renal dialysis

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  • 1. Remove waste products Fluid control BP control RBC production Keeping bones healthy

2. We may feel sick, sleepy, confused or nauseous. (waste products) We will feel tired and pale. (RBC) We may have ankle swellings & start to feel breathless. (extra fluid) We may have bad breath & loss of appetite. (waste products) 3. PRESENTED BY ANU ISSAC 4. First form of dialysis practised by Romans. 1854- the term dialysis was used for the first time by Thomas Graham. 1913- first article on hemodialysis- Artificial kidney 1920s- first dialysis performed by George Hass 1948- first successful dialysis in Mount Sinai hospital by Willem Kolff 5. 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 into a dialysis solution (dialysate) 6. Hemodialysis Peritoneal Dialysis 7. OSMOSIS 8. DIFFUSION 9. Ultrafiltration 10. 1. blood 6. dialysate 7. body 2. access 3. tx w/ heparin 4. dialyser 5. solute exchange 4-6 hours 11. Cleanses the blood of accumulated waste products Removes the by-products of protein metabolism (urea, creatinine & uric acid) Removes excessive fluids Maintains or restores the buffer system of the body Maintains or restores electrolyte levels 12. Removal of solutes and water from the blood across a semipermeable membrane 13. Selective filter for removing toxic or unwanted solutes from the blood 14. Rectangular cross section, parallel plate dialyser. 15. CIRCULAR CROSS SECTION; HOLLOW FIBER DIALYSER 16. Organic cellulose derivatives Synthetic membranes 17. DIALYSATE The fluid that is pumped through the dialyser on the opposite side of the semi permeable membrane to the patients blood. Correct the chemical composition of uremic blood to normal physiological levels. 18. SOLUTE CONCENTRATION SODIUM (mmol/L) 135- 143 POTASSIUM(mmol/L) 0-4 CHLORIDE 100- 111 CALCIUM 1.25 1.75 MAGNESIUM 0.75- 1.5 BICARBONATE 30- 35 GLUCOSE 0- 25 gm 19. Sodium chloride ; Na+ 176 gm ; 82 mEq/L Potassium chloride ; K+ 5.50 gm ; 2.0 mEq/L Calcium chloride ; Ca + 8.00 gm ; 3.0 meq/L Magnesium chloride ; Mg ++, Cl - 2.75 gm ; 0.75 mEq/L, 88.0 mEq/L Acetic acid 9.0 gm ; 4.0 mEq/L Purified water 1 liter 20. Sodium chloride 235 gms Sodium bicarbonte 600 gms Na + 55 mmoles HCO3- 35 mmoles Cl- 20 mmoles 21. Na + - 137 mEq/L K + - 2 mEq/L Ca ++ - 3.0 mEq/L Mg ++ - 0.75 mEq/L Cl - 108 mEq/L HCo3 35 mEq/L CH3COO 4 mEq/L 22. Filtration Activated carbon filters (adsorption) Water softners Reverse osmosis (RO) De ionization Ultraviolet light exposure 23. The removal of air The removal of any chemicals 24. PERMANENT VASCULAR ACCESS Arterio venous fistulas (AVFs) Arterio venous grafts (AVGs) Shunts 25. Advantages Disadvantages less danger of clotting and bleeding can be used indefinitely decreased incidence of infection no external dressing required freedom of movement cannot be used immediately after insertion venipuncture is required for dialysis infiltration of needles hematoma aneurysm in the fistula Arterial steal syndrome Congestive heart failure 26. Advantages Disadvantages less danger of clotting and bleeding can be used indefinitely decreased incidence of infection no external dressing required freedom of movement cannot be used immediately after insertion venipuncture is required for dialysis infiltration of needles hematoma aneurysm in the fistula Arterial steal syndrome Congestive heart failure 27. Access is formed by the surgical insertion of 2 silastic cannulas into an artery or vein in the forearm or leg to form an external blood path. 28. Advantages Disadvantages can be used immediately after insertion no venipuncture necessary for dialysis external danger of disconnecting or dislodging the shunt risk of hemorrhage, infection or clotting skin erosion around the catheter site 29. Rope ladder puncture Area puncture Button hole puncture 30. Thrombosis Stenosis of fistula Aneurysm Steal syndrome Infection 31. Subclavian vein Internal jugular vein Femoral vein 32. for acute dialysis In the patient who is imminently awaiting a kidney transplant for maturation of AV access Limited availability of vessels Patients undergoing plasmapheresis For continuos renal replacement therapies Patients on peritoneal dialysis requiring temporary hemodialysis because of peritonitis. 33. may be inserted for short term or temporary use in acute renal failure usually filled w/ heparin & capped to maintain patency between dialysis treatments may be left in place for up to 6 wks if complications do not occur 34. may be inserted for short term or temporary use in acute renal failure client should not sit up more than 45 or lean forward, or the catheter may kink & occlude. an IV infusion pump w/ microdrip tubing should be used if a heparin infusion through the catheter is prescribed 35. Weight Blood volume monitoring Blood pressure Temperature and pulse Serum biochemistry and hematology 36. Kt / V 1.2 URR 65% Albumin - >35 g/L Potassium 3.5 6.5 mmol/L Phosphate - < 1.8 mmol/L Calcium b/w 2.2 and 2.6 mmol/L Hb - > 10 g/L 37. URR( urea reduction ratio) = 100 (1- Ct/Co) Ct= post dialysis urea Co= pre dialysis urea 38. ETO Gamma irradiation Steam sterilization Electron or e-beam sterilization 39. Hypotension Muscle cramps Loss of blood Hepatitis Sepsis Disequilibrium syndrome Vascular steal Dialyser Reaction Hemolysis Air embolism 40. PERITONEAL DIALYSIS Adequate Patient Care in the Most Biocompatible Way 41. Sodium 132- 142 Potassium 0- 4 Calcium 2.5- 3.5 Magnesium 0.5- 1.5 Lactate 35- 40 Chloride 101- 107 pH 5.0- 5.8 Dextrose 1.5- 4.25 gm/dL 42. Inflow (fill) 10 minutes Dwell ( equilibration) 20 minutes to 8 or more hours Drain - 15 to 30 minutes 43. Automated peritoneal dialysis (APD) Continuous ambulatory peritoneal dialysis (CAPD) 44. Continuous cycling peritoneal dialysis ( CCPD) Nocturnal intermittent peritoneal dialysis (NIPD) Intermittent peritoneal dialysis (IPD) Tidal peritoneal dialysis (TPD) 45. Requires a peritoneal cycling machine called a cycler Can be done as intermittent peritoneal dialysis, continuous cycling peritoneal dialysis, or nightly peritoneal dialysis 46. 1. The dialysate is instilled into the peritoneal cavity through an implant catheter attached to a transferline, which is attached to a bag of dialysate. 2. Once the fluid has been instilled completely into the peritoneal cavity, the empty bag and transferline are folded up and worn in a cloth pouch beneath the clothing. Thus, the patient is free to ambulate and resume his normal daily activities. 47. 3. When it is time to drain off the effluent, the bag is unfolded, placed on the floor and drainage is achieved by gravity. A new bag of dialysate is then attached to the transferline and the process is repeated. Usually the solution exchange procedure takes about 15 minutes. 48. o FREEDOM FROM DIALYSIS MACHINE o CONTROL OVER DAILY ACTIVITIES o OPPURTUNITIES TO AVOID DIETARY RESTRICTIONS 49. History of multiple abdominal surgeries. Recurrent hernias Obesity Pre existing vertebral disease Severe obstructive pulmonary disease 50. Exit site infection Peritonitis Abdominal pain Outflow problems Hernias Lower back problems Bleeding Pulmonary complications Protein loss Carbohydrate and lipid abnormalities Encapsulating sclerosing peritonitis & loss of ultrfiltration 51. Venous access therapies [venovenous] Arterial access therapies [arteriovenous] 52. Venous access therapies o Continuous venovenous ultrafiltration (CVVU) o Continuous venovenous hemofiltration (CVVH) o Continuous venevenous hemodialysis (CVVHD) 53. ARTERIAL ACCESS THERAPIES SLOW CONTINUOUS ULTRFILTRATION (SCUF) CONTINUOUS ARTERIOVENOUS HEMOFILTRATION (CAVH) CONTINUOUS ARTERIOVENOUS HEMODIALYSIS (CAVHD) 54. 1) Fluid volume excess related to fluid accumulation/ inadequate dialysis 2) Risk for fluid volume deficit related to rapid removal of fluid during treatment 3) Risk for altered tissue perfusion related to risk of vascular access clotting/ disconnection 4) Risk for infection related to presence of access site and invasive procedure 5) Body image disturbance related to presence of access site. 55. Pain/discomfort related to dialysis process. Altered thought process related to dialysis diaequilibrium syndrome Ineffective individual/ family coping related to diagnosis of chronic illness Noncompliance to prescribed treatment regimen 56. a)Imbalanced nutrition, less than body requirement related to protein loss in the dialysate b)Risk for infection realted to presence of peritoneal dialysis catheter. c) risk for imbalanced fluid volume related to hypertonicity of the dialysate or inadequate exchange. d) activity intolerance to related to fatigue e) risk for complications related to the disease condition and dialysis procedure 57. 1) TUCKER MARTIN SUSAN, CANOBBIO. M. MARY, PAQUETTE VARGO ELEANOR WELLS FYFE MARJORIE, PATIENT CARE STANDARDS, COLLOBORATIVE PRACTICE PLANNING GUIDES, 6TH EDITION, 1996, MOSBY PUBLICATIONS, USA, PAGE NO:- 690-696. 2) THOMAS NICOLA, RENAL NURSING, THIRD EDITION (2008). BALLIERE TINDALL, ELSEVIER PUBLICATIONS, CHINA, PAGE NO: 181-244. 3) KALLENBACH Z. JUDITH, GUTCH F.C, STONER H.MARTHA., COREA L. ANNA, REVIEW OF HEMODIALYSIS FOR NURSES AND DIALYSIS PERSONNEL, SEVENTH EDITION, 2005, ELSEVIER PUBLICATION ,MISSOURI, PAGE NO: 61- 136. 4) LEWIS. L SHARON,HEITKEMPER McLEAN, MARGARET, DIRKSEN RUFF SHANNON, OBRIEN GRABER PATRICIA, BUCHER LINDA, LEWIS MEDICAL AND SURGICAL NURSING, ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEM, 7TH EDITION, 2011, ELSEVIER PUBLICATIONS, India, PAGE NO: 1216-1223.

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