Hemodialysis and peritoneal dialysis

Hemodialysis and peritoneal dialysis

1. DIALYSIS Aneez . K I st YEAR MSc. NURSING EMS CON

2. Definition Dialysis is the movement of fluid and molecules across a semipermeable membrane from one compartment to another. Clinically dialysis is a technique in which substances move from the blood through a semipermeable membrane and in to a dialysis solution called dialysate.

3. Historical Evolution in the Field Of Dialysis It was the romans first used a form of dialysis therapy by using hot bath to patients to remove urea .

4. 1854 the first time the term dialysis was used by Thomas Graham 1889 BW Richardson First referred the use of collodion membrane in the dialysis of blood .This help the living animals were dialysed in experimental conditions.

5. 1914 Hess & McGuigan were experimenting with dialysis in a pharmacology lab in Chicago. As a result they were able to transfer sugar from tissue to blood and from the blood across a collodion membrane . 1920s the first dialysis performed on human was carried out by George Hass. He used hirudin as an anticoagulant and later a crude form of heparin. He was honoured as a pioneer of dialysis.

6. 1923 Heinrich Necheles was discovered contemporary dialyser. In mid 1930s purification of the heparin occur. 1937 an American scientist, William Thalhimer use first synthetic membrane.

7. In 1945 William Kolff first clinical experience was gained on a 29 year old women with chronic nephritis. The blood urea was kept stable for 26 days but after 12 sessions of dialysis her blood urea began to increase and she subsequently died. After the world war Kolff technique was wildly used.

8. In 1950s Allis Chalmers Corporation was one of the first companies to produce dialysis machine commercially. In the late 1950s Fredrik Kiil of Norway made more modification in the field of dialyser. In 1960s the forerunner of today’s capillary – flow dialyser was produced by Richard Stewart. Belding Scribner was introduced the shunt to provide vascular access in dialysis.

9. Followed by this invention hemodialysis started. In late 1970s and early 1980s the continuous ambulatory peritoneal dialysis as the first choice of home treatment. The innovations in the field of dialysis is reaching up to the satellite dialysing unit nowadays. And the patient surveillance rate also increase.

10. Principles of Dialysis Diffusion: Diffusion is the movement of solutes from an area of greater concentration to an area of lower concentration.

11. Osmosis: Osmosis is the movement of fluid from an area of lesser concentration to an area of greater concentration of solutes.

12. Ultra filtration: Ultra filtration that is solution move when there is an osmotic gradient or pressure gradient across the membrane.

13. INDICATION OF DIALYSIS Renal failure Severe electrolyte and/or fluid abnormalities Acidosis Drug overdose Poisoning

14. TYPES OF DIALYSIS HEMODIALYSIS PERITONEAL DIALYSIS

15. HEMODIALYSIS HEMODIALYSIS APPARATUS Blood circuit Dialysis solution circuit Dialyser

16. BLOOD CIRCUTE

17. DIALYSIS SOLUTION CIRCUTE Water Purification System RO + Acetic Acid + NaHCO 3 + KHCO 3

18. REVERSE OSMOSIS

19. DIALYSER

20. VASCULAR ACCESS Intravenous Catheter Non-tunnelled or Temporary Catheter Tunnelled or Permanent Catheter or Prem Cath AV fistula AV graft

21. INTRAVENOUS CATHETERS

22. Replacement therapies of HD HEMOFILTRATION HEMODIAFILTRATION INTESTINAL DIALYSIS PLASMAFERESIS

23. PERITONEAL DIALYSIS Fill phase Dwell phase Drain phase

24. Complications of Peritoneal Dialysis Peritonitis Catheter Infection Cuff erosion Abdominal hernias Abdominal distension Hypotension

25. Hyperglycaemia Hypernatremia/ Hypernatremia Hyperkalaemia/Hypokalaemia Hypoalbuminemia Abdominal wall and pericatheer leak Genital edema Respiratory complications Back pain Dyslipidaemia

26. Psychosocial Issues in ESRD Patients Psychological problems like, Depression Dementia/ Delirium Anxiety and behaviour disorders

27. Psychosocial Issues like, Marital relationship Sexual dysfunction Socioeconomic issues Rehabilitation Quality of life Altered body image Awareness of early death Non adherence to the medical and nursing care

28. BIBLIOGRAPHY John T. Daugirdas , Peter G. Blake, Todd S. Ing “Handbook of Dialysis”(2007),4 th edition, Wolters Kluwer (India) publication, page no: 59-88 Allen R. Nissenson , Richrad N. Fine “Handbook of Dialysis Therapy” (2009), 4 th edition, Elsevier Publications, page no: 703-710, 1221-1225 Nicola Thomas “Renal Nursing” (2008), 3 rd edition, Elsevier Publication, page no: 73-78, 181-232 Lewis, Dirksen, Heitkemper , Bucher “Medical – Surgical Nursing Assessment and Management of Clinical Problems” (2011), 9 th edition, Elsevier Publications, page no: 1183-1188 Lippincott “Manual of Nursing Practice” (2009), 10 th edition, Wolters Kluwer (India) publication, page no: 785-788 http://en.wikipedia.org/wiki/Dialysis http://www.ncbi.nlm.nih.gov/pubmed/22916962

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