DIALYSIS

Done by:
Sadoun K. AL-
Dughmi


311100190
Dialysis
a method of removing toxic substances
(impurities or wastes) from the blood when
the kidneys are unable to do so.
most frequently used for patients who have
kidney failure, but may also be used to
quickly remove drugs or poisons in acute
situations. This technique can be life saving
in people with acute or chronic kidney
failure.


Dialysis: Methods
Hemodialysis
Peritoneal Dialysis
Indications for Dialysis
Acidosis
Electrolytes
Ingestions
Overload
Uremia
Peritoneal Dialysis
peritoneal
membrane =
partially
permeable
membrane
dextrose dialysate
diffusion and
osmosis until
equilibrium
3-10 dwells per
night with 2-2.5 L
per dwell
Hemodialysis
A dialysis process
which requires a
machine to
transport the blood
and dialysing fluid
on either side of a
semi-permeable
membrane to effect
the removal of
toxic metabolites
and excess water

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Hemodialysis: Functions
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
Hemodialysis: Access
Subclavian and femoral
catheter
External arteriovenous shunt
Internal arteriovenous fistual
Internal arteriovenous graft
Subclavian (vein) Catheter

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
Femoral (vein) Catheter
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
External AV Shunt
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.

External AV Shunt
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

Internal AV Fistula
for chronic dialysis
clients
created surgically by
anastomosis of a large
artery & a large vein in
the arm
Maturity: veins
become engorged due
to the flow of arterial
blood into the venous
system; takes 1-2
wks.
Maturity is required
before the fistula can
be used



Arteriovenous Fistula
Highest patency
Lowest risk of infection
Low risk of thrombus

Maturation time (3-
4mo)
Steal syndrome (poor
blood supply to the
rest of the limb)
Aneurysm formation


Internal AV Fistula
Advantages Disadvantages
less danger of clotting
and bleeding
can be used
indefinitely
decreased incidence of
infection
no external dressing
required
cannot be used
immediately after insertion
venipuncture is required
for dialysis
infiltration of needles
hematoma
aneurysm in the fistula
Arterial steal syndrome
Arteriovenous Graft
Easier to create
Maturation time 3-6
weeks

Poor patency (often
requires
thrombectomy or
angioplasty)
Infection
Aneurysms
Steal syndrome
Internal AV Graft
for chronic dialysis clients who
do not have adequate blood
vessels for the creation of a
fistula
Gore-Tex or a bovine (cow)
carotid artery as artificial vein
for blood flow
Procedure involves the
anastomosis of the graft to the
artery, a tunneling under the
skin, and anastomosis to a
vein.
can be used 2 wks after
insertion
Complications: clotting,
aneurysms and infection


Internal AV Graft
Advantages Disadvantages
less danger of clotting
and bleeding
can be used
indefinitely
decreased incidence of
infection
no external dressing
required
cannot be used
immediately after insertion
venipuncture is required
for dialysis
infiltration of needles
hematoma
aneurysm in the fistula
Arterial steal syndrome

How long do hemodialysis
treatments last?


Usually, each hemodialysis treatment lasts about four hours
and is done three times per week.