS

PATIENTS– RARELY USED ANYMORE– IT IS PROPORTIONED WITH 1 PART ACETATE AND 34 PARTS

TREATED WATER

• BICARBONATE BATH– TWO SEPARATE CONCENTRATES ARE USED “A” – ACIDIFIED

CONTAINS MOST OF THE NA, CA, MG, K, & CL– “B” – BICARBONATE - IT CONTAINS SODIUM (NA) AND BICARBONATE

(HCO3)– MORE COMPLEX DELIVERY SYSTEM (PROPORTIONING)

ADVANTAGES OF ACETATE

• CHEMICALLY STABLE

• NOT PRONE TO BACTERIA CONTAMINATION

• WIDE VARIETY OF FORMULAS AVAILABLE

• DELIVERY ARE MORE SIMPLER AND LESS COSTLY THAN BICARBONATE

• ACETATE MUST BE CONVERTED TO BICARBONATE BY THE BODY BEFORE IT CAN BE USED

• PATIENT’S BICARBONATE LEVEL USUALLY DECREASES AS BICARBONATE DIFFUSES ACROSS THE MEMBRANE

• CARBON DIOXIDE LEVEL DECREASES AS IT ALSO DIFFUSES ACROSS THE MEMBRANE, AND ALSO DURING THE REACTION TO PRODUCE MORE BICARBONATE

• PATIENT’S OXYGEN LEVEL DECREASES DUE TO LOWER RESPIRATOTRY RATE BECAUSE OF DECREASED CARBON DIOXIDE LEVELS

• PATIENT’S TOLERANCE TO FLUID REMOVAL IS REDUCED

DISADVANTAGES OF ACETATE

ADVANTAGES OF BICARBONATE

• DOCTORS CHOICE OF TREATMENT• LESS PATIENT COMPLICATIONS• PATIENT’S TOLERANCE TO FLUID REMOVAL IS INCREASED• PREVENT BICARB DIFFUSSION ACROSS THE MEMBRANE• DO NOT DECREASE PATIENT’S OXYGEN LEVEL

DISADVANTAGES OF BICARBONATE

• SUCEPTIBLE TO BACTERIAL CONTAMINATION

• LIQUID BICARB IS NOT STABLE AFTER 24 HOURS

• CAREFUL MIXING PROCESS OF POWDER BICARB SO AS NOT TO LOOSE CO2 FROM THE SOLUTION

• MANY FORMULATION OF ACIDIFIED SO EXTREME CARE MUST BE USED TO ENSURE THAT THE CORRECT PROPORTIONING SYSTEM IS USED

• SODIUM• POTASSIUM• CALCIUM• MAGNESIUM• BICARBONATE• GLUCOSE/DEXTROSE

• OCCASIONALY, A DOCTOR MAY REQUIRED TO ADD CERTAIN ELECTROLYTE TO THE CONCENTRATES TO RAISE THE LEVEL OF A PARTICULAR ION

• USUALLY K, Ca, or Mg

• CARE MUST BE USED TO PUT THE ADDITIVES IN THE CORRECT CONCENTRATE SO AS NOT TO CAUSE PRECIPITATION

• 1:34:1.83 OR 36.83X• 1:32.775:1.225 OR 35X• 1:42.28:1.72 OR 45X

CONDUCTIVITY MEASUREMENTS

• the ability of a substance to transmit electricity

• A simple test to assure correct proportioning

ESTIMATING FINAL CONDUCTIVITY

• ADD NA=140,CA=3.5,K=2,MG=1 (140+3.5+2+1=146.5)

• SUBTRACT 6 FROM THE SUM (146.5-6 =140.5)

• DIVIDE THE DIFFERENCE BY 10 (140.5/10=14.05)

• QUOTIENT IS THE ESTIMATED COND. (14.05 mS/cm)

WATER FOR DIALYSIS…

WATER DEFINITION

WATER IS CALLED THE UNIVERSAL SOLVENT- IN ITS PURE STATE, IT HAS A VERY HIGH ENERGY WHICH HAS THE CAPABILITY TO DISSOLVE THE QUANTITY OF MATERIAL UNTIL THE SOLUTION REACHES THE POINT OF SATURATION.

WATER - IS VERY ESSENTIAL FOR ALL LIFE.

WATER – IN DIALYSIS, IT IS ONE MAJOR COMPONENT TO PERFORM THE PROCEDURE.

THE HEART AND BLOOD OF DIALYSIS, NO WATER NO DIALYSIS CAN BE PERFORMED.

WATER EVAPORATES IN THE ATMOSPHERE FROM THE SURFACE SUPPLIES. THE EVAPORATED WATER THEN CONDENSES IN THE COOLER AIR AND RETURNS TO EARTH’S SURFACE AS RAIN,SNOW, OR OTHER PRECIPITATION. IT DISSOLVES GASSES SUCH AS CARBON DIOXIDE, OXYGEN,, AND NATURAL AND INDUSTRIAL EMISSIONS SUCH AS NITRIC AND SULFURIC OXIDES, AS WELL AS CARBON MONOXIDES. AS THE PRECIPITATION NEARS THE GROUND IT CONTINOUS TO PICK UP MANY ADDITIONAL CONTAMINANTS SUCH AS AIRBORNE PARTICULATES, SPORES, BACTERIA, AND EMISSIONS FROM OTHER COUNTLESS SOURCES.

Water Exposure

NORMAL PERSON

HEMODIALYSISPATIENTS

EXPOSURE 14 L PER WEEK 360 L PER WEEK

MECHANISMSELECTIVE ACROSS GI

TRACT

NON-SELECTIVE ACROSS THIN

DIALYSIS MEMBRANE

ELIMINATION EXCRETED BY KIDNEYS

NO RENAL EXCRETION

MEDICAL AND EQUIPMENT CONCERN

• TO PREVENT HARM TO THE PATIENT1. TO ELIMINATE BLOOD HEMOLYSIS2. TO ELIMINATE POTENTIAL PYROGENIC REACTIONS.3. TO ELIMINATE OTHER SIDE EFFECTS CAUSE BY

WATER CONTAMINATION.

• PREVENTING DAMAGE TO DIALYSIS EQUIPMENT HARD WATER CAN CAUSE PRECIPITATES OR SCALE

WHICH CAN CLOGGED UP DIALYSIS MACHINES COMPONENTS.

• WHAT IS WATER TREATMENT• WHAT SOURCE DO I HAVE ?• HOW MUCH VOLUME DO I NEED ?• WHAT QUALITY OF WATER I WANT TO HAVE ?• WHAT EQUIPMENT DO I NEED ?• WHAT MATERIALS DO I NEED ?• HOW I WILL SET IT UP ?• HOW CAN I MAINTAIN THE QUALITY OF WATER ?

• Any procedure or method used to alter the chemical composition of a water supply.

• Water purity used in hemodialysis should satisfy specific needs and standards to prevent toxicity either in the acute or chronic conditons

• GROUNDWATER – IT IS THE RAIN WATER THAT PERCOLATES DOWN THROUGH THE POROUS UPPER CRUST OF THE EARTH. IT IS FILTERED BY THAT PROCESS. IT DISSOLVES MANY GEOLOGIC MINERAL FORMATIONS SUCH AS CALCIUM, MAGNESIUM, IRON SULFATES AND CHLORIDES. THIS MINERAL-BEARING WATER IS STORED IN A NATURAL UNDERGROUND FORMATIONS CALLED AQUIFERS. THESE ARE THE SOURCE OF WELL WATER.

• SURFACE WATER – IT IS THE RAIN WATER THAT GOES DOWN TO THE OCEANS, LAKES RIVERS, AND MAN-MADE RESERVOIRS. IT CONTAINS LESS MINERAL CONTAMINATION BUT IT HOLDS A HIGHER LEVELS OF ORGANICS AND UNDISSOLVE PARTICLES.

1. MICROORGANISM & BACTERIA CONTAMINATION

2. ENDOTOXINS CONTAMINATION

3. SUSPENDED SOLIDS

4. DISSOLVE ORGANICS COMPOUNDS

5. SPECIFIC IONIC CONTAMINANTS

• QUALITATIVE IDENTIFICATION – IS USED TO DESCRIBE THE VISIBLE OR AESTHETIC CHARACTERISTIC OF WATER.

– TURBIDITY – TASTE– COLOR – ODOR

• QUANTITATIVE IDENTIFICATION – IS A MORE DEFINE WAY IN IDENTIFYING WATER IMPURITIES.

– pH– TOTAL DISSOLVE SOLIDS (TDS)– CONDUCTIVITY– STANDARD PLATE COUNT (SPC)– MOST PROBABLE NUMBER

(MPN)– DIRECT COUNT – LIMULUS AMOEBOCYTE LYSATE

(LAL)– CHEMICAL/PHYSICAL TEST

• IT IS USED TO ASSURE SUFFICIENT SUPPLIES OF WATER.

• IT ALSO SERVES AS A PROTECTION TO THE PUMPS AND REVERSE OSMOSIS.

• IT IS USED TO PROVIDE NECESSARY FLOW AND PRESSURE REQUIRED BY THE PRE TREATMENT EQUIPMENT AND REVERSE OSMOSIS

• IT IS USED TO REMOVE PARTICULATES MATTER FROM THE SOURCE WATER.

• IT IS LOCATED AFTER THE BOOSTER PUMP

• IT IS THE FIRST PRE TREATMENT EQUIPMENT IN DWTS

• IT IS USED TO REMOVE CHLORINE, CHLORAMINE AND DISSOLVED ORGANIC COMPOUNDS FROM WATER THRU ADSORPTION.

• IT ALSO IMPROVES THE TASTE AND ODOR OF THE WATER

• IT IS LOCATED AFTER THE MULTI MEDIA & BEFORE OR AFTER THE WATER SOFTENER

• IT CONTAINS GRANULAR ACTIVATED CARBON

• IT IS USED TO REMOVE CALCIUM AND MAGNESIUM (CAUSES OF WATER HARDNESS) THRU ION EXCHANE FROM THE SOURCE WATER . THRU ION EXCHANE

• IT IS LOCATED EITHER BEFORE OR AFTER THE CARBON

• IT CONTAINS INDUSTRIAL GRADE ION EXCHANGE RESIN

• IT IS USED TO REMOVE CARBON FINES AND OTHER PARTICULATES MATTER BIGGER THAN 5 MICRON IN SIZE BEFORE ENTERING THE REVERSE OSMOSIS.

• NORMALLY, IT IS INSTALLED IN THE REVERSE OSMOSIS.

AAMI recommendations forUltraviolet Disinfection

• The low pressure mercury lamp should emit a light wave-length of 254 nm and provide a dose of radiant energy of 30 milliwatt-sec/cm2 for the destruction of bacteria.

• The UV should be equipped for the anticipated maximum flow rate and have a monitor for on-line radiant energy output that activates an audible and visual alarm indicating the need for lamp replacement.

• It is recommended that UV be followed by ultrafiltration (UF) as the destruction of bacteria may increase endotoxin levels.

Ultrafiltration Ultrafiltration – It reject

contaminants in the range of 1000 Da ton 0.1μ particles such as organics, bacteria, pyrogens

- due to large pore size, UF needs low operating pressures

Microfiltration : absolute filters (0.1 - 2μ)

• IT IS USED TO PROVIDE NECESSARY FLOW AND PRESSURE REQUIRED BY THE DIALYSIS MACHINES AND ANCILLARY EQUIPMENT

• It circulates the water to all the plumbing loop back to the storage tank to prevent water stagnant water

1.DIRECT FEED

2. RECIRCULATION WITH STORAGE TANK

3. CONTINUOS FLOW SYSTEM

CLOSING THOUGTHS