HEMODIALYSIS MACHINE

MODEL: Fresenius/4008S

INTRODUCTION• Hemodialysis removes wastes and water by circulating blood outside the

body through an external filter, called a dialyzer, that contains a semi permeable membrane.

• The blood flows in one direction and the dialysate flows in the opposite. The counter-current flow of the blood and dialysate maximizes the concentration gradient of solutes between the blood and dialysate, which helps to remove more urea and creatinine from the blood.

• The concentrations of solutes (for example potassium, phosphorus, and urea) are undesirably high in the blood, but low or absent in the dialysis solution, Dialysis is an increasingly common type of treatment.

• The dialysis solution has levels of minerals like potassium and calcium that are similar to their natural concentration in healthy blood.

PURPOSE:

• When the nephrons in the kidneys are failure or not working properly, the ions like potassium, creatinine etc we go through dialysis.

• Diseases of renal failure are 1. Nephrotoxins2. Diabetic 3. Nephropathy 4. Hypertension 5. Glomerulonephritis6. Cystic kidney Disease

DEFINITION:• The Hemodialysis name it self contains hemo means blood and dialysis

means the diffusion of solute molecules through a semi permeable membrane, normally passing from the side of higher concentration to that 

of lower. •  Semi

 membrane is one that allows the passage of certain smaller molecules of such crystalloids as GLUCOSE and UREA, but prevents passage of larger molecules such as the colloidal plasma PROTEINS  and PROTOPLASM.

• Hemodialysis, also spelled haemodialysis, commonly called kidney dialysis or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. It is a method that is used to achieve the extracorporeal removal of waste products such as creatinine and urea and free water from the blood when the kidneys are in a state of renal failure. Hemodialysis is one of three renal replacement therapies (the other two being renal transplant and peritoneal dialysis). An alternative method for extracorporeal separation of blood components such as plasma

PRINCIPLE:

• The principle of Hemodialysis is the same as other methods of dialysis; it involves diffusion of solutes across a semi permeable membrane.

• Hemodialysis utilizes counter current flow, where the dialysate is flowing in the opposite direction to blood flow in the extracorporeal circuit.

• Counter-current flow maintains the concentration gradient across the membrane at a maximum and increases the efficiency of the dialysis.

• It involves diffusion,osmomis and ultra filtration.

DESCRIPTION:• Hemodialysis is diffusion across a semi permeable membrane (one that

allows only certain molecules to pass through it). The semi permeable membrane is used to remove the wastes from the blood and at the same time correct the level of electrolytes in the blood. Before Hemodialysis can be performed, a surgeon must make a way for the blood to be pumped out of the body and then be returned after it has been cleansed.

• To do this, the surgeon uses an artery and a vein in the forearm. • Arteries (which have muscles in their walls) bring oxygenated blood to the

body from the heart, and veins return blood to the heart, which needs to have oxygen.

• The surgeon connects the radial artery in the forearm to a large vein called the cephalic vein. This connection is called an arterio venous shunt.

• A shunt carries something from one place to another. In this case it carries blood from an artery to a vein. After this shunt is made, the veins in the forearm get big and eventually form muscles in their walls like arteries. They are now strong and can be punctured many times for dialysis.

Description cond’t

• 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.

• TYPES OF DIALYSIS: There are five types of dialysis.

1. Hemodialysis.2. Peritoneal Dialysis.3. Hemofiltration.4. Hemodiafiltration.5. Intestinal dialysis.

FRONT VIEW:

1. Monitor2. Blood Pressure Cuff3. Extracorporeal blood circuit

module4. Concentrate connectors5. Brake6. Shunt interlock for the dialyzer

connecting lines7. IV pole8. Status indicator

BACK VIEW:1. Monitor2. Sampling value3.Bracket for the dialyzer connection

lines4. Dialysate outlet tube5. Dialysate inlet tube6. Disinfection connector7. Filter8. CDS (red) option9. Drain10. Water connector (permeate)11. DIASAFE plus12. Vent tubing13. Power supply unit 

PARTS AND FUNCTIONS:S.NO PARTS FUNCTION

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 tubes.

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 the blood takes place.

4 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

1

S.NO PARTS FUNCTION

5 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 the venous pressure goes low, it probably due to disconnection/low blood flows in the circuit.

6 Air Leakage Detector The detector is settled in the venous blood line and detects as well as in the purpose of avoiding air embolus

7 Data Interfaces Dialysis machines can include USB, Ethernet, and a variety of serial interfaces to legacy hospital information systems. Wireless interfaces (such as Wi-Fi) may also be included for direct connection to the hospital wireless networks. Data card slots are also available on some designs.

8 Valves Several valves with electronic actuation are needed in the machine to allow variable mixing ratios. Various implementations are possible from simple opened/closed valves driven by solenoids to precision variable-position valves driven by stepper motors.

9 Sensors Dialysis machines require many different types of sensorsto 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.

PROCEDURE:

Step by step procedure:

1. After the dialysis procedure has been done to a patient, the machine should get ready for another new patient, we should clean the disposable tubing's and filter with sterilizing fluid and should checked with a type of litmus test.

2. When the patient arrives, the parameters like weight, blood pressure and temperature are measured.

3. For fistula procedure we have to connect to veins of arms or legs. For catheter procedure we have to connect to large veins at chest.

4. Then the patient is connected to the machine with complete loop, then the timer and pump are started.

5. Hemodialysis is under process.6. Periodically for every half hour, the blood pressure is taken. If, low blood

pressure can cause cramping, nausea, shakes, dizziness, lightheadedness, and unconsciousness .

7. The amount of fluid to be removed is set by the dialysis nurse according to the patient's "estimated dry weight."

Procedure cond’t8. At the end of the procedure time, the patient is disconnected from the

plumbing. Needle wounds are bandaged with gauze, held for up to 1 hour with direct pressure to stop bleeding, and then taped in place.

9. Temperature, standing and sitting blood pressure, and weight are all measured again. Temperature changes may indicate infection. BP discussed above. Weighing is to confirm the removal of the desired amount of fluid.

10.Care staff verifies that the patient is in condition suitable for leaving. The patient must be able to stand, to maintain a reasonable blood pressure, and be coherent.

RISKS:1. Anemia: due to the procedure associated blood losses and mild effect on oxygen

transporting function.2. Hematocrit (Hct): It levels, a measure of red blood cells, are typically low in

ESRD patients. This deficiency is caused by a lack of the hormone erythropoietin.3. Cramps, nausea, vomiting, and headaches: Some patients experience cramps and

flu-like symptoms during treatment. These can be caused by a number of factors, including the type of dialysate used, composition of the dialyzer membrane, water quality in the dialysis unit, and the ultra filtration rate of the treatment.

4. Hypotension: Because of the stress placed on the cardiovascular system with regular Hemodialysis treatments, patients are at risk for hypotension, a sudden drop in blood pressure. This can often be controlled by medication and adjustment of the patient's dialysis prescription.

5. Infection: Patients can also get infections through surroundings. The room and area used for patients must be kept clean.

6. Infectious diseases: There is a great deal of blood exposure involved in dialysis treatment, a slight risk of contracting hepatitis B and hepatitis C exists. The hepatitis B vaccination is recommended for most patients.

ADVANTAGES:

• Low mortality rate• Better control of blood pressure and abdominal cramps• Less diet restriction• Better solute clearance effect for the daily hemo dialysis: better tolerance

and fewer complications with more frequent dialysis

DISADVANTAGES:

• Restricts independence, as people undergoing this procedure cannot travel around because of supplies' availability

• Requires more supplies such as high water quality and electricity• Requires reliable technology like dialysis machines• The procedure is complicated and requires that care givers have more

knowledge• Requires time to set up and clean dialysis machines, and expense with

machines and associated staff

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