Hemodialysis
Thursday, February 7, 2008
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dealing Healthy kidneys clean the blood and remove excess fluid as urine. They also make substances that keep the body healthy. If the kidneys no longer work, dialysis replaces some of these functions. There are two different types of dialysis: hemodialysis and peritoneal dialysis.
A person needs dialysis if their kidneys are no longer able to remove waste and fluid from the blood in sufficient quantities to keep you healthy. Usually this happens if you just need 10 to 15 percent of kidney function. It is possible that the person has symptoms of nausea, vomiting, swelling and fatigue. However, it may not exhibit these symptoms, and only found high levels of waste in the blood, which can be toxic to the body.
Due to the similarity of healthy kidneys, dialysis keeps the body healthy. Dialysis does the following:
- Removes waste, salt and excess water to prevent buildup in the blood.
- Maintain an appropriate level of certain chemicals in the blood.
- Helps control blood pressure.
To perform hemodialysis using a dialysis machine and a special filter called a dialyzer, in order to cleanse the blood. To carry blood to the dialyzer, the doctor must establish an access or entry to the blood vessels. This requires minor surgery.
The dialyzer or filter consists of two parts: one for blood, the other for a flushing fluid called dialysate. A thin membrane separates the two sides. The red cells and white blood, proteins and other important elements remain in the blood because they are too large to pass through the membrane. The smaller waste products found in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are removed by washing. The size of certain substances in the blood determines whether they can be removed. Water, urea and creatinine are small enough that they can be filtered. Protein and blood cells are not.
Hemodialysis can be performed in a hospital, a dialysis center that is not part of a hospital or at home. In general, hemodialysis treatments last about four hours, and carries out three times a week.
A person needs dialysis if their kidneys are no longer able to remove waste and fluid from the blood in sufficient quantities to keep you healthy. Usually this happens if you just need 10 to 15 percent of kidney function. It is possible that the person has symptoms of nausea, vomiting, swelling and fatigue. However, it may not exhibit these symptoms, and only found high levels of waste in the blood, which can be toxic to the body.
Due to the similarity of healthy kidneys, dialysis keeps the body healthy. Dialysis does the following:
- Removes waste, salt and excess water to prevent buildup in the blood.
- Maintain an appropriate level of certain chemicals in the blood.
- Helps control blood pressure.
To perform hemodialysis using a dialysis machine and a special filter called a dialyzer, in order to cleanse the blood. To carry blood to the dialyzer, the doctor must establish an access or entry to the blood vessels. This requires minor surgery.
The dialyzer or filter consists of two parts: one for blood, the other for a flushing fluid called dialysate. A thin membrane separates the two sides. The red cells and white blood, proteins and other important elements remain in the blood because they are too large to pass through the membrane. The smaller waste products found in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are removed by washing. The size of certain substances in the blood determines whether they can be removed. Water, urea and creatinine are small enough that they can be filtered. Protein and blood cells are not.
Hemodialysis can be performed in a hospital, a dialysis center that is not part of a hospital or at home. In general, hemodialysis treatments last about four hours, and carries out three times a week.
Hemodialysis
This procedure allows the body to partially withdraw water and uremic waste products that accumulate because of renal disease, due to the inability of the kidneys to perform its function. This is done with a special filter that cleans the blood called a dialyzer (artificial kidney), which travels from the arterio-venous fistula, some pipes or blood lines to the dialyzer, which serves as a semipermeable membrane that replaces synthetic glomeruli and kidney tubules as affected kidneys filter which cleans the blood and returns to the body.
hemodialysis allows a faster change in the composition of plasma solutes and disposal of excess body water. A rapid correction of electrolyte imbalance may predispose to cardiac arrhythmia, while the rapid elimination of fluid is in some cases, poorly tolerated by patients.
Hemodialysis works by circulating the blood through special filters outside the body. Blood flows through a semipermeable membrane (the dialyzer or filter), along with solutions that help remove toxins. Since
is intermittent hemodialysis, fluid control and diet is essential to keep the patient under the best conditions. Moreover in hypercatabolic patients and those requiring rapid correction of an electrolyte imbalance, hemodialysis is the treatment of choice. Once patients undergoing hemodialysis should do for the rest of their lives, or until they practice a successful kidney transplant. The treatment is usually applied three times a week, each session lasting 3 to 4 hours.
PHYSIOLOGICAL BASES
Hemodialysis is a process by which the composition of solutes in a solution A is modified by exposing the solution to a second solution B, through a semipermeable membrane. Water molecules and low-weight solutes molecular in the two solutions can pass through the membrane pores and mingle, but the higher molecular weight solutes (like proteins) can not pass through the semipermeable barrier, so that the amount of high molecular weight solutes molecular on each side of the membrane remain unchanged. Solutes that can pass through the pores of the membrane are transported by two mechanisms:
RELEASE: When the solutes move from a solution of higher concentration to lower concentration.
ULTRAFILTRATION: Water molecules are very small and can pass through all semipermeable membranes. Ultrafiltration occurs when water is pushed by a hydrostatic or osmotic force across the membrane.
Principles related to hemodialysis.
The goals of hemodialysis are removing toxic nitrogenous substances from the blood and remove excess water along with trying to improve the quality of life for patients, plus:
- Prolong the life
- Prevent the occurrence of uremic symptoms
- Maintain nitrogen balance and adequate caloric intake
- Enhance the quality of life
- Minimize the problems trying to keep the style of life.
In hemodialysis, blood, loaded with toxins and nitrogenous wastes are diverted from the person to a dialyzer, where it is cleaned before returning to the person. For hemodialysis is needed: the machine, the dialysate, filter and a means to connect the patient to the machine (arteriovenous fistula).
The action of the procedure is based on three principles: diffusion, osmosis and ultrafiltration. The toxins and wastes blood is extracted by diffusion, and passing the area of \u200b\u200bgreatest concentration in the blood to the lower concentration in the dialysate, a solution which consists of all the electrolytes in extracellular concentrations ideals. The semipermeable membrane prevents the diffusion of large molecules, such as erythrocytes or plasma proteins.
The water in excessive amounts in the blood is removed by osmosis, as it passes from an area of \u200b\u200bhigh concentration (blood) to a low concentration (dialysate). Ultrafiltration is defined as moving water under high pressure to an area of \u200b\u200blower pressure. This process is more efficient than the osmosis to remove water. Ultrafiltration is achieved by applying negative pressure or suction force to the dialysis membrane. In the case of patients with neuropathy can not excrete water, mushroom force is necessary to remove it and reach a balance of fluids.
To keep the body buffer system using a dialysate bath, consisting of bicarbonate or acetate, which is metabolized to bicarbonate. Given anticoagulant such as heparin to prevent blood from clotting in the dialysis circuit. The clean blood is returned to the body. After treatment with dialysis many products waste have been removed, the electrolyte balance has returned to normal and the damping system has been replenished.
Teams: dialyzers.
dialyzer cartridge or tube is a box with four hits. Two of his hits communicate with the blood compartment and the other two with the dialysis fluid compartment. Semipermeable membrane separates the two compartments.
Most dialyzer or artificial kidney dialyzers are flat plate, hollow fiber artificial kidney containing thousands of small tubes of cellophane which act as semipermeable membranes. Blood flows through the tubules, while the solution, the dialysate circulates around the tubules. The exchange of wastes from the blood to the dialysate occurs through the semipermeable membrane of the tubules.
features dialyzer.
hollow fiber structure and parallel plates:
in hollow fiber dialyzers, also known as capillaries, blood flows into a chamber located in one end of the cylindrical cartridge. From here the blood flows into thousands of tiny capillaries in a strongly united single beam. Blood flows through the fibers and the dialysis fluid flows around them. After passing through the capillaries, blood is collected in a chamber at the other end of the cylindrical cartridge and returned to the patient.
dialyzers in parallel plates (plate dialyzers), blood leads between the overlapping layers of the membrane. The dialyzer is designed for blood and dialysis fluid moving alternately between the layers of the membrane.
Membranes:
membrane composition: Used four types of membranes, cellulose, substituted cellulose, and synthetic celulosintéticas.
Pulp: This is obtained from processed cotton. Cellulose membranes are known by different names, such as regenerated cellulose, cellulose cuprammonium, cuprammonium-rayon and saponified cellulose ester. Cellulose
replaced: The cellulose polymer has a number of free hydroxyl radicals on its surface
Celulosintéticas: To manufacture a synthetic material is added to liquefied cellulose during the formation of the membrane. As a result the surface of the membrane is modified, which enhances biocompatibility. Synthetic
: These membranes do not contain cellulose and polyacrylonitrile materials used include, among others.
modern dialysis machines consist of a blood pump, a distribution system of the dialysis solution and the appropriate safety monitors.
pump blood: The blood pump moves blood from the vascular access to the dialyzer and returned to the patient. The current flow in adult patients is 350-500 ml / min.
Indications for Hemodialysis
Absolute indications for dialysis
· Pericarditis. Chronic Renal
· inadequate.
· Drug Poisoning.
· volume overload or pulmonary edema resistant to diuretics.
· Hypertension accelerated resistant hypertensive blood.
· uremic encephalopathy and neuropathy.
· plasma creatinine greater than 12 mg / dl or BUN greater than 100 mg / dl.
vascular access for hemodialysis.
vascular access in patients with renal impairment may be temporary or permanent. Temporary access is used in a few hours dialysis (dialysis only) or months while waiting for arteriovenous fistula matures. Ø
venous access.
temporary Hits: temporary access is established with the insertion of a percutaneous double-lumen catheter or multiple lights in a large vein (internal jugular or subclavian). These venous catheters are used in emergency situations eg
• In patients with acute renal failure
• In patients requiring hemodialysis or hemoperfusion for intoxication or overdose.
• patients with ESRD who require dialysis and have no mature access (arteriovenous fistula).
Ø
Complications:
1. Catheter insertion:
· Hemothorax.
· pneumothorax.
· Arrhythmia
· Infection.
2. Delayed:
· Infection.
· Clotting of the catheter.
· thrombosis or stenosis of the subclavian vein.
· Bleeding.
NURSING CARE OF PATIENTS WITH HEMODIALYSIS CATHETER.
- Place patient in comfortable position
- Connect the patient with aseptic technique
- Assess status of gauze, site of insertion, mounting points, presence of exudate.
- Healing with the use of masks, gloves and sterile fields.
- Use of local antiseptic: Alcohol or chlorhexidine
- Make healing in each session of hemodialysis.
- Aspirate each branch of the catheter.
- Keep branches plucked
- Connect the patient with the help of paramedics
- At the end of the session each branch heparinised catheter, sealed with sterile cap and cover with sterile gauze.
Education: Maintain good hygiene, bathing catheter to protect, prevent displacement or accidental removal, avoiding physical activity.
permanent Hits:
1. Fistula: fistulas are the most permanent access are performed surgically (forearm) by anastomosis of an artery with a vein, which can be latero-lateral or end-side. The needles are inserted into the vessel to ensure that adequate blood flow passes through the dialyzer. The arterial segment of the fistula is used for arterial and venous flow to the dialyzed blood retransfusion. Are required to take between four to six weeks after fistula creation to use it. This time is necessary for healing and for the venous segment to dilate the fistula so as to receive two large-bore needles, so this should educate the patient to perform exercises such as squeezing a rubber ball, which makes the fistula.
Anastomosis between:
- radial artery and cephalic vein
- brachial artery and cephalic vein
- brachial artery and basilic vein
- radial artery and cubital vein
2. Graft: also called a prosthesis. To create an arteriovenous graft is interposed a subcutaneous biologic graft material, or synthetic semibiológico between an artery and vein. Graft are created when the patient's blood vessels are inadequate for a fistula. Usually the grafts are placed in the forearm, upper arm or thigh and among the most frequent complications are infections and thrombosis. The waiting time is approximately two weeks. FEATURES
OPTIMA an arteriovenous fistula.
- enable continued safe approach to the vascular system
- Provide sufficient flow to allow the provision of scheduled dialysis dose
- Lack of complications
- proper maturation
- not an inch deeper.
- Among the factors that lead to a failure of arteriovenous fistula are: age, sex, obesity, diabetes mellitus, hypertension and cardiovascular disease.
Care in the period of maturation of the fistula. Ü
takes four to six weeks
ü Educate the patient in daily monitoring of your fistula
ü Teach the meaning of thrill [1] and blow [2]
ü Observe for signs of infection or Watch signs
ischemia ü Avoid contamination of the wound
ü Start limb exercise rubber ball (starting at three weeks)
Use loose clothing ü ü
heavy lifting with the arm where is the fistula.
ü Do not sleep on the arm
ü Do not use a watch or bracelet on the limb.
ü Do not take blood pressure or take blood tests at the tip of the fistula.
ü Do not use tight sleeves or something close
Care catheters.
ü ü No Cover it soak in the bath
ü Avoid tub baths and pools submersible
ü Do not open it up. Should only be handled by the renal unit staff
ü Do not apply lotions, powders or perfumes near the catheter
ü Do not administer medications or blood transfusions through the catheter, as it has heparinization a special process and if not handle it can lead to over-heparinization of the patient or tamponade.
[1] Thrill: Vibration transmitted and noticeable by palpation
skin [1] Puff: sound audible by auscultation, due to turbulent flow
skin [1] Puff: sound audible by auscultation, due to turbulent flow
COMPLICATIONS DURING HEMODIALYSIS .
complications may arise at the time of dialysis or shortly thereafter. There are two types of complications:
- Complications of patient
-
team Complications Complications
patient:
team Complications Complications
patient:
Hypotension occurs in 20 to 30% of patients. Can occur for a high rate of ultrafiltration or dialysis solution with low sodium. You can also occur because the solution has a high temperature. The ideal temperature is 34 º to 36 º C.
Cramps: painful muscle contractions within the predisposing factors are: ü
Hypotension Ü Solution
low sodium dialysis
ü tissue hypoxia during hemodialysis
ü Ph Altered blood.
massage is recommended, apply cold compresses and administer sodium chloride 10%.
Nausea and Vomiting: This may be related to hypotension, intradialytic food intake or digestive disorders. Antiemetic should be administered as directed and carry out water balance to calculate the total loss.
Headache: Among its causes are: hypertensive crisis, disequilibrium syndrome, hemolysis, psychogenic origin.
chest pain accompanied by sweating and cold.
team Complications:
ü air embolism or air into the patient by breaking or disconnection of lines
ü heater malfunction dialysis fluid filter
ü Break
or errors in the bath, over-concentrated, not added or was added concentrated less thereof.
COMPLICATIONS AFTER HEMODIALYSIS.
ü hypotension. Ü
Syndrome balance, you feel sick, with headaches, increased blood pressure and seizures. Ü
Bleeding from anywhere. Ü
cramps
For the dialysis patient's blood from clotting during dialysis, it puts a certain amount of heparin is an anticoagulant substance, but when he returned to the body, you have to add a substance that counteracts to prevent bleeding and allow the body to have its normal volume, the substance that counteracts the action del anticoagulante(heparina) es la Protamina.
Tratamiento a largo plazo.
Durante la diálisis, el paciente, el dializador y el baño de dializado requieren de vigilancia para detectar y prevenir complicaciones. La enfermera desempeña un papel importante en la vigilancia, apoyo, valoración e instrucción del paciente.
Cuidados en el Catéter para Hemodiálisis:
§ Colocar al paciente en posición cómoda
§ Connect the patient with aseptic techniques
§ Assess status of gauze, site of insertion, mounting points, presence of exudate. § Healing
use of masks, gloves and sterile fields.
§ Use of local antiseptic: Alcohol or chlorhexidine
§ Perform healing in each session of hemodialysis. §
Aspirate each branch of the catheter. § Maintain
branches plucked
§ Connect the patient with the help of paramedics
§ At the end of the session each branch heparinised catheter, sealed with sterile cap and cover with sterile gauze. Check the integrity of the skin.
Adverse Rating: allergies, nausea, vomiting, dizziness, ringing in the ears, weakness, muscle cramps, chest pain and back pain, chills, heat, cold, blurred vision, headache and any unusual discomfort.
- Visual assessment of clotting during dialysis.
- Education on the usual diet: Reduced sodium, potassium, protein and water. Carbohydrates increase.
- Education about self-care measures: The importance of daily weight control and fluid intake (patient self-monitoring).
- Education on the use of a catheter for hemodialysis: Using watch and bracelets in the same arm of the catheter, do not use tight sleeves or something to compress eg blood pressure control, can not take tests laboratory on the same arm of the catheter. Hemodialysis via exclusive.
- Education maintenance hemodialysis catheter: Maintain good hygiene, bathing catheter to protect, prevent accidental displacement or removal, avoiding physical activity.
- Perform protein restriction (Increase BUN) and phosphorus-rich foods (milk, vegetable, beverage, beer, cheese, flour, nuts, fruits, vegetables, seafood, chocolates etc.)
- Education on alternative methods to decrease the sensation of thirst (sucking on small ice cubes, lemons or candy)
- Education about the importance of the appearance of weight gain over 2 kg, Increased fatigue or weakness, edema, confusion, lethargy).
- Perform oral hygiene in the presence of uremic fetor.
- Rating the presence of Neurological Disorders: lethargy, apathy, impaired concentration, fatigue, irritability, confusion, drowsiness and impaired mental capacity.
- Evaluation of Hyperkalemia Symptoms: Weakness, muscle cramps, arrhythmias and sudden intolerance to activity.
Care in patients with intradialytic hypotension:
- Place patient in position Trendelenburg (lower extremities up).
- Reassure the patient if conditions permit.
- Managing Saline through the blood circuit.
- Decrease rate of ultrafiltration.
- Vital Signs Monitoring.
- Assess the patient's general condition.
- If there is impairment of consciousness: Ensure patency of airway, removal of dentures, administer high flow oxygen therapy, aside the ultrafiltration, Managing
- Request Evaluation by doctor on duty.
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