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Technical Aspects of Hemodialysis. Saramma Mathew, RN,BSN,CNN Renal Educator Hackensack University Medical Center, Hackensack, NJ. Anatomy. Two Kidneys Two Ureters One bladder One Urethra. Nephron. Nephron –functional unit of the kidney Filter the waste

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Technical aspects of hemodialysis

Technical Aspects of Hemodialysis

Saramma Mathew, RN,BSN,CNN

Renal Educator

Hackensack University Medical Center, Hackensack, NJ


Anatomy
Anatomy

  • Two Kidneys

  • Two Ureters

  • One bladder

  • One Urethra


Nephron
Nephron

  • Nephron –functional unit of the kidney

  • Filter the waste

  • Kidney has lot of blood vessels-capillaries


Kidney physiology
Kidney Physiology

  • Glomerulus- ball of capillaries

  • Bowman’s capsule

  • Selectively permeable

  • Glomerular Filtration

  • Tubule


Functions of kidneys
Functions of Kidneys

  • Excretory Functions:

    • Gets rid of waste

  • Endocrine functions:

    • Hormones

    • EPO

    • Calcitriol


Principles of dialysis
Principles of dialysis

  • Solutions:

    • Solvent

    • Solute

    • Semi permeable membrane

    • Ultra filtration


First principle of hd diffusion
First Principle of HD - Diffusion

Solutes move from a region of higher concentration to a region of lower concentration until concentration is equal on either side.


Factors affecting diffusion
Factors affecting diffusion

  • Concentration gradients:

  • Molecular weight of the solutes:

  • Temperature


Factors affecting diffusion1
Factors affecting Diffusion

  • Membrane permeability:

  • Surface area of the membrane:

  • Flow geometry:


2 nd principle of hd osmosis
2nd Principle of HD - Osmosis

  • Osmosis is the movement of solvent through the semi permeable membrane from an area of lower concentration to an area of higher concentration.

  • Ultra filtration:


Adequacy of dialysis
Adequacy of Dialysis

Formula for Urea Reduction Rate

Pre Dial BUN - Post Dial BUN

________________________ x100

Pre Dialysis BUN

= URR Calculation


Adequacy kt v
Adequacy - Kt/V

  • K= Dialyzer clearance

  • T= Length of dialysis time (in minutes)

  • V= Urea distribution volume in millimeters.

  • Kt/V must be greater than 1.2


Adequacy
Adequacy

  • UKM – Urea Kinetic Modeling

  • Provides More Accuracy

  • Measures Protein levels


Machine alarms
Machine alarms

  • PRIORITY ALARMS

  • Air detector alarm

  • Blood leak detector

  • Arterial pressure –high/low alarm

  • Venous pressure high/low alarm


Technical complications
Technical Complications

  • POTENTIAL PROBLEMS

  • Air in Bloodlines:

  • Blood loss:

  • Clotting in extracorporeal circuit.


Complications potential problems
Complications: POTENTIAL PROBLEMS

  • Dialyzer membrane leak:

  • Hemolysis:

  • Power failure:


Heparin purposes in hd
Heparin – Purposes in HD

  • Function: to prevent clotting

  • Sensitivity:

  • Inadequate Heparin


Heparin protocols
Heparin Protocols

  • Heparin free

  • Strength of Heparin

  • Administering heparin:

    • Systemic

    • Continuous infusion

    • Intermittent

    • Low-dose “tight “ heparinization


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