Dialysis machine

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Dialysis machine
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What is dialysis machine

• Dialysis machine is a electro-mechanical-hydrauli
  cs device which helps us to remove the unwanted
  particles (Eg.- K, Na, CL-, Calcium, Magnesium
  etc.) from the patients blood through hollow
  fiber artificial dialyzer.

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Principle of dialysis

• Dialysis works on the principles of the diffusion
  and osmosis of solutes and fluid across a
  semi-permeable membrane. Blood flows by one side
  of a semi-permeable membrane, and a dialysate or
  fluid flows by the opposite side. Smaller solutes
  and fluid pass through the membrane. The blood
  flows in one direction and the dialysate flows in
  the opposite. The concentrations of undesired
  solutes (for example potassium, calcium, and
  urea) are high in the blood, but low or absent in
  the dialysis solution and constant replacement of
  the dialysate ensures that the concentration of
  undesired solutes is kept low on this side of the
  membrane. The dialysis solution has levels of
  minerals like potassium and calcium that are
  similar to their natural concentration in healthy
  blood. For another solute, bicarbonate, dialysis
  solution level is set at a slightly higher level
  than in normal blood, to encourage diffusion of
  bicarbonate into the blood, to neutralise the
  metabolic acidosis that is often present in these
  patients.

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Types of dialysis

• Hem filtration
• Peritoneal dialysis
• Hemo-dialysis

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Hem filtration

• Hemofiltration is a similar treatment to
  hemodialysis, but it makes use of a different
  principle. The blood is pumped through a dialyzer
  or "hemofilter" as in dialysis, but no dialysate
  is used. A pressure gradient is applied as a
  result, water moves across the very permeable
  membrane rapidly, facilitating the transport of
  dissolved substances, importantly ones with large
  molecular weights, which are cleared less well by
  hemodialysis. Salts and water lost from the blood
  during this process are replaced with a
  "substitution fluid" that is infused into the
  extracorporeal circuit during the treatment.
  Hemodiafiltration is a term used to describe
  several methods of combining hemodialysis and
  hemofiltration in one process.

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Peritoneal dialysis
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Working principle of peritoneal dialysis

• In peritoneal dialysis, a sterile solution
  containing minerals and glucose is run through a
  tube into the peritoneal cavity, the abdominal
  body cavity around the intestine, where the
  peritoneal membrane acts as a semipermeable
  membrane. The dialysate is left there for a
  period of time to absorb waste products, and then
  it is drained out through the tube and discarded.
  This cycle or "exchange" is normally repeated 4-5
  times during the day,
• (sometimes more often overnight with an automated
  system). Ultrafiltration occurs via osmosis the
  dialysis solution used contains a high
  concentration of glucose, and the resulting
  osmotic pressure causes fluid to move from the
  blood into the dialysate. As a result, more fluid
  is drained than was instilled. Peritoneal
  dialysis is less efficient than hemodialysis, but
  because it is carried out for a longer period of
  time the net effect in terms of removal of waste
  products and of salt and water are similar to
  hemodialysis. Peritoneal dialysis is carried out
  at home by the patient and it requires
  motivation. Although support is helpful, it is
  not essential. It does free patients from the
  routine of having to go to a dialysis clinic on a
  fixed schedule multiple times per week, and it
  can be done while travelling with a minimum of
  specialized equipment.

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Hemodialysis
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Principle of hemodialysis

• In hemodialysis, the patient's blood is pumped
  through the blood compartment of a dialyzer,
  exposing it to a semipermeable membrane. The
  cleansed blood is then returned via the circuit
  back to the body. Ultrafiltration occurs by
  increasing the hydrostatic pressure across the
  dialyzer membrane. This usually is done by
  applying a negative pressure to the dialysate
  compartment of the dialyzer. This pressure
  gradient causes water and dissolved solutes to
  move from blood to dialysate, and allows removal
  of several litres of excess fluid during a
  typical 3 to 5 hour treatment. In the US,
  hemodialysis treatments are typically given in a
  dialysis center three times per week

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How to know dialysis is required

• The decision to initiate dialysis or
  hemofiltration in patients with renal failure can
  depend on several factors, which can be divided
  into acute or chronic indications.
• Acute indications for dialysis/hemofiltration
• Hyperkalemia
• Metabolic acidosis
• Fluid overload (which usually manifests as
  pulmonary edema)
• Uremic Serositis complications, such as uremic
  pericarditis and uremic encephalopathy
• And in patients without renal failure, acute
  poisoning with a dialysable drug, such as
  lithium, or aspirin
• Chronic indications for dialysis
• Symptomatic renal failure
• Low glomerular filtration rate (GFR) (RRT often
  recommended to commence at a GFR of less than
  10-15 mls/min/1.73m2)

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What is AV fistula
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Phenomenon of AV fistula

• AV (arteriovenous) fistulas are recognized as the
  preferred access method. To create a fistula, a
  vascular surgeon joins an artery and a vein
  together through anastomosis. Since this bypasses
  the capillaries, blood flows rapidly through the
  fistula. One can feel this by placing one's
  finger over a mature fistula. This is called
  feeling for "thrill" and produces a distinct
  'buzzing' feeling over the fistula. Fistulas are
  usually created in the nondominant arm and may be
  situated on the hand (the 'snuffbox' fistula'),
  the forearm (usually a radiocephalic fistula, or
  so-called Brescia-Cimino fistula, in which the
  radial artery is anastomosed to the cephalic
  vein), or the elbow (usually a brachiocephalic
  fistula, where the brachial artery is anastomosed
  to the cephalic vein). A fistula will take a
  number of weeks to mature, on average perhaps 4-6
  weeks. During treatment, two needles are inserted
  into the fistula, one to draw blood and one to
  return it.

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AV GRAFT
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What is dialyzer
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Principle of dialyzer

• The dialyzer is the piece of equipment that
  actually filters the blood. Almost all dialyzers
  in use today are of the hollow-fiber variety. A
  cylindrical bundle of hollow fibers, whose walls
  are composed of semi-permeable membrane, is
  anchored at each end into potting compound (a
  sort of glue). This assembly is then put into a
  clear plastic cylindrical shell with four
  openings. One opening or blood port at each end
  of the cylinder communicates with each end of the
  bundle of hollow fibers. This forms the "blood
  compartment" of the dialyzer. Two other ports are
  cut into the side of the cylinder. These
  communicate with the space around the hollow
  fibers, the "dialysate compartment." Blood is
  pumped via the blood ports through this bundle of
  very thin capillary-like tubes, and the dialysate
  is pumped through the space surrounding the
  fibers. Pressure gradients are applied when
  necessary to move fluid from the blood to the
  dialysate

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Block diagram of dialysis
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Basic function of dialysis

• The hemodialysis machine pumps the patient's
  blood and the dialysate through the dialyzer. The
  newest dialysis machines on the market are highly
  computerized and continuously monitor an array of
  safety-critical parameters, including blood and
  dialysate flow rates dialysis solution
  conductivity, temperature, and pH and analysis
  of the dialysate for evidence of blood leakage or
  presence of air. Any reading that is out of
  normal range triggers an audible alarm to alert
  the patient-care technician who is monitoring the
  patient. Manufacturers of dialysis machines
  include companies such as Fresenius, Gambro,
  Baxter, B. Braun, and Bellco.