Hemodialysis Unit

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  • HEMODIALYSIS

    ROCHI P. BENITO, RN MSNJunior Assistant Manager

    MANILA DOCTORS HOSPITAL

  • DESCRIPTIONS:

    Hemodialysis is the diffusion of dissolved particles from one fluid compartment into another across a semipermeable membrane.

    The clients blood flows through one fluid compartment, and the dialysateis in another fluid compartment

  • FUNCTIONS OF HEMODIALYSIS:

    Cleanses the blood of accumulated waste products

    Removes the by-products of protein metabolism such as urea, creatinine, and uric acid.

    Removes excessive fluids

    Maintains or restores the buffer system of the body

    Maintains or restores electrolyte levels

  • PRINCIPLE OF DIALYSIS

  • PRINCIPLES OF HEMODIALYSIS: Diffusion is the movement of particles

    from an area of greater concentration to one of lesser concentration

    Osmosis is the movement of fluids across a semipermeable membrane from an area of lesser concentration of particles to an area of greater concentration of particles

    Ultrafiltration is the movement of fluidacross a semipermeable membrane as a result of an artificially created pressure gradient

  • DIALYSATE BATH:

    A dialysate bath is composed of water and major electrolytes

    The dialysate need not be sterile because bacteria are too large to pass through; however, the dialysate must meet specific standards, and water treatment systemsare used to ensure a safe water supply

  • DIALYSATE

  • DIALYSIS MACHINE

  • DIALYSIS SET-UP

  • NOSOCOMIAL INFECTION ASSOCIATED WITH HEMODIALYSIS:

    Dialysis patient have a compromised immune system and other disorder that place them at risk for infectious diseases

  • A typical hemodialysis system consist of a water supply

    A system for mixing water and concentrated dialysis fluid

    A machine to pump the dialysis fluid through the artificial kidney

    Which we refer to as hemodialyser or dialyser

    Bacterial and chemical contaminant in hemodialysis system

  • The dialyser is connected to the patient circulatory system, and the blood pump through it to accomplished dialysis by means of a membrane to removed waste product from the patients blood

    Bacterial and chemical contaminant in hemodialysis system

  • BACTERIAL CONTAMINATION OF WATER

    There are many situations where certain types of gram negative bacteria can persist and actively multiply in aqueious environment associated with hemodialysis equipment

    This may affect patient by septicemia or endotoxemia.

  • E.g. water borne bacteria

    Acinetobacter

    Aeromonas

    Serratia

    xanthomonas

    BACTERIAL CONTAMINATION OF WATER

  • WATER SUPPLY

    1. Water treatment system water used for the production of dialysis fluid must be treated to remove chemical and microbial contaminants

    e.g. reverse osmosis and water softener

  • 2. Distribution system - water that has passed through the water system , may be distributed to individual dialysis machine where it is combined with dialysate concentrate

    Routine disinfection of water or dialysate should be performed at least weekly

    An ultrfilter distal to the storage tank is recommended

    WATER SUPPLY

  • 3. Hemodialysis machine to ensure adequate disinfection of the machine . The disinfectant must reach all parts of the systems fluid pathways

    BACTERIAL CONTAMINATION OF WATER

  • Disinfection of the hemodialysis system

    The total dialysis system (water treatment system, distribution system, dialysis machine) should be included in the disinfection procedure.

    Chlorine-based disinfectant, such as sodium hypochloride solution, are convenient and effective in most parts of the dialysis system

  • Aqueious formaldehyde, peroxyacetic acid or glutaraldehyde solution produces good disinfection results.

    BACTERIAL CONTAMINATION OF WATER

  • Monitoring of water and dialysis fluid

    Water samples should be collected from a source as close as to where water enters the dialysate concentrate proportioning unit

    Water samples should be collected at least monthly

    Dialysis fluid samples should be collected during or at the termination of dialysis from a sourece close to where the dialysis fluid enters or leaves the dialyser.

  • Hemodialyser reuse

    Dialyser can be reuse if performed according to strict and established protocol.

    Reprocess hemodialysers constitute high level rather than sterilization

    Peracetic acid and glutaraldehyde are effective

    Also formaldehyde need to exposed up to 36 hours

  • Other Bacterial Infection

    Vascular access infection

  • AV FISTULA CARE

  • DIALYSIS EQUIPMENTS

  • INTERNAL AV FISTULA (Inside View)

  • AV FISTULA (Outside View)

  • INTERNAL AV GRAFT (Inside view)

  • The following precaution should be used during care of all dialysis patient

  • Patient should have a specific station assigned to them, like chairs and tables should be clean after use

    Sharing of ancillary supply, like BP cuff, scissors, thermometer, trays should be avoided

    Non disposable items should be clean or approximately disinfected between use

    Medications should be prepared and distributed from centralized area.

  • Clean and contaminated area should be separated

    Separate handwashing area

    Disposal of blood and waste should be separated

    pantry room should always be closed

  • Non-disposable equipment should be cleaned and disinfected or sterilized.

    Wear disposable gloves when touching the patient.

    Also, wear mask, face shield or eye wear during cleaning of the dialyser

    Special care should be taken to prevent needle sticks injury. NEVER RECAP

  • Staff Nurse should not smoke, eat or drink in the dialysis treatment area

    The patients dialysis record should include all mishaps, demographic data, laboratory results, and all incidences, like needle sticks injury.

    Also include the machine use

    And prophylactic measures

  • Prevention of Infection at Hemodialysis

    Patient with infection shall be treated in a separate room and uses a machine designated only for patien with such case

    Dialyser of the patient with hepatitis shall be discarded after use

  • Prevention of Infection at Hemodialysis

    Nurses caring for such patient should adhere to standard precaution

    Proper disposal of waste and other consumable shall be followed

    New patient shall undergo hepatitis screening and other blood test

  • Prevention of Infection at Hemodialysis

    All patient who have non-reactive anti-Hbs result should received 3 doses of hepatitis vaccine

    All regular patient should have their hepatitis profile every 6 months

    Terminal cleaning of room should be done

  • Prevention of Infection at Hemodialysis

    Patient with HIV/AIDS shall be reported to HACT for counselling

  • The End