HEMODIALYSIS

MACHINE
INTRODUCTION

 HEMODIALYSIS removes wastes and water by circulating blood outside the

body through an external filter, called a dialyzer, (artificial kidney) that
contains a semi permeable membrane.

 The blood flows in one direction and the dialysate flows the opposite. The
counter- current flow of the blood and dialysate maximizes the concentration
gradient of solutes between the blood and dialysate, which helps to remove
more urea and creatinine from the blood.
 The concentration of solutes (like potassium, phosphorus, and urea) are
undesirably high in the blood, but low or absent in the dialysis solution,
dialysis is an increasingly common type of treatment.

 The dialysis solution has levels of minerals like potassium and calcium that
are similar to their natural concentration in healthy blood.
Purpose

 When the nephrons in the kidneys are failed or not working properly, ions like
potassium, creatinine, etc we go through dialysis.

 Disease of renal failure are.

 Nephrotoxins
 Diabetic
 Nephropathy
 Hypertension
 Glumerulonephritis
 Cystic kidney disease
HEMODIALYSIS

 The hemodialysis name itself contains hemo means blood and dialysis means
the diffusion of solute molecules through a semi permeable membrane,
normally passing from the side of higher concentration to that of lower
concentration.

 Semi permeable is one that allows the passage of certain smaller molecules of
such crystalloids as glucose and urea, but prevents passage of larger
molecules such as the colloidal plasma protein and protoplasm.
 Hemodialysis, is also spelled haemodialysis, commonly called kidney dialysis
or simply dialysis, is a process of purifying the blood of a person whose
kidneys are not working normally.
 Before hemodialysis can be performed, a surgeon must make a way for the
blood to be pumped out of the body and then be returned after it has been
cleansed.
 To do this, the surgeon uses an artery and a vein in the forearm. Arteries
(which have muscles in their walls) bring oxygenated blood to the body from
the heart, and veins return blood to the heart, which needs to have oxygen.
 The surgeon connects the radial artery in the forearm to a large vein called
the cephalic vein. This connection is called an arterio venous shunt.
HD temporary access
HD PERMANENT ACCESS
Highlights

 The essential components for HD includes the following:

DIALYZER
DIALYZER SOLUTION
DIALYSIS TUBING
HD MACHINE
 DIALYZER
Also known as the
ARTIFICIAL KIDNEY.
An apparatus in which the dialysate
fluid and blood are in contact
across a semipermeable membrane.
PORTS

 There are four ports attached:

2 for dialysate
2 for the blood

Blood flowing from the patient to the dialysis machine is carried

along the ‘arterial’ limb of the circuit.
Conversely the ‘venous’ limb carries purified blood from the
dialysis machine back to the patient.
Water for haemodialysis
Dialysis water is purified in a number of steps, including
softening (removing impurities such as chloramine), removal
of small- mw solutes (either by reverse osmosis or
deionisers) and sterilization (by passage through a bacterial
filter.

Recommendations exit for the minimum levels of these

contaminants in water for dialysis (refer to the AAMI
guidelines for the reference)

Regular testing of water quality is highly recommended

Impurities that should be
removed include:

 Aluminum- may cause dialysis dementia, bone

disease and anemia.
 Chloramine- may cause haemolysis bacteria
 Endotoxins- may cause pyrogenic reactions on dialysis
(usually filtered
out by the dialyser
membrane,
but not the high-flux
membranes)

DIALYSER SOLUTION (DIALYSATE)
 The dialysate is made by mixing treated water with prepared ionic
concentrates using a proportioning device with the HD machine.
 Typical composition of a bicarbonate- based dialysate:
 pH 7.1-7.3,
 Sodium 135-145mm
 Pottasium 2-4mm
 Chloride 90-120mm
 Calcium 0.9-1.7mm
 Magnesium 0.3-0.8mm
 Bicarbonate 27-40mm
 Dextrose 5-10mm
DIALYSATE CONCENTRATES

 The acid concentrate contains most of the important ionic constituents of

blood (examples are sodium, potassium, chloride, calcium, magnesium and
dextrose)

 The bicarbonate concentrate is added from a separate concentrate reservoir

for it would form insoluble carbonate if stored in the same concentrate.
ACID AND BICARBONATE CONCENTRATES
DIALYSIS TUBING
 Disposable tubing
connects the
dialyser to the
patient.
 Low-priming
volume lines used
for dialysing
children in the
paediatric setting.
 PROPER HANDLING OF
DIALYSIS MACHINE
 DEFINITIONS

RINSE- Flushing the internal hydraulics of the dialysis machine with water
that meets CSA dialysis standards.

DESCALENT
Removal of calcification / precipitate from within the internal hydraulics of the
dialysis machine. i.e., citric acid or acetic acid-based product or removal of
calcification.
HEAT DISINFECTION
Destruction of pathogenic and other kinds of microorganisms by thermal means.
NOTE: Disinfection is a less lethal process than sterilization. It destroys most
recognized pathogenic microorganisms but does not necessarily destroy all microbial
forms

CHEMICAL DISINFECTION
Destruction of pathogenic and other kinds of microorganisms by chemical means.
Chemicals can include: sodium hypochlorite (bleach), sodium carbonate, peracetic
acid / hydrogen peroxide blend .
RECOMMENDATIONS…

#1: Each HD unit develops a process to

identify, update and document the
frequency of machine disinfection required
for a specific patient

#2: Disinfect internal pathways, the

external surface of the HD machine and
peripheral equipment and accessories
SYSTEM DISINFECTION
 All dialysis unit must have written policies that deals with the dialysis fluid
pathway and dialysis machine
 Disinfection procedures should be done on a regular base according to
manufacturer’s instruction

 TARGET:
 To control bacteria contamination. HIV, HCV and HBC viruses are known to be
inactivated by common household beach

 METHOD:
 Heat disinfection requires temperature greater than 85-90 c
 Chemical disinfection such as formaldehyde, sodium hydrochloride and acetic
acid.
PERSONAL PROTECTIVE EQUIPMENT
(PPE) IN DIALYSIS
 PURPOSE OF PPE
 Protect you from contact with infectious material
 Prevent transmission of pathogens between patients

DIALYSIS- SPECIFIC PPE is needed during times where spurting or spattering of blood,
body fluids, potentially contaminated substances, or chemicals might occur
-gloves, gowns, and nose/mouth/eye protection such as goggles or face shield
And face masks.

If your PPE becomes soiled or contaminated with blood, body fluids, or other
materials such as dialysate, change it immediately as it increases the risk of spreading
pathogens between patients.
ALARM DURING HEMODIALYSIS
PROBLEM SOLVING
 When an alarm is activated during dialysis do the following
 Identify which alarm has been activated
 Identify the cause
 Correct the cause
 Resume dialysis if safe to do so
POWER

 turn the system on and off: if still no power check the power cord
make sure power is available
 Check the fuse

ARTERIAL AND VENOUS PRESSURE:

 Check to see that blood pump is running and connected properly
 Check to see if blood flow rate has changed
 Determine if patient has coughed or moved
 Check to see if the monitor line is leaking
 Check the blood line for kinks and leaks
 Ensure the monitoring lines are connected to proper drip chambers
HIGH VENOUS PRESSURE
 Manipulate the needle and or the line. If access is small a
tourniquet must be used, being certain the blood is off,
recannulation with new needle if needed.

 Adjust the blood flow rate, proper heparinization, treat

access problem and proper needle and needling.

 Extreme care must be exercised when dialyzing a patient

with high venous pressure.
HIGH NEGATIVE PRESSURE

 Manipulation of the arterial needle is similar to

that of venous needle. In most cases the needle
may have to be placed with the same
precaution as with venous needle.
 Treat the cause
 Proper needling
 Assess the access
HIGH POSITIVE DIALYSATE
PRESSURE ALARM
Check to see if drain is occluded or
kinked
Check to see if dialysate hoses are
leaking
LOW NEGATIVE DIALYSATE
PRESSURE ALARM

Check to see if dialysate hoses are

kinked
AIR DETECTOR ALARM
Check for leaks around tubing joints
Excessive undetected negative pressure
Check for unattended intravenous
solution administration
 MANAGEMENT OF AIR EMBOLISM
IF PRESENT

 Clamp the venous line and stop the blood pump

 Place the patient in Trendelenburg position on the
left side with the chest and head tilted downward to
trap the air at the apex of right ventricle away from
the outflow tract
 Cardiorespiratory support oxygen 100%
HIGH TEMPERATURE ALARM

 Determine temperature of dialysate in the

line actually high
 Check
to ensure incoming water
temperature is below 90F
LOW TEMPERATURE ALARM

 Detemine temperatue of dialysate to dialyzer in the line is actually low

 Allow adequate time for the system to stabilize and come to proper
temperature range
 Check to ensure incoming water temperature is above 40F
HIGH CONDUCTIVITY ALARM

 Check to see if water is flowing too slowly or turn off

 Check for kink in the concentrate outlet
 Make sure that the system has had time to stabilize
 Analyse the dialysate to confirm high conductivity at the
dialyzer line connection:
a. If normal there is malfunction in the machine itself
b. If high again concentrate before resuming dialysis
c. Be certain that the flow rate is proper
LOW CONDUCTIVITY ALARM
 Turn the mode selector switch to dialyze
 Connect the concentrate line to the system
 Drop the concentrate line into the concentrate container
 Check for kinks
 Make sure the filter on the concentrate is clean
 Allow adequate time for the system to stabilize
 Change the containers when empty
 Analyse the dialysate if the conductivity still low after changing the
concentrate bottle and compare to the other machine.
 Be certain that the dialysate flow rate is proper.
BLOOD LEAK ALARM
 Make sure the blood leak detector is clean
 Check the effluent for traces of blood
 Bilirubin in dialysate in jaundice patient, air bubbles in
dialysate, dirty sensor
 If leak confirmed and you can not manage the cause
 Reduce the dialysate compartment pressure to -50mmHg to
avoid bacterial entry to the blood
 Discontinue dialysis
DIALYSIS MACHINE PREVENTIVE
MAINTENANCE
 The contractor shall provide all necessary to provide full service
maintenance.
 Preventive maintenance is defined as such services which involves checking
the correct functioning of the machine.
 The equipment is used in delivering safe patient care and needs maintenance
to be completed immediately
 Downtime may cause life threatening issues and/or rescheduling. Due to the
propriety nature of the equipment and software only a certified technician
should perform the maintenance.
PERFORMANCE REQUIREMENTS

1. MATERIALS TO BE FURNISHED
2. SERVICE MANUALS/TOOLS/EQUIPMENT
3. REPORT OF SERVICES/ DOCUMENTATION
4. EQUIPMENT TO BE SERVICED
1. MATERIALS TO BE FURNISHED

 The contractor shall furnish all lubricants, test

equipment, cleaning supplies, parts and tools
necessary to perform the work described. Only
accessories, disposable items and spare parts that
do not pose a technical safety risk and
demonstrably comply may be used. To ensure the
full functionality of the dialysis machine, we
recommend using products/parts by the company
where the unit was purchased.
2. SERVICE MANUALS/TOOLS/EQUIPMENT
REPORT OF SERVICES/DOCUMENTATION

Upon completion of any maintenance

and/or repair services, the contractor
shall report and provide an electronic
report detailing services performed
and obtain an acceptable signature.
 OPERATION AND APPLICATION
 PREVENTIVE MAINTENANCE AND CLEANING/ DISINFECTION
 SAFE KEEPING AND STORAGE
 TAGGING AND LABELING
 ELECTRICXAL LOAD CONSUMPTION