‫‪Dialysis‬‬ ‫‪interview‬‬

‫بسم هللا الرحمن الرحّم ‪.‬‬

‫ّ‬
‫واح ُل ْن ُع ْق َد ًة ِّمن ِل َسا ِهُ (‪ْ َِ )27‬ف َق ٌٍُا َق ٍْ ِلُ (‪)) )28‬‬
‫((‪َ ...‬ر ّب ْاش َر ْح ِلُ َص ْدري (‪َ )25‬وِ ِ ّس ْر ِلُ َا ْمري (‪ْ )26‬‬
‫ِ‬ ‫ِ‬ ‫ِ‬
‫سٍرة طي ‪.‬‬

‫‪ ‬دعاء قبن المذامرة ‪...‬‬

‫‪ ‬اللٌم اهَ اسالك فٌم الوبّن وحفظ المرسلّن والمالئلة المقربّن اللٌم اجعن لساهَ عامرا بذمرك‬
‫‪...ツ‬‬
‫وقلبَ بخشّجك وسرى بطاعجك اهك علَ ما ثشاء قدِر وحسبَ هللا وهعم الٍمّن‬

‫‪ ‬دعاء بعد المذامرة ‪...‬‬

‫‪ ‬اللٌم اهَ اسجٍدعك ما قرات وما حفظت فردى لَ عود حاججَ وال ثوسّوّي موي شّائ إهك علَ ما ثشاء‬
‫قدِر ‪...ツ‬‬

‫‪‬‬
‫مت ِزاعبح االخزصبر ف األجٌثخ‪.‬‬

‫اجلّعيدلصزيو أل ِزاض اٌىٍي عٍي اٌيٌريٌة‪.‬‬

‫اًوسفٌر أً حمبظزاد ح‬
‫د‬ ‫ٌٌ حمزبج رذاوز اورت يجمي‬

‫ثبٌزٌفيك ٌٍجّيع يبريذ ٌٌ ف أخؽبء يزُ دوزىب ٌٍزصذيخ‪.‬‬

‫القلٍب ‪َ ...‬و َ ْا َ ِب َما ِب ِي َّص‬

‫الل ْد ُر َّصالر ِح ّْ ُ ‪...‬‬ ‫ُ‬ ‫ْ‬
‫اشجملت علَ الّاس‬ ‫إذا‬
‫الخ ُط ٍْ ُب ‪...‬‬‫الملارى واسجقرت ‪َ ...‬و َا ْر َس ْت فُ َا َمام ِو ٌَا ُ‬
‫ِ ِ‬ ‫ُ‬ ‫و اوطوت‬
‫وجٌا ‪ ...‬و ال اغوَ بحّلجي االرِ ُ ‪...‬‬ ‫اللر ً‬‫ّ‬ ‫َ‬
‫و لم ثر الهلشاف ِ‬
‫اللطّي المسجتّ ُ ‪...‬‬ ‫ُ‬ ‫ِمن بي‬‫غٍث ‪ُّ ...‬ن‬ ‫ثاك علَ قوٍو موك ُ‬ ‫ا َ‬
‫ٍ‬
‫ثواًت ‪َ ...‬ف َم ٍْ ُص ٌٍل ِب ٌَا َف َر ٌج َق ْر َِ ُ ‪...‬‬
‫الحاددات اذا ْ‬
‫ِ‬ ‫و ُّنمن‬
‫ال حٍلقٍةوالإال باهلل^^ ‪...‬‬ ‫ال إلي إال هللا ‪ ...‬واسجغفر هللا ‪...‬‬ ‫هللا امبر ‪...‬‬ ‫‪...‬‬ ‫الحمد هلل‬ ‫سبحان هللا ‪...‬‬
‫‪2‬‬
 Dialysis interview

1 Hemodialysis .

 Definition: extracorporeal circuit which filtered blood from

waste products and remove of water.
 Why extracorporeal ? as its occur outside of body.
 Hemo means: blood.
 Dialysis: clean or wash.

2 Disequilibrium syndrome .

 Definition :rapid efficiency diffusion of solutes from

extracellular space and the solutes can't move from
intracellular at the same rate of removal lead to
imbalance between solutes and fluids of extracellular and
intracellular space this is called disequilibrium syndrome.
How?
.‫اخلالي‬
‫ ثزه ا‬1 / 3ً ‫ جٌه اخلاليب‬2/03 ‫ ادليو ِزٌسعو ف اجلسُ وبٌزبيل‬

. ‫ داخً اٌٌعبء اٌدٌِي‬1 / 4ً‫ ثني اخلاليب‬3 / 4‫ خبرج اخلاليب ِمسُ ايل‬1 / 3 

‫ اثنبء اٌغسيً اٌدٌِي ثمدر أًصً ٌٍّيو اٌٍي داخً اٌٌعبء اٌدٌِي عشبْ وده اٌؽجيعي أو حيصً رٌاسْ ثني اخلاليب‬

.‫ًخبرجيب عشبْ اجلسُ يمدر حيبفظ عٍي ًظبئفو‬

‫ اٌمبعده ثزمٌي أينّب ًجد ادلٍخ ًجد ادلبء ؼيت ىنب ثيذصً ايو أب خبزج اِالح ًمسٌَ ِٓ جسُ ادلزيط ِٓ اٌٌعبء اٌدٌِي‬

‫ًٌسو اٌسٌَّ دي ٌِجٌده داخً اخلاليب ثنست اعٍي اٌسٌَّ دي رشد ادليو ثسجت رزويشىب اٌعبيل فجيذصً عدَ رٌاسْ ف‬

.‫جسُ ادلزيط‬

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
3
 Dialysis interview
 Patient has risk:
1 First dialysis treatment .
2 Elevation of urea more than 175
3 Neurological disorder.
 Headache.
 Nausea.
 Restlessness.
 Blurred vision.
 Vomiting.
 How to prevent :
 Time:2 hours.0 ‫ِعين اصخ اغسً غسٍو ِٓ غري ظّرياساي‬
 Blood flow rate : 200 to 250 ml/min.
 Dialyzer surface area :,8 to 1,4.
 Dialysate flow :400 ml/min.
 How to manage it
 Taking vital signs especially blood pressure
 Stop UF .
 Trendelenburg position.
 Saline infusion .
 Still unstable we can give saline 3%.
 Still unstable we can give mannitol20%.
‫ثعًّ وً دا ٌيو عشبْ عبيش اسذت ِيوَْ داخً اخلاليب خلبرج اخلاليب ٌٌٍعبء اٌدٌِي عشبْ حيصً رٌاسْ ف‬

.ُ‫اجلس‬

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
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 Dialysis
3 Complication during session .
1 Hypotension .
2Muscles cramps .
... ^^‫ال حٍلقٍةوالإال باهلل‬
interview
 Causes :anemia ,albumin loss,increase temperature of
patient ,abnormal in electrolytes, decrease vascular
volume ,rapid UF, antihypertension medications,
cardiac problems.
 Signs, symptoms:‫لكنا عارفني اعراض هبوط الضغط‬
 Management:
 According to patient status .
1 If mild .
 Stop uf ,trend position ,decrease temperature of machine
less ,5.also you can decrease blood flow rate not for
hypotension but for cardiac stability ,access safety.
2 If Sever .
 Stop Uf ,trend position decrease temp of machine ,
saline bolus and follow up patient condition .
 If still you can give hypertonic saline or glucose 25% 50 ml
according to doctor order .but take care from hypertonic .
 Unknown causes but can expected
 Decrease vascular volume.
 Abnormal electrolytes.
 Rapid UF.
 How to manage .
 Stop or decrease UF. Trend position ,massage to affected
limb, follow up patient status may be needed for saline
infusion.
... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
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 Dialysis interview
3 Arrythmia .  Decrease in K level.
4 Hypoxia .  Maybe related to hypersensitivity
5 Hypertension .  May be related to medications or incorrect dry weight.
6 Nausea,  May be related to hypotension.
vomiting .
7 Hypersensitivity
type A .
Related to dialyzer sterilization
8 Hypersensitivity
type B .
 Related to cytokines

4 Medications during dialysis .

 EPrix: for ttt anemia through stimulant bone marrow to produce RBCS .
 Renvella or renagel: for phosphors control (should be during meal).
 One alpha :instead of vitamin D for absorption of calcium.
Calcium tablets :for some patients as low calcium level.
 Ferrosac: iron provider.
 Cinacalcet: for control of PTH.

 Other medication according to patient status.

5 Duration of session .
 In general cases 4 hours three times per week.
ِٓ ‫ًالسَ ادلزيط يىٌْ فبىُ أو السَ يىًّ ًلزو عشبْ اىُ عبًِ ثيأثز عٍي اخزاج اٌفسفٌر‬

. ‫اجلسُ ىٌ اٌٌلذ‬

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
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 Dialysis interview
6 Dialysate .

It consist of pure water ,acid and bicarb.

 Pure water :96%.
 Acid and bicarb:4%.
‫ىٌ عجبره عٓ خٍيػ ِٓ ادليو اٌٍي خبرجو ِٓ حمؽو ادليو ًاحلّعٌاٌجيىبرة ثنست ِعينو عشبْ ف االخز رىٌْ صبحلو‬

.‫ٌٍغسيً ًِنبسجو‬

. ‫ عشٍٓ وده ثزىٌْ ثنست ِعينو‬1:34 ً‫ ا‬1:35‫ٌٌ ججذ جزوٓ احلّط ىزاللي ِىزٌة عٍيو ِثال‬

 Dialysate flow rate :500ml/min .or Blood flow x2.

. ‫ ىي األٔست‬500‫ ثس ده ثيىٍف ِيخ وزري غبٌجب‬%10 ‫اجلٍس ثنسجو‬
‫وفبء ح‬‫ح‬ ‫ثعط ادلصبدر ثزمٌي ٌٌ ساد ثيأثز عٍي‬

7 UF rate .

 Safe UF rate :<10 ml * Kg per hour

 For example: pt weight 70 Kg.
UF =10 *70=700 ml per hour=700 *4=2800 ml.

8 Diet .

 Restricted sodium : increase thirst.

 Restricted fluids .
 Protein :40 gm per day .
 Phosphors foods :mill ,cheese,pepsi ,fish bread.(I can't prevent patient
from this foods but can be limited).
 Potassium foods and fruits :limited also .
)‫ًاجلٌٍوٌسًاٌيٌريب‬
, ‫اورت دبجو ختٍي االٔسبْ يعؽش ىي ( ادلٍخ‬

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
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 Dialysis interview
9Priming definition .

 Volume used to remove air ,make membrane of blood lines wet to

decrease amount of anticoagulation dose .
 Volume :500 to 1000 ml according to instructions.
 Blood pump :from 200 to 250 ml.
ٓ‫اذلدف ِنو أي اخزج اذلٌا ِٓ ًصالد اٌغسيً عشبْ ًجٌد اذلٌا ِشىٍو وجريه ىزبثز عٍي وفبءه اجلسٍو ًممى‬

.َ‫وّبْ رعًّ جتٍػ ٌٍد‬

10 Access .

.‫دا ٌِظٌع يؽٌي شزدو ثس غبٌجب ممىٓ ٔزىٍُ ف اىُ اٌنمبغ‬

 Three types of access :-

1)fistula.
2)graft.
3)CVC.

 Fistula . . ْ‫ىي عجبره عٓ رٌصيً ًريد ثشزيبْ ِجبشزه عشبْ يصجخ اٌٌريد شزيب‬
 Anastomosis= connection between artery and vein .
 How to insure of fistula maturation : 6 criteria.
1 Flow :600 ml/min by Doppler .
2 Waiting for 6 weeks .
3 Diameter 6 mm .
4 Depth maximum 6 mm under skin.
5 Has obvious margins(length of vein 6 mm or more ) .
6 Distance between two needles 6 cm .
 Graft . Connection between artery and vein by artificial
material.
.‫دلب ثيىٌْ ادلزيط غري لبدر عٍي اٌفسزٌال ثٍجأ ايل اجلزافذ‬
Two types straight and loop graft .
... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
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 Dialysis interview

Maturation time : after connection directly but for

safety waiting from two weeks for four weeks after
that can cannulation.
Health education to patient has access .
.‫دي اىُ ٔمؽو اٌعنبيوثبٌفسزٌال اً اجلزافذ‬

1Making exercise through lifting maximum 1.5 Kg ,

ball exercise.
2Don’t sleep on this arm.
3Don’t wear tight clothes.
4Don’t wear any jewelry in this arm .
5If hading any problem such redness ,pain ,edema
should call the center at the time.
How to assess vascular access .
Look: inspection and observation of condition of
access (redness, edema, pain, hotness)
Feel: by your finger buzzing sound called thrill.
Listen: by stethoscope whooshing sound called bruit.
.‫ٌٌ الليذ أي دبجو ِش ؼيعيو السَ رجٍغ ادلشزف اً اٌدوزٌر اٌٍي ِعبن‬

 CVC . ‫عجبره عٓ رزويت لسؽزه ٌٍّزيط ف ًريد وجري ذلدف اٌغسيً اً ف دبالد‬

.‫اٌؽٌارئ‬
When used . Emergency dialysis in ARF or cant
created vascular access.
Types .
Temporary : maximum two weeks and removed
Permanent : according to function still work no
problem .
... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
9
 Dialysis interview
Another types form :.
 Cuffed tunneled catheter :
‫ادلسزديُلجً ِب ردخً ٌٌٍريدثزّشي ف ٔفك حتذ اجلٍد عشبْ وده امسيب‬
‫ح‬ ‫ىي اٌمسؽزح‬

. Tunneled

.‫عشبْ وده ىي عجبره عٓ جشئني جشء جٌاه اجلسُ ًجشء حتذ اجلٍد‬

‫اجلشء اٌٍي حتذ اجلٍد يسّي‬

Cuffed.
‫اٌمسؽزف اجلسُ ًرثجيذ ِىبهنب ف‬
‫ح‬ ‫ًدا ثيزذٌي عٍي ِبده ِعينو ثزسبعد عٍي دتبسه‬

.َ‫ٔفس اٌٌلذ ثزّنع دخٌي اٌجىرتيب جٌه اٌد‬

Sites of insertion : Right internal jugular ,left
internal jugular ,femoral, subclavian .
 Most common causes of catheter
removal :infection ,can't achieved blood flow
needed for dialysis.

Care about CVC .

 Avoid kinking position ,dressing well ,catheter lock

(heparine ,duralock ) should be according to prescribed.

11 Care of patient .

Pre : health education about foods ,water ,access .

Intra : good observation patient condition ,vital signs ,access condition.
Post: access condition, vital signs. patient general condition. dry weight
achieved.

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
10
 ‫‪Dialysis‬‬ ‫‪interview‬‬
‫‪12  RO .‬‬

‫ِيبه اٌشزة غري صبحلو ٌٍغسيً ٔؽزا دلب فييب ِٓ شٌائت ًاِالح فالسَ رعدي عٍي ِزادً رنفيو ديت رىٌْ ِنبسجو ‪.‬‬

‫‪ Pre RO .‬‬

‫ِزدٍو ِب لجً ِعبجلو ادليبه ًثيزُ فييب االري ‪0‬‬

‫‪ .1‬اخلشاْ االثزدائي ًدا يزُ جتّيع ِيبه اٌجٍديو فيو‪.‬‬

‫‪ِ 50‬يىزًْ‪.‬‬
‫‪ .2‬اٌفٍرت اٌزٍِي ِسئٌي عٓ رنميو اٌشٌائت اٌيت يشيد دجّيب عٓ‬

‫‪ .3‬فٍرت خزؼٌشي رنميو شٌائت ايل‪ِ 25‬يىزًْ‪.‬‬

‫‪ .4‬فٍرتوزثٌٔي رنميو ادليو ِٓ اٌزًائخ ًاٌىٌٍر ‪.‬‬

‫‪ .5‬فٍرت خزؼٌشي رنميو ايل‪ِ 10‬يىزًْ ‪.‬‬

‫‪ .6‬اٌسٌفنز‪ 0‬اساٌو اٌىبٌسيٌَ ًادلغنسيٌَ‪.‬‬

‫‪ .7‬فٍرت خزؼٌشي رنميو اٌشٌائت ايل‪ِ 5‬يىزًْ ‪.‬‬

‫‪ RO (REVERSE OSMSIS ).‬‬
‫ًظع ادليو حتذ ظغػ عبيل جدا ديث يسّخ مبزًر ادليو فمػ ‪.‬‬

‫ىنبن فٍرت يسّخ مبزًر اادليو ًال يسّخ ثبٌعٌده ِزه اخزي ‪.‬‬

‫‪ RO summary .‬‬

‫‪ Multimedia filter , carbon filter ,softner , preRO filter‬‬
‫‪,RO , ultraviolet radiation.‬‬
‫‪ Multimedia filter :‬‬ ‫‪removal of dust ,microbes ,hardness.‬‬
‫‪ Carbone filter : removal of chlorines chloramines .‬‬
‫‪ Softner : removal of ca ,mg‬‬
‫‪ Ro : all microbes passing only water.‬‬

‫ال حٍلقٍةوالإال باهلل^^ ‪...‬‬ ‫ال إلي إال هللا ‪ ...‬واسجغفر هللا ‪...‬‬ ‫هللا امبر ‪...‬‬ ‫‪...‬‬ ‫الحمد هلل‬ ‫سبحان هللا ‪...‬‬
‫‪11‬‬
 Dialysis interview

 Ultraviolet radiation : to kill all microbes in water.

‫ٌٍّيو اٌٍي داخً ِٓ اٌجٍديو‬
‫ممىٓ راللي حمؽو اادليو اٌٍي عندن فييب فالرز ربٔي غري دًي ِثبي فٍرت ٌٍذديد ًىىذا داثريجع‬

.ً‫حملؽو اٌغسي‬

 Role of nurse in RO :

1 Every day test to hardness of water and chloramines, chlorines.

2 Microbiological test for water .
3 Endotoxines test for water.

13  High flux dialyzer .

 According to KUF if more than 20 ml/h /mmHg consider High flux.

 less than 10 ml/h/mmHg is low flux .
 Between them consider middle flux dialyzer.

 Kuf :-
‫ِعنبه ِعبًِ ٔمً ادليو ِٓ اٌدَ ايل اٌديٍشيذ يعين وّيو ادليو اٌٍي ىززذزن ِٓ اٌدَ ٌٍديٍشيذ ف وً سبعو‬

. ‫ًدي ثزىٌْ جبىشه ًِىزٌة عٍي اٌفالرز جٌه اٌىزرٌٔو‬.‫ٌىً فزق ًادد ظغػ‬
 Solutes clearance + water removal = dialyzer performance.
Also we should use high flux dialyzer in HDF.

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
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 Dialysis interview

14 TMP : transmembrane pressure.

 Difference between blood pressure and dialysate pressure.

.‫فزق اٌعغػ ثني اٌدَ ًاٌديٍشيذ‬

 High TMP : attention to prevent clotting of dialyzer .

15 Alarm of machine .

1 High venous pressure : assess blood circuit ,needle position ,venous

chamber observation .blood flow rate ,arm condition .
2 High arterial pressure : blood circuit .needle position .access condition.
3 TMP high : dialyzer condition.
4 Low venous pressure : dialyzer assessment for clotting .
5 Blood leak: assess for dialysate clearance ,color, any abnormality.
6 Short dialysate flow : RO and loop of machine.
7 Water alarm : check RO flow.
8 Air bubbles : air in circuit .
9 Conductivity alarm : check acid ,bicarb ,water .
10 Temperature : check temp of machine.

16  RENAL LABS .

 Urea ,creat: better to do creat as more specific ,for renal function .

 Urine analysis : for urine specific gravity.

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
13
 Dialysis
 Residual kidney function :
 Normal creat clearance
in serious condition.
 Renal biopsy: very cost and very dangerous.
 Ultrasound;
interview
=creatinine clearance =urea clearance
= U*V / P .
 U= urine creatinine in 24 hours.
 V=volume of urine in 24 hours.
 P= plasma creatinine through blood sample.
:100 to 150 ml/min if decrease means kidney
kidney size and any abnormality in shape, diameter function.

17 Hand washing : 5 moments

 Two before : before touching patient ,before wearing gloves(Invasive,

clean procedure)

 Three after : after touching patient ,after removing gloves (finishing

invasive procedure),after touching environmental objects
around patient, after exposure to body fluids.

18 Dry weight .

 weight that’s patient can be tolerated without any SOB or

dizziness , tiredness , no cramp fatigue which general condition of
patient is good.

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
14
 ‫‪Dialysis‬‬ ‫‪interview‬‬
‫‪19 KT/V .‬‬

‫‪ Efficacy of dialysis session in which‬‬

‫‪ K = Clearence of urea by dialyzer.‬‬
‫‪ T=time of session .‬‬
‫‪ V = volume of urea distribution in body.‬‬
‫‪ Normal KT/V: 1,2.‬‬
‫=‪K‬‬ ‫رنميو اٌفٍرت ٌٍدَ عند مبت ِعني ثزىٌْ ٌِجٌده داخً وزرٌٔو اٌفالرز ًال يزُ دسبهبب‬

‫=‪ T‬‬ ‫ًلذ اجلٍسيجزبعزنب ايل ىٌ‪ 4‬سبعبد‬

‫=‪V‬‬ ‫دجُ اٌيٌريب ادلٌجٌده ف اجلسُ‬

‫ادسجيب اساي اٌيٌريب ٌِجٌده داخً اجلسُ ثنست ًادده يعين جٌاه اخلاليب سي خبرج اخلاليب ًاٌيٌريب ٌِجٌده ف ادليو اٌٍي ف‬

‫اجلسُ ؼيت ادليو دي ثزّثً‪ً ِٓ %60‬سْ ادلزيط يجمي ثبخد‪ً ِٓ % 60‬سْ ادلزيط يجمي ىٌ دا دجُ اٌيٌريب اٌٍي ٌِجٌده‪.‬‬

‫مثال لو قلنا مثال ‪-:‬‬

‫‪ K =250ml/min When blood flow 300ml/min , Time :4 h .‬‬
‫‪so time = 4*60 = 2400 minute‬‬
‫‪Patient weight : 70 Kg.so weight = 70 *1000 =70000 divided 60%=42‬‬
‫?‪KT/V‬‬
‫‪= 250 *4*60/42 *1000=1.4.‬‬

‫ال حٍلقٍةوالإال باهلل^^ ‪...‬‬ ‫ال إلي إال هللا ‪ ...‬واسجغفر هللا ‪...‬‬ ‫هللا امبر ‪...‬‬ ‫‪...‬‬ ‫الحمد هلل‬ ‫سبحان هللا ‪...‬‬
‫‪15‬‬
 Dialysis interview
20 Difference between HD and HDF .

 HD =Diffusion , ultrafiltration .
 HDF= Diffusion , ultrafiltration , convection .
 Indications for HDF : Anemia ,cardiac patient ,hyperphosphatemia ,
B2 micro globin removal. Neurological disorder like restlessness .
 Needs for HDF : good vascular access .ultrapure dialysate .achieves
convection volume 23 liter.

21  Anticoagulation.

 There is several types of anticoagulation like .

1 Unfraction heparine : heparine .
2 Low molecular weight heparine : innohep.
3 Calcium citrates .
 Heparine : most famous one but more side effects (affected on
Vision ,bone .bleeding time) .
 LMWH: best as low side effects but more cost .

" ‫" و آخر دعوامه آن امحلد هلل رب العاملني‬

... ^^‫ال حٍلقٍةوالإال باهلل‬ ... ‫ واسجغفر هللا‬... ‫ال إلي إال هللا‬ ... ‫هللا امبر‬ ... ‫الحمد هلل‬ ... ‫سبحان هللا‬
16