Dialysis - is used to control uremia and to physically prepare the client to receive a trans planted kidney.

It also removes excess water and nitrogenous wastes, reducing the manifestations of renal failure. Four basic goals of dialysis therapy - To remove the end products of protein metabolism, such as urea and creatinine, from the blood. To maintain a safe concentration of serum electrolytes To correct acidosis and replenish the bicarbonate levels of the blood. To remove excess fluid from the blood.

Principles to accomplish the goals of Dialysis: Ultrafiltration refers to removal of fluid from the blood using either osmotic or hydrostatic pressure to produce the necessary gradient. Diffusion - is the passage of particles (ions) from an area of high concentration to an area of low concentration. Hemodialysis - A medical procedure that uses a special machine (a dialysis machine) to filter waste products from the blood and to restore normal constituents to it. This shuffling of multiple substances is accomplished by virtue of the differences in the rates of their diffusion through a semi permeable membrane (a dialysis membrane).Is the one of three renal replacement therapies (the other two being renal transplant; peritoneal dialysis).Dialysis treatments in a clinic are initiated and managed by specialized staff made up of nurses and technicians; dialysis treatments at home can be self initiated and managed or done jointly with the assistance of a trained helper who is usually a family member. Indications Chronic Renal Failure Severe Hypertension Acute renal failure Metabolic alkalosis Poisons and Drug intoxication Hypercalcemia

Side Effects of Hemodialysis -If too much fluid is removed it can lead to side effects: Low blood pressure Fatigue chest pain

Heparin is the most commonly used anticoagulant in hemodialysis, as it is generally well tolerated and can be quickly reversed with protamine sulfate. Heparin allergy can infrequently be a problem and can cause a low platelet count. In such patients, alternative anticoagulants can be used. In patients at high risk of bleeding, dialysis can be done without anticoagulation.

Complications of Hemodialysis: - Hypotension - Cramps - Febrile reactions - Arrhythmia - Hemolysis - Hypoxemia

Three basic kinds of vascular access for hemodialysis: A. Arteriovenous fistula - is useful because it causes the vein to grow larger and stronger for easy access to the blood system. The best long-term vascular access for hemodialysis because it provides adequate blood flow, lasts a longtime, and has a lower complication rate than other types of access. A surgeon creates an AV fistula by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier.

b. Arteriovenous graft the graft becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesnt need to develop as a fistula does, so it can be used sooner after placement, often within 2 or 3 weeks.Compared with properly formed fistulas, grafts tend to have more problems with clotting and infection and need replacement sooner. However, a well-cared-for graft can last several years.

c. Venous catheter for temporary access - If your kidney disease has progressed quickly, you may not have time to get a permanent vascular access before you start hemodialysis treatments. You may need to use a venous catheter as a temporary access. A catheter is a tube inserted into a vein in your neck, chest, or leg near the groin. It has two chambers to allow a two-way flow of blood.Once a catheter is placed, needle insertion is not necessary.Catheters are not ideal for permanent access.They can clog, become infected, and cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, a catheter will work for several weeks or months while your permanent access develops

Three types of hemodialysis: A. Conventional hemodialysis - The procedure of conventional hemodialysis are: patients attached to a dialysis machine; the function of a dialysis machine is to push blood to circulate through the patients body and machine, at the same time, monitor temperature, blood pressure and time of the procedure; if patient is using fistula or graft, two huge-gate needles on patients side: one brings wastes-full blood from patients body to the dialyzer, while another needle carries clean blood back to the body; it is offered three times a week and 3 or 4 hours per session. Patients are required to follow their rigid schedule. B. Daily hemodialysis - The procedure of daily hemodialysis is similar to the conventional hemodialysis except it is performed six days a week and about 2 hours per session. C. Nocturnal hemodialysis - The procedure of nocturnal hemodialysis is similar to conventional hemodialysis except it is performed six nights a week and six-ten hours per session while patient sleep

Dialysis Machine The dialysis machine is about the size of a dishwasher. This machine has three main jobs: pump blood and watch flow for safety clean wastes from blood watch your blood pressure and the rate of fluid removal from your body

Dialyzer - The dialyzer is a large canister containing thousands of small fibers through which your blood is passed. Dialysis solution, the cleansing fluid, is pumped around these fibers. The fibers allow wastes and extra fluids to pass from your blood into the solution, which carries them away. The dialyzer is sometimes called an artificial kidney. Reuse Your dialysis center may use the same dialyzer more than once for your treatments. Reuse is considered safe as long as the dialyzer is cleaned before each use. The dialyzer is tested each time to make sure it's still working, and it should never be used for anyone but you. Before each session, you should be sure that the dialyzer is labeled with your name and check to see that it has been cleaned, disinfected, and tested.

Dialysis Solution - Dialysis solution, also known as dialysate, is the fluid in the dialyzer that helps remove wastes and extra fluid from your blood. It contains chemicals that make it act like a sponge. Your doctor will give you a specific dialysis solution for your treatments.This formula can be adjusted based on how well you handle the treatments and on your blood tests. Needles - Many people find the needle sticks to be one of the hardest parts of hemodialysis treatments.Most people, however, report getting used to them after a few sessions. If you find the needle insertion painful, an anesthetic cream or spray can be applied to the skin. The cream or spray will numb your skin briefly so you won't feel the needle. Most dialysis centers use two needles-one to carry blood to the dialyzer and one to return the cleaned blood to your body. Some specialized needles are designed with two openings for two-way flow of blood, but these needles are less efficient and require longer sessions. Needles for high-flux or high-efficiency dialysis need to be a little larger than those used with regular dialyzers.

Peritoneal Dialysis (PD) is a different kind of dialysis Home Hemodialysis (HHD) and Peritoneal Dialysis (PD) both remove waste and excess fluid from your body as your kidneys once did. Unlike HHD, however, which uses an external machine with a dialysis filter to clean your blood, PD uses your bodys abdominal lining, the peritoneal membrane, as a natural filter and filters your blood continuously throughout the day. With PD, no blood leaves your body and its a therapy thats performed in the comfort of your own homesafely and without needles.

There are two types of Peritoneal Dialysis

1. Automated Peritoneal Dialysis (APD) or CCPD APD is usually done overnight, with a cycler machine that performs exchanges automatically, while you sleep. APD is good for people who want more freedom from dialysis during the day. Since you dont have to do exchanges during the day, you have more independence.

2. Continuous Ambulatory Peritoneal Dialysis (CAPD) CAPD cleans your blood most hours of the day, 7 days a week. And you can walk around, even during exchanges. Exchanges usually take about 30 minutes 3-4 times a day and only require a solution bag with tubing attached to it that connects to your catheter. The fluid from the solution bag "dwells" in your abdomen for about five hours, drawing waste products and excess fluid from the bloodstream. An exchange can be performed in any clean area at home, work or while traveling.