Hemodialysis

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 ( pH< 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
 Solution 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
o Takes 6 weeks for development(arterialization
of vein)
o Both the dialysis needles are inserted into
the native vein
Types
 Radiocephalic (first choice)
 Brachiocephalic (second choice)
 Brachiobasilic (third choice)
o 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
o 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