AIM: TO STUDY THE HEMODIALYSIS MACHINE NATURAL KIDNEY AND ITS FUNCTION: Function of the kidney: The main

function of the kidney is to form urine out of blood plasma, which basically consists of two processes i) The removal of waste product from blood plasma ii) The regulation of the composition of blood plasma These activities not only lead to the excretion of nonvolatile metabolic waste product but also are also largely responsible for the remarkable consistency of the volume, osmotic pressure, pH & Electrolyte composition of the extra cellular body fluids The human body has two kidneys, which lie, in the back of the abdominal cavity !ust below the diaphragm, one on each side of the vertebral, column Each kidney consists of about a million individual units, all similar in structure & function these tiny units are called ne!h"on#$ The kidneys work only on plasma The erythrocytes supply oxygen to the kidneys but serve no other function is urine formation each substance in plasma is handled in a characteristics manner by the nephrons involving particular combination of filtration re absorption & secretion The total amount of glomerular filtrate is about "#$ lit per day whereas the amount of urine formed from it is only "%" & lit This means that very large amount of water &other substance are reabsorbed, by the kidney tubules The reabsorbtion is partly an automatic process because the absorption of water is accurately controlled by the anti%diuretic hormones of the pituitary gland in relation to the body's need for water Need Fo" E%t"& Co"!o"e&' ('ood )u"ific&tion: The symptoms and signs of profound renal malfunction are known as uremia, meaning urine in the blood (ince most urinary contents are water soluble they reach high concentration in blood and result in deranged body parts and their physiology (evere cases of acute renal failure are characteri)ed by the virtual cessation of urine formation *t is obvious that the kidney can not exert any appreciable excretory or regulatory function *n such patients, even protein foods are omitted completely from the diet, the production of urea &other nitrogenous waste product continuous because of the metabolic breakdown of the body's own tissue proteins these product when retained result in progressive rise in their level in the plasma further more since acids are formed by the oxidation of the sulphur & phosphorous contained in protein, the plasma bi carbonate will fall
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+artly because of the acidosis & partly because of the cellular & tissue breakdown, potassium is liberated into the extra cellular compartments and the plasma potassium level rises ,angerous changes in the volume & distribution of body water may also occur in acute renal failure -hronic renal failure result in changes in the body fluids which are due to a progressive decrease in the number of functioning response the decrease in the functional response, the clearance of urea, creatinine and other metabolic waste product will decrease proportionally *n conse.uence the plasma concentration of these substance will rise / reduction in glomerular filtration rate 0123) will also lead to an increase in the plasma concentration of substance 0e g phosphate & sulphate) which are removed from the blood by filtration & partially reabsorbed by tubules (ince, however tubular absorption of these substances also declines with the falling 123 both their clearances & their plasma concentration usually remains unchanged until the 123 has fallen to about 4&5 of normal /t these stage, there is also a fall in plasma bicarbonate 6ith the decline in the number of functioning nephrons, the kidney also becomes less effective as a regulatory organ /ccordingly, the patient with chronic renal failure is liable to develop either deficiencies or excess of body fluid water & sodium However the volume & sodium concentration of the extra cellular fluids often virtually unchanged until renal function is very seriously impaired (o to reduce the accumulation of these waste product & water & thus blood concentration of these substances are returned to normal level, extra corporeal blood purification is needed
DIFFERENT METHODS OF E*TERNAL (LOOD )URIFICATION+

There are three basic design consideration external blood purification 0Hemo%dialyser) +arallel flow dialyser -oil hemodialyser Hollow fiber hemodialyser )&"&''e' f'o, di&'y#e": +arallel flow dialyser has a low internal resistance, which allows ade.uate blood flow through the dialyser with the patient's arterial blood pressure, eliminating the need for a blood pump The dialy)ing surface area of a parallel flow dialyser is about "m /t a blood flow rate of 4$$ml 7min & dialysate flow of &$$ml7min, the urea and creatinine clearance is about #$ & 89ml7min the rigid support used in parallel flow dialysers permit negative pressure to be created on the dialysate side of the membrane for ultra filtration the water is ultra filtered at rate of a : 4ml7min with a negative pressure of ";$mmHgo this rate is " #ml7min without negative pressure dialyser flows continuously at
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&$$ml7min in a direction counter current to the blood, permitting exchange to takes place throughout the dialyser The fig shows the <*== dialyser, which is most commenly, used form of parallel dialyser Coi' He-odi&'y#e" / -oil Hemodialyser comprises a tubular membrane placed between flexible support wrapped around a rigid cylindrical core The coil is immersed in dialy)ing path The tubular membrane can be a cellophane or cuprophane The average wall thickness of cellophane membrane is 4$%;$ um & that of cuprophane in the range of "#%>&um The coil membrane supports are woven screens or unwoven lattice ?sually the twin coils is made with three layers of woven, polyvinyl chloride coated fiberglass screen separated by four narrow strips of the same material, which are sewn in to place with cotton threads -oil dialysers are available with several design variations, which include the type of membrane the membrane support, the number of blood channels, the width of blood channels & surface area coil dialysers can be prefabricated because of simple design They are characteri)ed by high dialysate flow rates &high resistance to blood Ho''o, fi.e" He-odi&'y#e" : The Hollow fiber Hemodialyser consists of blood "$,$$$ hollow deacetylated cellulose di%acelated capillaries are !acketed in a plastic cylinder "#cm in length and >cm in diameter The capillaries are sealed on each end in to a tube sheet with an elastomer The capillaries range from 4$$%;$$um internal diameters and a wall thickness of 4&%;$um The dialy)ing area is approximately :$$$cm47unit The primary volume with blood manifolds exclusive of tubing is approx ";$ml The blood is introduced & removed from the hemodialyser through manifolds headers the dialyser is drown through !acket under negative pressure around the outside of the capillaries counter current to blood flow The dialysers are disposable He-odi&'y#i# M&chine : / Hemodialysis @achine is used for production of warm dialysate, which is then circulated through an external dialyser assembly *t also controls the cycling of the blood from the patient through the artificial kidney 0dialyser) and back to the patient *t continuously monitors and controls all important parameters automatically halting treatment in the event of parameters going out of preset limits The hemodialysis machine perform five basic functions ") @ixes the dialysate 4) @onitors the dialysate ;) +umps the blood & control the administration of anti%coagulants
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9) @onitors the blood for the presence of the air & drip chamber pressure &) @onitors the ultra filtration rate The machines are designed to be totally ad!ustable t meet individual therapy re.uirements The machine pumps and controls the flow of blood from the patient through the dialyser at the predetermined rate and pressure to ensure effective clearances &fluid removal in specified time period (ome machines also provide an ultra filtration rate meter that measures the ultra filtration rate in kilograms per hour This allows to operator to efficiently and accurately calculate predict and control fluid removal during dialysis Hemodialysis machine consists of proportionating pumps dialysate tempt -ontrol & measurement, conductivity measurement, dialysate pressure control and measurement, venous pressure measurement, blood leak detector, flow meter, efficient pumps, blood pumps, bubble trap, heparin pumps, etc
)RECAUTION AND SAFETY CONSIDERATION IN HEMODIALYSIS:

/ hemodialysis apparatus re.uires several control circuits 3upture of membrane can lead to rapid loss of blood, there is therefore, a blood leak detector / temperature control system is used to raise the tempt of the dialysate to the re.uired tempts which can be varied from ;8 to 94 A c / secondary safety cut out ensures that the heaters are switched off if the tempt exceed 9; A c / conducting cell, to verify comparing the electrical conductivity of the dialysate with standard sample of dialysate checks the accuracy of proportioning the composition of dialysate, continuously monitors the conductivity of the dialysate being produced +roper tempt compensation is essential as the conductivity of the dialysate changes by about 45 for every " A c change in tempt *n pressure control & measurement, a relief valve limits the maximum negative pressure available, thus minimi)ing the risk of a burst in the dialyser membrane which may be caused by high transient pressure +ressure valve can be ad!usted within the range $ to 9$$ mmHg The diaphragm types pumps are not preferred because they give problem due to diaphragm fatigue when operated over a long periods (o in modern machine , either the gear type or magnetically coupled pumps are preferred @onitoring & control e.uipment ensure a safe clinical procedure against any potential ha)ards

REASON FOR FAILURE OF THE KIDNEY: " /bsence of renal function because of surgical removal of kidney 4 Because of chronic renal disease, permanent of dysfunction ; Because of acute renal disease or re!ection period of a transplanted kidney 9 Cverloading of drug poisoning hemoglobinemia, bilirubinemia & ,ue to decline in number of nephrone, less effective 0functioning) 8 /cidosis, *ncrease in potassium concentration SELECTION FACTORS OF DIALYSIS: " Type & (i)e 4 Efficiency, -ost & intelligence level re.uired for assembly ; Type of ,ialysate , supply system & monitoring system 9 (afety maintenance DIALYSATE )RE)ARATION: Dry chemical preparation: (odium bi%carbonate or sodium acetate & lactic acid to ad!ust pH D(odium chloride D (odium acetate D +otassium chloride D ,extrose D =actic /cid D@agnesium chloride D calcium chloride For preparation of dialysate fluid: pump at /0: 1 dialysate ratio Each unit volume concentration with /23unit volume of water Fo" 144 'ite"E 4 #8 lit of -oncentration

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