 Dialysis
Dr .Fakhria Jaber
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 Dialysis may peritoneal dialysis or haemodialysis.
 Remove toxins in the blood through ultrafiltration and
diffusion.
 Ultrafiltration uses osmotic or hydrostatic pressure to
remove excess fluid from the blood.
 Diffusion when particles (ions) pass-or fail to pass (because
of their size)-through the pores of a membrane.
 Dialysis
 The result is the removal of waste products from the blood
such as:
 Urea, creatinine excess fluid,
 The restoration of electrolytic balance,
 Elimination of acidosis.
 Peritoneal Dialysis
 In peritoneal dialysis, solution is instilled in the peritoneal
cavity. Excess substances in the blood enter the dialysate and
needed substances in the dialysate enter the blood, then the
dialysate is removed. This cycle is repeated as needed:
 In intermittent peritoneal dialysis, machine dialyzes for
8-to 12-hour periods 3 to 5 times per week.
 In chronic ambulatory peritoneal dialysis,
nonautomated dialysis requires 3 to 5 passes every day.
 In continuous cycling peritoneal dialysis, an automated,
closed system dialyzes 3 to 7 times during sleeping hours,
with an additional non-automated pass made during waking
hours.
 Peritoneal Dialysis:
 Advantages:
 Inexpensive.
 Hemodynamically tolerated. Is low risk.
 No vascular access.
 No anticoagulant therapy.
 Several forms.
 Intermittent peritoneal dialysis passes 3 to 5 times per
week but 8 to 12 hours and may be performed during
sleeping hours.
 Chronic ambulatory peritoneal requires no machine. 3 to
5 times daily every day. The hazard of peritonitis is greater
than intermittent peritoneal dialysis.
 Continuous cycling peritoneal dialysis.
 Disadvantages:
 There is slow correction of fluid and electrolyte disturbances.
 There is high risk of peritonitis.
 Be leakage of peritoneal dialysate.
 Peritoneal Dialysis:
 Requires insertion of a catheter for peritoneal access.
 Tenckhoff catheter.
 During peritoneal dialysis, the catheter should be monitored
for signs of potential complications:
 signs of a perforated abdominal viscera.
 An obstructed catheter may be cause by kinking, air lock,
fibrin clot.
 Peritoneal Dialysis:
 Extrinsic obstruction is related to constipation abdominal
distension.
 If catheter extravasations are found, dialysis route should
temporarily discontinued allow adequate wound healing with
closure of the seal between the peritoneum and catheter.
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Haemodialysis:
Advantages:
Fluid and electrolyte abnormalities are corrected rapidly.
Better tolerated.
Self-care tasks are much less demanding than with peritoneal
dialysis.
 The insertion site be evaluated for signs of local infection
daily.
 Haemodialysis:
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Disadvantage:
Expensive.
Greater Hemodynamic.
Dialysis disequilibrium syndrome.
Vascular access is required, risk of complications, infection,
obstruction, or thromboembolic event.
Anticoagulant therapy is required, associated risk of
haemorrhage.
Patients who benefit infants, children, older adults difficult
vascular access, compromised cardiovascular function.
Haemodialysis:
In haemodialysis, (dirty) arterial blood flows into the
dialyzer in a hemodialysis machine, toxins and excess fluid
pass through an artificial membrane into dialysate solution,
needed electrolytes and other elements from the solution
pass through the membrane and into the "clean" blood,
which is then returned to the patient's venous system.
Arteriovenous (AV) shunt/Fistula requires surgical
intervention, it is preferred for continuous AV hemofiltration.
Vascular Access:
Haemodialysis:
Each access device poses risks of complications.
Thrombosis: Pulsations indicate patency. Blood pressure
cuffs or constrictive tourniquets should not be used above
the fistula to avoid hypovolemia and risk of clotting.
Local infections: Site is assessed regularly for signs of
infection. Antibiotics are administered. The patient should
be taught to self-monitor for infection.
Aneurysms: For aneurysm formation. Venipuncture
should be rotated.
Steal syndrome (ischemic pain related to vascular
insufficiency from fistula creation): Be assessed for
diminished pulses, pallor, pain distal to the site. Surgical
revision.
Renal Transplantation:
The organ may be donated by a living person or removed
from a cadaver donor.
 Selecting a donor.
 Transplant patients face the prospect of organ rejection:
 Hyper acute rejection occurs immediately after
transplantation. No effective treatment available.
 Acute rejection occurs 1 to 2 weeks after transplantation.
Prompt management with intravenous Solu-Medrol usually
reverses symptoms.
 Chronic rejection occurs over months or years.
Immunosuppressive medications and diet slow-but rarely
reverse-rejection.