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 client’s 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 system’s 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 patient’s 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