It is one of type of a renal replacement therapies.
RRT are performed when kidneys are unable to perform there work as like removal of waste, maintain electrolytes and regulate fluid balance
The RRT can be :
1.Acute (short term)
2.Chronic (long term)
The process of removing waste products and excess fluids from the body.
According to Dr.C.Kanniammal
Dialysis is used to remove fluid and uremic waste products from the body when the kidney are unable to do so.
TYPES OF DIALYSIS
1.Haemodialysis
2.Peritoneal Dialysis
INDICATION:
ACUTE
1.Increase level of serum potassium
2.Fluid overload
3.Impending pulmonary edema
4.Increasing acidosis
5.Pericardiatis
6.Medication intoxication
CHRONIC
1.End stage renal disease
2.Hyperaemia
3.Fluid overload not responsive to diuretics.
HAEMODIALYSIS:
'Haemo' means 'blood', 'dialysis' denotes a separation or filtration process.
Metabolic waste or toxins are filtered from the blood by the semi-permeable membrane and carried away by the dialysis fluid.
PRINCIPLES OF HAEMODIALYSIS:
The principles on which haemodialysis is based are diffusion osmosis and ultra filtration
(a).DIFFUSION:- The toxins and wastes in the blood are removed by diffusion, that is, they move from an area of higher concentration to an lower concentration in the blood to an area of lower concentration
(b).OSMOSIS:-Excess water is removed from the blood by osmosis, in which water moves from an area of higher solute concentration (the blood) to an area of lower solute concentration (thedialysate both).
(c) ULTRAFILTRATION:-In ultrafiltration water moves from an area of higher pressure to an area of lower pressure.this process is much more efficient than osmosis of water removal and is accompolished by applying negative pressure (or)a suctioning force to the dialysis membrane.
DIALYZER:
1. Dialyzer is often refer to as "artificial kidney".Its function is to remove the excess waste and fluid from the blood when the patients kidney can no longer perform that task.
2. Dialyzers are hollow, fiber device containing thousands of tiny cellophane tubules that act as a semi-permiable membrane.
VASCULAR ACCESS:
The access allows blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter called dialyzer.
An access is placed by a minor surgery.
Types of access are:
1.Arteriovenous fistula
2.Arteriovenous graft
3. Vascular access device
PRE-DIALYSIS ASSESSEMENT:
A.Pre-assessment for the patients
1.Explain the procedure to the patient and relatives.
2.Take a sign consent for it.
3.Monitor the followings:
a.vitals sign (b.p in sitting and standing positions)
b.weight
c.serum electolytes level.
d. Skin colour
e.Temperature
f.Turgor and integrity
4.Assess the vascular access patency and freedom from bleeding and infection.
B. Pre-assessment for machine:
1. Dialyzer membrane checked for patency
2.Blood tubings wntact withour leaks.
3.Appropriate prescribed dialysate fluids compositions and potassium and calcium as ordered and within the rate limits.
4. Correlation of machine conductivity with an external meter reading of dialysate.
5.The extra corporeal blood circuit free from of air record
6.The blood pump properly checked.
7.All alarms programmed and set within limit
INTRADIALYTIC ASSESSEMENT:
1.The patient and the machine are monitored every hourly by the dialysis nurse
2.Monitoring is done more frequently in unstable patients.
3.The vitals signs are checked every 15 mins.
4.Monitoring the machine parameter such as arterial pressure, venous pressure, fluid removal, dialysate flow, blood flow and heparin pump.
5.Checking of the air foam alarm status.
6.All assessment are logged on the dialysis flow
PERITONEAL DIALYSIS
Peritoneal dialysis is the process during which the peritoneal cavity act as a reservoir for the dialysates and the peritonium serves as a semipermeable membrane across which excess body fluid and solutes including uremic toxins are removed.
Different ways of performing peritonial dialysis:
1. Manual form of peritoneal dialysis :-manual form of peritoneal dialysis is called continuous ambulatory peritoneal dialysis(CAPD).
2Automated peritoneal dialysis :- automated peritoneal dialysis is performed with cycler ,usually at night while the patient sleep.
PERITONEAL DIALYSIS PROCESS :-
PROCEDURE(P.D):
Preparing the patient :
1.The nurse explain procedures to patient family and obtained singed consent for it
2.The vital signs, weight and serum electrolyte levels are recorded.
3.The patient is encouraged to empty the bladder and bowel to reduce the risk of puncturing internal organs.
4.The nurse also assess the patient anxiety about the procedure and provide support and instructions.
5.Administered the broad spectrum antibiotic agent to prevent infections.
6.If the peritoneal catheter is to be inserted in the operating room,this is explained to the patient and family member.
Preparing the equipment:
1.Heparin may be added to prevent fibrin formation and resultant occlusion of peritoneal catheter.
2. chloride be prescribed to prevent hypokalemia.
3.Antibiotics may be added to treat peritonitis.
4.Regular insulin may be added for patients with diabetes.
5.All medications are added immediately before the solution is instilled.
6.Aseptic technique is imperative
7.Before initiating dialysis the nurse assembles the administration set
8.The tubing is filled with theprepared dialysate to reduce the amount of air entering the catheter and peritoneal cavity.
Performing the exchange :
1.Peritoneal dialysis involves a series of exchange or cycles.
An exchange is defined as the :
a.Infusion
b.Dwell
c.Drainage of the dialysate
2.The dialysate is infused bye the gravity into the peritoneal cavity.
3.A period of 5 to 10 minutes is used to infuse about 2 to3 liters of fluids.
4.The prescribed time allows to complete the process
5.The tube is unclamed and the solution drains from the peritoneal cavity by gravity through a closed system.
6.Drainage is usually completed into 10 to 30 mins.
7.The drainage fluid is normally colourless or straw coloured and should not be cloudy.
8.The entire exchange( infussion,dwell and drainage) takes 30 to 45 minutes.
Post-operative care:
1.The nurse must assess for the sign and symptoms of infection such as redness, swelling, drainage from the exit site, fever.
2.The nures must asses the integrity of the dressing and change it as needed
3. Infection control measures must be used for all procedure.
4.Controlling electrolyte level and diet.
5.Managing discomfort and pain.
6.Catheter care must be performed.
7.The patient may wear a gauze are semitransparent dressing over the exit site.
8.Documentations should be maintained in proper ways.
9 Nurses must teach the patient about the all the aspects of dialysis, especially home care.
10.Nurses must provide opportunities for these patients to express their feelings and reactions.
COMPLICATION
Haemodialysis complications :-
1.Hypotension
2. Painful muscle cramps
3.Hypoxia
4.Chest pain
5.Infection
6.Haemorrhage
7.Heart failure
8.Haemolysis
Peritoneal dialysis complications:-
1.Peritonitis
2.Leakage of dialysis through the catheter site
3.Bleeding
4.Abdominal hernia
5.constipation
Nursing Management
1.The nurse in the dialysis unit has an important role in monitoring, supporting, assessing and educating patients
2.The nurse assess the vascular access for patency and precautions.
3.Tight dressing,restraints, jewellery over vascular access must be avoided.
4.Monitoring the blood pressure.
5.The nurse must observe the signs and symptoms of infections such as redness,swelling and drainage from the exit site, fever and signs.
6.The nurse must assess the integrity of the dressing and change it as needed. Infection control measures must be used for all procedures.
7.Managing discomfort and pain.
8.Nurse must provide opportunities to these patients to express their feelings and reactions and to explore options.
9.Documentations should be maintained in proper way.
10. Nurse must tech the patients about the all the aspects of dialysis, especially home care.
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