HAEMODIALYSISBy

PRADEEP.SBSC (N), MBA

DEFINITION

A medical procedure to remove fluid and waste products from the blood and to correct electrolyte imbalances. This is accomplished using a machine and a dialyzer, also referred to as an "artificial kidney."

Dr. WILLEM KOLFF FATHER OF DIALYSISHE WAS THE FIRST TO CONSTRUCT A

WORKING DIALYSER IN 1943

CONDITIONS WHICH LEADS TO HAEMODIALYSIS 1. ARF a. Decreased renal blood flow b. Damage to kidneys c. Hydronephrosis 2. CRF a. DM (40%) b. Hypertension (25%) c. Glomerulonephritis

INDICATIONSAcid base imbalance ( pH< 7.1)Electrolyte imbalance ( K+ > 6.5 mEq/ L)Intoxication (Alcohol or drug intoxication)Overload of fluids ( pulmonary oedema)Uremic syndrome (↑ed level of urea & CR)

GOAL OF HAEMODIALYSIS

1. Solute clearance 2. Fluid removal

PRINCIPLES OF HAEMODIALYSIS 1. DIFFUSION : Passive movement of solute

across a semipermeable membrane

2. ULTRAFILTRATION : Solute + fluid removal across semipermeable membrane down a pressure gradient

ULTRAFILTRATION

HAEMODIALYSIS APPARATUS a. Dialyser b. Dialysis solution ( dialysate) c. Tubings for transport of blood d. Dialysis Machine

DIALYSER

DIALYSATE A solution used in dialysis to draw

fluids and toxins out of the blood stream and supply electrolytes and other chemicals to the blood stream.

Contents of dialysate Na+ : 137 mEq/L K+ : 2 mEq/L Ca++ : 7 mg/dl Mg++ : 0.75 mEq/L Cl- : 108 mEq/L HCO3-- : 35 mEq/L

TUBINGS OF DIALYSIS

HAEMODIALYSIS MACHINE

ACCESS FOR HAEMODIALYSIS 1. Arterio venous fistula ( AVF ) 2. Arterio venous graft ( AVG ) 3. Cuffed, tunneled dialysis catheter 4. Temporary access sites a. Internal jugular vein b. Femoral vein

AVF

AVG

Cuffed tunnelled dialysis catheter

Internal jugular vein

Femoral vein

Assessment of patient before dialysis 1. Weight 2. Serum biochemistry , serology and

haematology 3. Blood pressure 4. Temperature and pulse 5. Assessing Hepatitis B vaccination status BEFORE HD Take consent Verification of physician’s order

Process of dialysis

Process of dialysis

Process of dialysis

Effect of dialysisBlood result of CRF pt

Content of dialysate

Post dialysis values

1. CR – 8mg/dl CR- 0 mg/dl (8+0)/2 = 4 mg/dl

2. Urea – 100 mg/dl Urea - 0 mg/dl (100+0)/2 = 50 mg/dl

3. Na+ - 137 mEq/L Na+ - 137 mEq/ L

(137+137)/2 = 137 mEq/L

4. K+ - 8 mEq/L K+ - 2 mEq/L (8+2)/2 = 5 mEq/L

5. HCO3- 18 mEq/L

HCO3- 35 mEq/L

(18+35)/2= 26.5mEq/L

Complications of haemodialysis 1. Hypotension 2. Muscle cramps 3. Loss of blood 4. Air embolism 5. Hypoglycemia 6. Dialyser reaction 7. Disequilibrium syndrome 8. Haemolysis 9. Sepsis 10. Vascular steal

Post dialysis care Needle site care Monitoring of post HD vitals Collection of sample for post HD

investigations Administration of medication such as Inj.

Espogen Measurement of weight Diet education & fixing next appointment

THANK YOU……...