2. Introduction of dialysis
Types
Dialysis process
Physiological principles
Types of peritoneal dialysis
Indications
Complications
Nursing care : before, during and after
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3. Dialysis is the procedure used to correct fluid and
electrolyte imbalances and to remove waste
products in renal failure.
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4. DO:
waste removal and fluid removal.
Do Not
Do not correct the endocrine functions of the
kidney.
Hence ,
dialysis is not a cure for kidney failure.
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7. How long does hemodialysis take?
Hemodialysis usually is done three times
a week.
Each treatment lasts from 2 to 4 hours.
During treatment, patient can read, write,
sleep, talk, or watch TV.
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11. Dialyzer are hollow-fiber artificial kidneys that
contain thousands of tiny tubules that act as
semipermeable membranes.
The blood flows through the tubules, while a
solution (the dialysate) circulates around the
tubules.
The exchange of wastes from the blood to the
dialysate occurs through the semipermeable
membrane of the tubules
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12. The blood flows in one direction and the dialysate
flows in the opposite.
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15. Diffusion- movement of solutes from an area of
greater concentration to an area of lower
concentration.
◦ In renal failure urea, creatinine, uric acid,
and electrolytes( Potassium, phosphate),
move from the blood to the dialysate with
the net effect of lowering their
concentration in the blood.
◦ But WBC’s, RBC’s and other contents
within the blood are too large to diffuse
across the membrane.
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16. The movement of fluid from an area of
lesser to an area of greater
concentration of solutes.
Glucose is added to the dialyzing
solution and creates an osmotic gradient
across the membrane to remove excess
fluid from the blood.
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17. Ultra filtration is defined as water moving under
high pressure to an area of lower pressure. This
process is much more efficient at water removal
than osmosis.
Ultra filtration is accomplished by applying negative
pressure or a suctioning force to the dialysis
membrane.
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18. Access to the patient’s vascular system must be
established to allow blood to be removed,
cleansed, and returned to the patient’s vascular
system .
Several types of access are available.
◦ Fistula
◦ Graft
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19. FISTULA
A more permanent access.
created surgically (usually in the forearm) by joining an
artery to a vein, either side to side or end to side.
The arterial segment of the fistula is used for arterial flow
and the venous segment for reinfusion of the dialyzed blood.
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FISTULA
20. The fistula takes 4 to 6 weeks to mature before
it is ready for use. This gives time for healing
and for the venous segment of the fistula to
dilate .
The patient is encouraged to perform exercises
to increase the size of these vessels (i.e,
squeezing a rubber ball for forearm fistulas).
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21. An arterio venous graft can be created by
subcutaneously inserting a biologic, semi
biologic, or synthetic graft material between an
artery and vein .
Indications:
When the patient’s vessels are not suitable for
a fistula.
Grafts are usually placed in the forearm, upper
arm, or upper thigh.
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24. Peritoneal membrane , serves as the semi
permeable membrane for dialysis.
It involves repeated cycle of instilling dialyzing
solution into the peritoneal cavity through a
catheter into it.
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26. CAPD - which stands for Continuous Ambulatory
Peritoneal Dialysis - happens throughout the day,
at home or at work, while the person goes about
his or her daily life.
Between 1.5 and 3 litres of fluid is run each time
for four times a day, exchanging for the fluid from
the previous exchange.
Patient doesn’t need a machine for CAPD; all
he/she needs is gravity to fill and empty the
abdomen.
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27. APD - Automated Peritoneal Dialysis - in which the
dialysate solution is changed by a machine, at night,
while you are asleep.
The machine will exchange 8-12 litres over 8-10
hours .
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31. Informed Consent
Explanation
Ask the patient to void.
Check Wt., vitals ( BP ) at the beginning and at
least every 30 minutes.
Check for cannula and fistula for patency and
palpate for the thrill and auscultation of bruits.
Withhold antihypertensive on the day of HD.
Assurance
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32. Regular observation of complications.
Check and record vitals X15 minutes.
Serve foods as patient’s interest ( not for
hypotensive prone patients)
Each treatment lasts from 2 to 4 hours. During
treatment, Pt. is allowed to read, write, sleep,
talk, or watch TV.
Back care and divertional therapy
Inform to Dr. if complications.
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33. Check and record vital signs, Wt. after HD and
total UF.
Record the condition of the patient.
Medications as ordered( if)
Explain about the care necessary after HD.
Inform the family and patient of date for next
dialysis.
Send the patient home or ward.
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34. Make sure that nurses or Dr check the access
before and after each treatment.
Use the access site only for dialysis.
Keep access clean at all the time.
Do not let anyone put a BP cuff on access
arm.
Do not wear jewellory or tight clothes over
access site.
Do not sleep with your access arm under head
or body.
Do not lift heavy objects or put pressure on
access arm.
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35. Care of vascular access.
Detection of complications.
Diet : Tell the patient
to eat animal proteins such as meat and chicken.
to Avoid too much potassium diet.
to limit fluid intake
to avoid excess salt.
to limit foods contain the mineral phosphorus such as
milk, cheese, nuts, etc.
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