It is the removal of solutes and water from body across a semipermeable membrane (dialyzer) care during and after the dialysis is very important to prevent the entry of pathogens in to the body.

1. HEMODIALYSIS
Mr.Sachin Dwivedi
M.SC. Medical surgical Nursing
K.G.M.U Institute of Nursing , Lucknow

2. Mr.Sachin Dwivedi
M.SC. Medical surgical Nursing
K.G.M.U Institute of Nursing , Lucknow

3. HEMODIALYSIS
It is the removal of solutes and water
from body across a semipermeable
membrane (dialyzer)

4. Father of hemodialysis
• William Kolf invented the first “artificial
kidney”

5. PRINCIPLES underlying HD
• Diffusion
• Osmosis
• Ultra filtration & solvent drag

6. DIFFUSION
• Movement of molecules from an area of
higher concentration to an area of lower
concentration

7. OSMOSIS
• Movement of solvent molecules from
lower concentration to higher
concentration

8. Ultra filtration & Solvent drag
• Water moves from an
area of high pressure
to an area of lower
pressure
• More efficient in fluid
removal than osmosis
• Molecules which are
dissolved in the
solvent also get
removed- solvent drag

9. INDICATIONS
• Acute poisoning
• Acute renal failure
• Severe edema
• Chronic renal failure
• Hepatic coma
• Metabolic acidosis
• hyperkalemia

10. INDICATIONS……
• Transfusion reaction
• Post partum renal insufficiency
• Cardiac tamponade
• Fluid overload not responding to
diuretics & fluid restriction

11. CONTRAINDICATIONS
• Other chronic disease
• No vascular access
• Hemorrhage
• hypertension
• Very old people
• Inability to cope with treatment
regimen
• Coagulopathy
• Inability to survive procedure

12. VASCULAR ACCESS
1. AV FISTULA
2. AV GRAFTS
3. AV SHUNTS
4. Percutaneous access

13. AV FISTULA
• Anastamosis of an artery to a
vein
• Sites- radial artery & cephalic
vein, brachial artery &
cephalic vein, brachial artery
& basilic vein
• The increased blood flow and
pressure causes the vein to
dilate.

14. Pre-op care in AV fistula
• Full explanation of the procedure and
aftercare
• Let him talk to someone who has a well
established fistula
• Should be well hydrated before the
surgery
• Part preparation

15. Post op care in AV fistula
• Limb should be kept warm &well supported
to maintain the peripheral cerculation.
• Monitor the BP and maintained at 100
systolic minimum to reduce the risk of fistula
thrombosis.
• Avoid antihypertensive therapy
• Examine the wound site for bleeding/swelling
• Check the blood flow regularly(bruit/ thrill)
regularly

16. Post op care of AV fistula
• Avoid using the fistula arm for carrying
heavy loads
• Avoid tight and restrictive clothing on the
arm.
• Hand exercises promote fistula
maturation
• Arm should not be used for phlebotomy
cannulations or recording the BP
• Notify physician if any bleeding

17. Long term care
• Keep your access clean at all times
• Be careful not to bump your access
• Don’t wear jewellery over your access
• Don’t sleep with your access arm under
your head or body.
• Check the pulse in your access every
day.

18. Complications of Av fistula
• Thrombosis- due to hypotension
• Aneurysm- due to repeated area
puncture
• Steal syndrome- due to reduced blood

19. ARTERIOVENOUS GRAFT
• A graft is put b/w an
artery &vein
• Synthetic graft(PTFE)
is used most
commonly
• Indications
- Peripheral vascular
disease
- Diabetes
• Can be used after 14
days

20. AV shunt
• Very rarely made
• Teflon tubings are inserted into
the vessels and silicon tubings
are attached.

21. Percutaneous access
• Internal jugular vein
• Subclavian vein
• Femoral vein
• Indications
- Acute dialysis
- Temporary
- Inadequate vessels
- Failed access

22. Percutaneous access

23. Post insertion care
• Correct insertion is checked by X-ray
• Check for pneumothorax & puncture of the
adjacent vessels
• Maintain the patency of the catheter
- Heparin lock injected after each dialysis
- Heparin is removed & flushed with saline
(0.9%)before next dialysis
- Never flush the catheter if can’t be aspirated
• Examine the sites for any soreness, redness,
or presence of exudates

24. Canulation
• Allow the fistula to mature
• A thorough physical examination is
done before canulating
• Adhere to units protocol
• Universal precautions are followed
• A tourniquet may be used to get the
vessels engorged

25. Types of canulations
• Rope ladder puncture
• Area puncture
• Button hole puncture

26. Rope ladder technique
• The entire vessel is used systematically
• Each needle is inserted at 2cm above
the last site and back again
• It helps expand the lifespan of the
fistula
• Gives the previous stick site time to
heal
• Helps the fistula mature more evenly

27. Button hole technique
• The same site is repeatedly puncture at
exactly the same angle
• Over time the scar tissue develops
guiding the needle into the right place
• Advantage
- Less pain
- Less hematoma

28. Area puncture
• Use of one or two areas of the fistula
which are regularly used
• Aneurysm chances are more

29. Canulation technique
• Needles to be inserted at 45 deg to the
skin
• Arterial and venous needle should be
placed 5 cm apart
• Don’t pull or push the needle blindly
• Ask for assistance if cannulations
attempt had failed for 2/3 times

30. HEMODIALYSIS EQUIPMENT
• The dialyzer
• The membrane

31. Dialyzers
• Coiled dialyzers
• Parallel plated dialyzers
• Hollow fiber dialyzer

32. Membranes
• FLUX PROPERTY: the efficiency with
which a membrane clears water and
solutes
• Cellulose membrane- low flux
• Modified cellulose membrane : low/high
flux
• Synthetic membrane: low/high

33. Preparation of the dialyzer
• Air must be completely removed from
the dialyzer and the bloodlines
• Removal of the chemical or the
sterilizing agent is essential
• Minimum of 1 lr of saline for flushing in
c/o ETO sterilization

34. Dialysate
• The fluid which is pumped on the
opposite side of the semi permeable
membrane to the patients blood
• It is prepared by mixing a concentrated
electrolyte solution with a
buffer(bicarbonate) & purified water.

35. Composition of Dialysate
SOLUTE BLOOD DIALYSATE
SODIUM(mmol/) 130- 149 132-1755
Potassium 3.5- 5 0- 3.0
Urea 2.5 – 6.5 0
Creatinine 60 – 120 0
Calcium(mmol/l) 2.2 – 2.6 0.25 -0. 75
Magnesium 0 – 85 0 – 1.0
Glucose(g/l) 4 – 6.6 0-10
Bicarbonate (mmol/l) 2.2- 3.0 30- 40

36. Anticoagulation
• Heparin in the beginning 2000- 5000U
or 50 U/Kg and then as a continuous
infusion at 1000- 1500U/hr till 15-60
mts before the end of dialysis
• Heparin free dialysis if bleeding
disorder is there.

37. f