haemodialysis-170422111605.pptx..............

Signs and symptoms
Cause
Types
Etiology
Pathogenesis
Treatment

1. Procedure & Complication of Haemodialysis Angel Das Y.L No:17

2. Haemodialysis Medical procedure to remove fluid & waste products from blood & to correct electrolyte imbalance. done using a haemodialysis machine & dialyzer also called as ‘artificial kidney.’

3. Indications For Dialysis Acidosis ( p H < 7.1) Electrolyte imbalance ( K+ > 6.5 mEq / L) GFR <10ml/min Overload of fluids ( pulmonary oedema ) Uremic symptoms (↑ ed level of nitrogenous waste products)

4. Principle Of Haemodialysis 1. DIFFUSION : Passive movement of solute across a semipermeable membrane 2. ULTRAFILTRATION : Solute + fluid removal across semipermeable membrane down a pressure gradient

5. Haemodialysis Apparatus a . Dialyzer b. Dialysate c. Blood delivery system

6. Dialyzer(Artificial Kidney) Plastic chamber – contains bundles of capillary tube through which blood circulates while dialysis solution travels outside the bundle in opposite counter current direction. Diffusion & ultrafiltration happens here.

7. Membranes using in dialyser -Cellulose -Substituted Cellulose- cellulose acetate - Cellulosynthetic-Cellosyn / Hemophan -Synthetics- polyacrylonitrile , polysulfone,polymethyl methacrylate

8. Dialysate S olution used in dialysis which has same solute concentration as those in plasma. Water used in the dialysate is purified by reverse osmosis. Contents of dialysate Na+ - 136-140mmol/L K+ - 0-4mmol/L Mg2+ -0.25-0.75mmol/L HCO3- 27-40mmol/L(buffer) Dextrose- 0-5.5mmol/L

9. Blood Delivery system Blood Pump – moves blood from access site through the dialyzer & back to the patient Blood flow Rate – 250-500 ml/min

10. Acess 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 c. Subclavian Vein

11. Arterio -Venous Fistula Takes 6 weeks for development(arterialization of vein) Both the dialysis needles are inserted into the native vein Types Radiocephalic (first choice) Brachiocephalic (second choice) Brachiobasilic (third choice) Subcutaneous anastomosis of an artery to an adjacent native vein

12. Arterio Venous Graft

13. Procedure Blood Flow Rate- 300-500 ml/min Dialysate - 500-800ml/min Usually done – 3 times a week & each dialysis lasts for 4 hours.

14. Complications Of Haemodialysis Hypotension (25-55%) Cramps (5-20%) Nausea and vomiting (5-15%) Headache (5%) Chest pain (2-5%) Back pain (2-5%) Itching (5%) Fever and chills (<1%)

15. Hypotension Causes Volume Related Inadequate Vasoconstriction Cardiac Factors Large weight gain Short dialysis High dialysis solution temperature Antihypertensives Eating during treatment Diastolic dysfunction Arrhythmia

16. Muscle Cramps Predisposing Factors Hypotension Hypovolemia High filtration Rate Leads to vasoconstriction cause muscle hypoperfusion leading to muscle cramps Low sodium dialysis solution

17. Nausea & Vomitting due to hypotension Headache Common Chestpain & Back pain Itching precipitated by dialysis. May be due to hypersensitivity reaction to dialyzer Fever & Chills

18. Less Common But Serious Complications Disequilibrium Syndrome set of systemic & neurologic symptoms with characteristics electroencephalographic findings occur either during / following dialysis Early Manifestation- Nausea , Vomitting , Restlessness & headache Serious Manifestation- Seizure , Obtundation , Coma Cause Acute increase in brain water content

19. Dialyzer reactions can be Anaphylactic type (type A) & nonspecific type (type B) Arrhythmia common in patients receiving digitalis & those with coronary artery disease Cadiac Tamponade recurrent hypotension – sign of impending cardiac tamponade Hemolysis its a medical emergency. Can be due to obstruction/narrowing in the blood line & if there is any problem with dialysis solution

20. Thank you