Dialysis

Under supervision
Dr : Noura Ahmed

Group (A2)
 ‫‪-‬احمد عبدالفتاح زهران‬
‫‪-‬احمد عبدالمنعم ابو زونا‬
‫‪-‬احمد عزت احمد جمعه‬
‫‪-‬احمد عزت احمد محمد‬
‫‪-‬احمد عصام محمود‬
‫‪-‬احمد عطيه دكروري‬
‫‪-‬احمد علي سالم‬
‫‪-‬احمد فتح هللا محمد‬
‫‪-‬احمد فتحي عز العرب‬
‫‪-‬احمد فريد ابراهيم‬
‫‪-‬احمد فؤاد شكر‬
‫‪-‬احمد لطفي فتحي‬
‫‪-‬احمد محمد الصاوي‬
‫‪-‬احمد محمد رجب األحمر‬
‫‪-‬احمد محمد رشاد هنداوي‬
‫‪-‬احمد محمد فوزي موسي‬
‫‪-‬احمد محمد مغاوري‬
‫‪-‬احمد محمود الدمهوجي‬
‫‪-‬احمد محيي محمد الجندي‬
‫‪-‬احمد مصطفي عبدالعزير عطيه‬
‫‪-‬احمد ممدوح العويني‬
‫‪-‬احمد هشام الجزيري‬
‫‪-‬احمد احمد هيثم عبدالعظيم‬
‫‪-‬احمد وجدي المزين‬
‫‪-‬احمد ياسر ابراهيم عبد الجواد الجعبيري‬
 ‫‪-‬احمد يسرى مبروك الحجاج‬
‫‪-‬احمد يسرى مصطفى القاضي‬
‫‪-‬ادهم ايمن عبد الصبور المصلحي شاهين‬
‫‪-‬ادهم محمد طه مجاهد شعله‬
‫‪-‬ادهم محمد عبدالمرضى نصر‬
‫‪-‬اروی اشرف عبدهللا قايد‬
‫‪-‬اروى عبد الحميد محمد سالمه‬
‫‪-‬اسامه شفيق عبد العزيز ابوشنب‬
‫‪-‬اسراء ابراهيم حمد هللا محمد‬
‫‪-‬اسراء احمد ابراهيم عطيه منتصر‬
‫‪-‬اسراء احمد محمد عيد‬
‫‪-‬اسراء السيد بسيونى عبد السالم‬
‫‪-‬اسراء العربي طه على هشام‬
‫‪-‬اسراء ثروت عبد الرازق حسين ابراهيم‬
‫‪-‬اسراء جابر شحاته عماره‬
‫‪-‬اسراء حسن عبدالسالم حسين‬
‫‪-‬اسراء خالد السيد عبد المقصود‬
‫‪-‬اسراء خالد محمد جابر محمد‬
‫‪-‬اسراء رضا السيد عمارة‬
‫‪-‬اسراء رضا محمد سمك‬
‫‪-‬اسراء سعيد السيد محمود محمد‬
‫‪-‬اسراء سعيد عبدالعزيز الدكر‬
‫‪-‬اسراء سعيد محمد جاد هللا‬
 Dialysis

Introduction
The kidneys are two bean-shaped organs, each about the size of a fist.
They are located just below the rib cage, one on each side of your
spine.

Kidneys play an important part in child's growth as they remove waste

products, regulate blood pressure, electrolyte balance and make
erythropoietin hormone which responsible for stimulation of bone
marrow to produce RBCs. So, if kidney becomes unable to perform
its function this will cause more problems, so, patients go to dialysis
which take place kidney. Dialysis is a renal replacement therapy
(RRT) Patients need dialysis when kidney becomes insufficient or
unable to do its function. There are two types of dialysis. (Peritoneal
dialysis and hemodialysis).
During partial or acute renal failure, peritoneal dialysis is the best
choice to be used.
Definition
It is the process of separating substance in solution through semi-
permeable membrane

Or
It is a treatment that filter purifies blood by using a machine to keep
fluid and electrolytes in balance when kidney becomes unable to
perform its function

Principles
Dialysis involves passing the patient’s blood against a semi-
permeable membrane, with dialysis solution on the other side. At this
stage, three processes can occur to remove unwanted waste products.
Passive diffusion occurs when a high to low concentration gradient is
present between the patient’s blood and dialysis solution (dialysate)
used. Waste products in the blood diffuse into the dialysate solution
while essential minerals diffuse into the blood; diffusion stops once
equilibrium is achieved. The size of the molecule determines whether
diffusion occurs: only low molecular weight solutes and water are
able to pass through the semi-permeable membrane and therefore red
blood cells are not lost
Ultrafiltration ensures excess fluid is cleared from the body through
the use of a positive (blood) or negative (dialysate) pressure gradient,
moving fluid from a high to low pressure region
Convection allows effective clearing of larger molecules from the
blood by creating a higher hydrostatic pressure in the blood (using a
blood pump), leading to the passive movement of solutes dissolved in
fluid. Convection relates to solutes in fluids crossing the membrane
where ultrafiltration is related to movement of fluid under pressure

Types of dialysis:
• Haemodialysis
• Peritoneal dialysis
 Hemodialysis
Hemodialysis is the most common type of dialysis. This process uses
an artificial kidney (hemodialyzer) to remove waste and extra fluid
from the blood. The blood is removed from the body and filtered
through the artificial kidney. The filtered blood is then returned to the
body with the help of a dialysis machine.
 Advantages of hemodialysis:
 Hemodialysis carries a relatively low risk of infection
 Hemodialysis treatments may occur at a hospital, dialysis center
Or In Your own home three times a week, with each session
lasting Between three and five hours. This leaves most of the
week
 Dialysis-free. By contrast, peritoneal dialysis takes between 10
Hours every day.
 Hemodialysis requires less surgical interventions.
 AV fistulas for dialysis last many years, longer than transplanted
 Kidneys and catheters for peritoneal dialysis. This type of
dialysis doesn't typically require additional surgeries.
 Hemodialysis requires less time than peritoneal dialysis.
Disadvantages of hemodialysis: -
 Travel is more complex, requiring advanced planning and
arrangements diet and fluid restrictions must be adhere to
strictly.
 Fistula may seem ungainly and ugly to patient.
 Needles are required to access a fistula. Strict renal diet and
fluid restrictions are required.
 Some patients experience discomfort such as headaches,
Nausea, leg cramps, tiredness and weakness
 Travel to dialysis center may be required three times a week.
 If undergoing home hemodialysis, a partner must be home, and
must be involved in the nursing
Indications
 Acute kidney injury
 Uremic encephalopathy
 Pericarditis
 Life-threatening hyperkalaemia
 Refractory acidosis
  Hypervolemia causing end-organ complications (e.g.,
pulmonary edema)
 Failure to thrive and malnutrition
 Peripheral neuropathy
 Intractable gastrointestinal symptoms
Contraindications
Absolute contraindication to hemodialysis is the inability to secure
vascular access, and relative contraindications include:
 Difficult vascular access
 Needle phobia
 Cardiac failure
 Coagulopathy
Side effects of haemodialysis
 Low blood pressure
 Low blood pressure (hypotension) is one of the most common
side effects of haemodialysis.
 It can be caused by the drop in fluid levels during dialysis. Low
blood pressure can cause nausea and dizziness.
 The best way to minimise these symptoms of low blood pressure
is to keep to your daily fluid intake recommendations.
 If your symptoms persist, you should consult your dialysis care
team as the amount of fluid used during dialysis may need to be
adjusted.
 Sepsis
 People receiving haemodialysis are at increased risk of
developing sepsis (blood poisoning).
 This is where bacteria enter the body and spread through the
blood, potentially leading to multiple organ failure.
 Warning symptoms include dizziness and a high temperature.
  If you have a high temperature, phone your dialysis unit
immediately for advice. Alternatively, you can contact NHS 111
or your local out-of-hours service.
 If you develop sepsis, you'll need to be admitted to hospital and
treated with injections of antibiotics.
 Muscle cramps
 During haemodialysis, some people experience muscle cramps,
usually in the lower leg.
 This is thought to be caused by the muscles reacting to the fluid
loss that happens during haemodialysis.
 Consult your dialysis care team if you have muscle cramps that
become particularly painful. Medicine may be available to help
you cope with the symptoms.
 Itchy skin
 Many people receiving haemodialysis experience itchy skin,
caused by a build-up of minerals in the body between dialysis
sessions.
 Tell your care team if your skin becomes itchy. They may
recommend creams to soothe and moisturise your skin.
Other side effects
Other side effects of haemodialysis can include:
 difficulties falling asleep (insomnia) or staying asleep
 bone and joint pain
 loss of libido (sex drive) and erectile dysfunction
 dry mouth
 anxiety
 There is evidence to suggest that having more regular
haemodialysis at home could help to ease some of these side
effects
Management of complications
 During the hemodialysis procedure, the blood flows slowly
through a special filter that removes waste and fluid, before
the clean blood is returned to the body.
This helps control high blood pressure and balances the levels
of chemicals within the body, such as potassium and sodium.
The blood will be tested about once a month to make sure the
dialysis treatments are working effectively to remove waste
from the blood. Hemodialysis
Treatment is usually administered three times a week for three
to five hours. During treatment, patients can read, watch TV,
sleep or perform other activities. It is important for patients to
adjust their schedule to accommodate these lengthy treatment
sessions. Most patients choose to have their treatments
performed at the same time in order to develop a regular
schedule.
 Patients with hypotension managed by:
Placing the patient in the Trendelenburg position.
Reducing the ultrafiltration rate or stop ultrafiltration.
Infusing boluses of 100 mL of 0.9% isotonic
 Electrolyte Abnormalities
Hypokalemia is abnormally low potassium in the blood.
Potassium is one of the most important electrolytes that the body
uses to regulate fluid balance, muscle contractions, and nerve
signals. When potassium levels drop excessively, it can affect
all of these functions, causing: Fatigue, Weakness, Constipation,
Muscle cramping, Heart palpitations
For most people, the risk of hypokalemia is low if they follow
the prescribed diet and treatment plan. Even those at increased
risk are unlikely to experience anything more than mild
hypokalemia if they do.
  Infection
Antibiotics are typically used to treat the infection. Heparin, a
type of blood thinner, may be used to prevent blood clots and
limb ischemia. Maintaining optimal hygiene and sanitary
practices can significantly reduce the risk of infection.
It is important to avoid bumping or knocking the dialysis access,
since doing so can cause bleeding, especially if the graft or
fistula is new. Bleeding increases the risk of infection, anemia,
and vascular aneurysm (bulging of the arterial wall).
 Fluid Overload
Adhering to fluid restrictions and tracking your fluid intake can
significantly reduce the risk of hypervolemia.
Treatment of malnutrition in dialysis
Patients include amino acids in peritoneal or haemodialysate, appetite
stimulants and use of recombinant human growth hormone and
insulin
Health education
 Exercise
 Don't abuse over the counter painkillers
 Weight control
 Get a physical annually
 Practice a healthy diet
 Find out your family's medical history
 Watch your cholesterol and blood pressure
 Find out about kidney disease
 Don't abuse alcohol or smoke, if you are at risk
 Renal dietitians encourage most people on hemodialysis to eat
high-quality protein because it produces less waste for removal
during dialysis. High-quality protein comes from meat, poultry,
fish, and eggs.
  Peritoneal dialysis
Peritoneal dialysis/ is a way to remove waste products from your
blood when your kidneys can’t adequately do the job any longer.
This procedure filters the blood in a different way than does the
more common Blood -filtering procedure called hemodialysis.

Advantage of Peritoneal dialysis:

 Better control of hypertension and cardiovascular Stability and
greater Independence.
 Peritoneal Dialysis is also more cost-efficient.
 The obstacle to PD is the drop-out rate.
 Fewer negative side effects (such as nausea, vomiting cramping,
and weight gain) than with hemodialysis.
 Provides continuous therapy, which acts more like natural
kidney
 Needle-free treatments direct shipment of PD supplies to your
home or travel destination.
 Do not have to travel to the dialysis center for treatments.
 Greater lifestyle flexibility.
 These can be especially important if you work, travel or live far
from a hemodialysis center.
  Peritoneal dialysis is done more continuously than
Hemodialysis, resulting in less accumulation of potassium,
sodium And fluid
 This allows you to have a more flexible diet than you could have
on hemodialysis.
 Longer lasting residual kidney function.
Disadvantages of peritoneal dialysis
 It requires 7 days a week treatment at home.
 permanent catheter is installed outside the body
 Causes high risk of infection/peritonitis
 People experience weight gain along with a
 Larger waistline.
 Might require ample storage space in your
 Home for supplies.
 One must be responsible and should be trained to perform this
Complications of peritoneal dialysis can include:
 Infections. An infection of the abdominal lining (peritonitis) is a
common complication of peritoneal dialysis. ...
 Weight gain. The dialysate contains sugar (dextrose). ...
 Hernia. Holding fluid in your abdomen for long periods may
strain your muscles.
 Inadequate dialysis.
Mechanism
 During peritoneal dialysis, a cleansing fluid flows through a
tube (catheter) into part of your abdomen.
 The lining of your abdomen (peritoneum) acts as a filter and
removes waste products from your blood.
 After a set period of time, the fluid with the filtered waste
products flows out of your abdomen and is discarded
 Vascular access

Definition
Vascular access procedure involves the insertion of a flexible and
sterile thin plastic tube, or catheter, into a blood vessel to provide an
effective method of drawing blood or delivering medications, blood
products, or nutrition into a patient's bloodstream over a period of
weeks, months or even years.
Types of vascular access:
o Peripheral access
o Arteriovenous fistula
o Atriovenus graft.
o Central access: central vein catheter.
o Atriovenus fistula: an access made by :
 Joining an artery and vein in your arm It's taken from 4to 6
weeks to maturation before it ready to use and in some
patient take from 1 to 4 months.
TYPE 1: FISTULA
A fistula is a natural type of vascular access where your own vein is
surgically connected to an artery. The increased blood flow that
results from this connection causes the vein to become larger and
stronger.
The fistula is the preferred access for hemodialysis because of its low
complication rate and longer life-span as compared to other vascular
access options available.

Advantage of Atriovenus fistula.

o It's considered to be the best choice for vascular access.
o Af fistula uses your own arteries and veins without need for
artificial materials.
o Provide good blood flow for dialysis and increase
effectiveness and reduce treatment.
Disadvantage of arteriovenous fistula.
 It's required several weeks to month to mature to use.
 People with acute renal failure may need to temporary vascular
access until fistula is strong.
 It's not suitable for people with weak vein and arteries.
 Av fistula need exercise daily to be strong.
 It's are visible in arm.
 If it fail to mature must be repeated another surgery.
Complications of arteriovenous fistula
 Thrombosis
 Arteries insufficient.
  Infection.
 Aneurysms.
 Bleeding.
 Increase venous pressure.
 Carpal tunnel syndrome.

TYPE 2 Atriovenus venous graft

It's an access made by using U shaped plastic tube to join an artery
with vein in your arm that's needle insert into the graft when you have
dialysis its can be use in 2 to 4 weeks.
Advantage of Atriovenus graft
 Av graft provides a solution for small or weak vein.
 Av graft can be used as soon as 2to 4 weeks after placement.
 Av graft surgery done on outpatient basis under local
anaesthesia. Dis advantage of arteriovenous graft
Disadvantage of arteriovenous graft
 Use a synthetic material in the body.
 With Av graft there is increases risk of blood clotting,
aneurysms, infection.
 Repeated blood clots can block flow of blood.
 Af graft need constant attention and keep up.
 Af graft doesn't last as longer than fistula and will probably
need to replace.
Complications of Af
 Seroma.
 Neuropathy Graft infection
 Blood clotting.
 Infection.
 Aneurysm.
 Central vascular access.
 Central access: central vein catheter
Definition
Soft tube that placed in large vein usually in the neck, its general used
as temporary access but sometimes used to permanently.
Advantage on CVC
• It's good choice if urgent or emergency dialysis.
• Can remain in place for days, weeks, even month.
Disadvantage of CVC
• Discomfortable.
• It's temporary method for permanent dialysis.
Complications of CVC
• Pneumothorax.
• Venous air embolism.
• Arteries injury.
• Local infection.
• Thrombosis.
Health education about vascular access:
 Check the flow of blood called thrill sound in your access.
 Changes where the needle goes into your fistula or graft.
 Don't leave any one to take your blood pressure.
 Don't let anyone to draw a blood Sample from fistula.
 Don't sleep on your access arm.
 Don't carry more than 4.5 kg.
 Don't wear a watch, jewellery, or tight clothing.
 Be careful don't cut or bump your access.