DIALYSIS

ANEEZ. KIST YEAR MSC. NURSING

EMS CON

Definition

Dialysis is the movement of fluid and molecules across a semipermeable membrane from one compartment to another. Clinically dialysis is a technique in which substances move from the blood through a semipermeable membrane and in to a dialysis solution called dialysate.

Historical Evolution in the Field Of Dialysis It was the romans first used a form of dialysis

therapy by using hot bath to patients to remove urea.

1854 the first time the term dialysis was used by Thomas Graham

1889 BW Richardson First referred the use of collodion membrane in the dialysis of blood .This help the living animals were dialysed in experimental conditions.

1914 Hess & McGuigan were experimenting with dialysis in a pharmacology lab in Chicago. As a result they were able to transfer sugar from tissue to blood and from the blood across a collodion membrane.

1920s the first dialysis performed on human was carried out by George Hass. He used hirudin as an anticoagulant and later a crude form of heparin. He was honoured as a pioneer of dialysis.

1923 Heinrich Necheles was discovered contemporary dialyser.

In mid 1930s purification of the heparin occur. 1937 an American scientist, William Thalhimer use

first synthetic membrane.

In 1945 William Kolff first clinical experience was gained on a 29 year old women with chronic nephritis. The blood urea was kept stable for 26 days but after 12 sessions of dialysis her blood urea began to increase and she subsequently died.

After the world war Kolff technique was wildly used.

In 1950s Allis Chalmers Corporation was one of the first companies to produce dialysis machine commercially.

In the late 1950s Fredrik Kiil of Norway made more modification in the field of dialyser.

In 1960s the forerunner of today’s capillary – flow dialyser was produced by Richard Stewart.

Belding Scribner was introduced the shunt to provide vascular access in dialysis.

Followed by this invention hemodialysis started. In late 1970s and early 1980s the continuous

ambulatory peritoneal dialysis as the first choice of home treatment.

The innovations in the field of dialysis is reaching up to the satellite dialysing unit nowadays. And the patient surveillance rate also increase.

Principles of Dialysis Diffusion: Diffusion is the movement of solutes from an

area of greater concentration to an area of lower concentration.

Osmosis: Osmosis is the movement of fluid from an area of lesser concentration to an area of greater concentration of solutes.

Ultra filtration: Ultra filtration that is solution move when there is an osmotic gradient or pressure gradient across the membrane.

INDICATION OF DIALYSIS

Renal failure Severe electrolyte and/or fluid abnormalities Acidosis Drug overdose Poisoning

TYPES OF DIALYSIS

HEMODIALYSIS

PERITONEAL DIALYSIS

HEMODIALYSIS

HEMODIALYSIS APPARATUSBlood circuitDialysis solution circuitDialyser

BLOOD CIRCUTE

DIALYSIS SOLUTION CIRCUTE

Water Purification System

RO + Acetic Acid + NaHCO3 + KHCO3

REVERSE OSMOSIS

DIALYSER

VASCULAR ACCESS Intravenous Catheter

Non-tunnelled or Temporary CatheterTunnelled or Permanent Catheter or

Prem Cath AV fistula AV graft

INTRAVENOUS CATHETERS

Replacement therapies of HD

HEMOFILTRATION HEMODIAFILTRATION INTESTINAL DIALYSIS PLASMAFERESIS

PERITONEAL DIALYSIS

Fill phase Dwell phase Drain phase

Complications of Peritoneal DialysisPeritonitis

Catheter InfectionCuff erosionAbdominal herniasAbdominal distensionHypotension

HyperglycaemiaHypernatremia/ HypernatremiaHyperkalaemia/HypokalaemiaHypoalbuminemiaAbdominal wall and pericatheer leakGenital edemaRespiratory complicationsBack painDyslipidaemia

Psychosocial Issues in ESRD Patients

Psychological problems like,DepressionDementia/ DeliriumAnxiety and behaviour disorders

Psychosocial Issues like,Marital relationshipSexual dysfunctionSocioeconomic issuesRehabilitationQuality of lifeAltered body imageAwareness of early deathNon adherence to the medical and nursing care

BIBLIOGRAPHY John T. Daugirdas, Peter G. Blake, Todd S. Ing “Handbook of Dialysis”(2007),4th edition,

Wolters Kluwer (India) publication, page no: 59-88 Allen R. Nissenson, Richrad N. Fine “Handbook of Dialysis Therapy” (2009), 4th edition,

Elsevier Publications, page no: 703-710, 1221-1225 Nicola Thomas “Renal Nursing” (2008), 3rd edition, Elsevier Publication, page no: 73-

78, 181-232 Lewis, Dirksen, Heitkemper, Bucher “Medical – Surgical Nursing Assessment and

Management of Clinical Problems” (2011), 9th edition, Elsevier Publications, page no: 1183-1188

Lippincott “Manual of Nursing Practice” (2009), 10th edition, Wolters Kluwer (India) publication, page no: 785-788

http://en.wikipedia.org/wiki/Dialysis http://www.ncbi.nlm.nih.gov/pubmed/22916962

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