Dialysis

HEMODILAYSIS AND PERITONEAL DIALYSIS

1. DIALYSIS

2. HD It is a technique of artificial filtration and removal of waste products Dialysis acts upon 3 principles: Diffusion Osmosis Ultrafiltration

3. Diffusion : The solute particle movement from higher concentration to lower concentration is called diffusion. E.g. Creatinine, urea, K + , PO 4, Uric acid. Osmosis : The solvent particle movement from lower concentration to higher concentration. E.g. Glucose, water, heparin, Antibiotic, Na + . Ultrafiltration : the fluid movement from higher pressure to lower pressure through a semipermeable membrane is called ultrafiltration.

4. There are two type od dialysis: Hemodialysis Peritoneal dialysis

5. HD is performed by the help of artery and veins by making fistula and graft known as a.v fistula or a.v graft. * Most common use artery and veins are radial artery and cephalic vein.

6. Complication Hypotension Septic shock Disequilibrium syndrome: N/V, restlessness, confusion

7. Some Important Points Don’t take temperature from affected extremities Don’t take BP from affected arms. Don’t infuse any typ e of drug in graft and fistula. HD commonly performed between radial artery and cephalic vein. It may be performed between femoral catheter and subclavian vein for temporary. Graft is reliable for 1-2 year. Glucose is added in dialysate solution to increase the removal of waste products. HD in a week 3 times HD maximum 4hours because it cause hypotension.

8. Peritoneal Dialysis PD is commonly used for short term. It is used for drug toxicity. The semipermeable membrane is peritoneum. Peritoneum is very rich in blood supply.

9. Continuous ambulatory peritoneal dialysis (CAPD) You fill your abdomen with dialysate, let it remain there for a prescribed dwell time, then drain the fluid. Gravity moves the fluid through the catheter and into and out of your abdomen. You may need three to five exchanges during the day and one with a longer dwell time while you sleep You can do the exchanges at home, work or any clean place You're free to go about your normal activities while the dialysate dwells in your abdomen

10. Continuous cycling peritoneal dialysis (CCPD) Also known as automated peritoneal dialysis (APD), this method uses a machine (automated cycler) that performs multiple exchanges at night while you sleep. The cycler automatically fills your abdomen with dialysate, allows it to dwell there and then drains it to a sterile bag that you empty in the morning. You must remain attached to the machine for about 10 to 12 hours at night. You aren't connected to the machine during the day. But in the morning you begin one exchange with a dwell time that lasts the entire day.

11. Complication Peritonitis Bladder Perforation Bowel Perforation Chronic abdominal pain Bleeding Septicemia