It is the removal of solutes and water from body across a semipermeable membrane (dialyzer)
care during and after the dialysis is very important to prevent the entry of pathogens in to the body.
6. DIFFUSION
• Movement of molecules from an area of
higher concentration to an area of lower
concentration
7. OSMOSIS
• Movement of solvent molecules from
lower concentration to higher
concentration
8. Ultra filtration & Solvent drag
• Water moves from an
area of high pressure
to an area of lower
pressure
• More efficient in fluid
removal than osmosis
• Molecules which are
dissolved in the
solvent also get
removed- solvent drag
10. INDICATIONS……
• Transfusion reaction
• Post partum renal insufficiency
• Cardiac tamponade
• Fluid overload not responding to
diuretics & fluid restriction
11. CONTRAINDICATIONS
• Other chronic disease
• No vascular access
• Hemorrhage
• hypertension
• Very old people
• Inability to cope with treatment
regimen
• Coagulopathy
• Inability to survive procedure
13. AV FISTULA
• Anastamosis of an artery to a
vein
• Sites- radial artery & cephalic
vein, brachial artery &
cephalic vein, brachial artery
& basilic vein
• The increased blood flow and
pressure causes the vein to
dilate.
14. Pre-op care in AV fistula
• Full explanation of the procedure and
aftercare
• Let him talk to someone who has a well
established fistula
• Should be well hydrated before the
surgery
• Part preparation
15. Post op care in AV fistula
• Limb should be kept warm &well supported
to maintain the peripheral cerculation.
• Monitor the BP and maintained at 100
systolic minimum to reduce the risk of fistula
thrombosis.
• Avoid antihypertensive therapy
• Examine the wound site for bleeding/swelling
• Check the blood flow regularly(bruit/ thrill)
regularly
16. Post op care of AV fistula
• Avoid using the fistula arm for carrying
heavy loads
• Avoid tight and restrictive clothing on the
arm.
• Hand exercises promote fistula
maturation
• Arm should not be used for phlebotomy
cannulations or recording the BP
• Notify physician if any bleeding
17. Long term care
• Keep your access clean at all times
• Be careful not to bump your access
• Don’t wear jewellery over your access
• Don’t sleep with your access arm under
your head or body.
• Check the pulse in your access every
day.
18. Complications of Av fistula
• Thrombosis- due to hypotension
• Aneurysm- due to repeated area
puncture
• Steal syndrome- due to reduced blood
19. ARTERIOVENOUS GRAFT
• A graft is put b/w an
artery &vein
• Synthetic graft(PTFE)
is used most
commonly
• Indications
- Peripheral vascular
disease
- Diabetes
• Can be used after 14
days
20. AV shunt
• Very rarely made
• Teflon tubings are inserted into
the vessels and silicon tubings
are attached.
23. Post insertion care
• Correct insertion is checked by X-ray
• Check for pneumothorax & puncture of the
adjacent vessels
• Maintain the patency of the catheter
- Heparin lock injected after each dialysis
- Heparin is removed & flushed with saline
(0.9%)before next dialysis
- Never flush the catheter if can’t be aspirated
• Examine the sites for any soreness, redness,
or presence of exudates
24. Canulation
• Allow the fistula to mature
• A thorough physical examination is
done before canulating
• Adhere to units protocol
• Universal precautions are followed
• A tourniquet may be used to get the
vessels engorged
26. Rope ladder technique
• The entire vessel is used systematically
• Each needle is inserted at 2cm above
the last site and back again
• It helps expand the lifespan of the
fistula
• Gives the previous stick site time to
heal
• Helps the fistula mature more evenly
27. Button hole technique
• The same site is repeatedly puncture at
exactly the same angle
• Over time the scar tissue develops
guiding the needle into the right place
• Advantage
- Less pain
- Less hematoma
28. Area puncture
• Use of one or two areas of the fistula
which are regularly used
• Aneurysm chances are more
29. Canulation technique
• Needles to be inserted at 45 deg to the
skin
• Arterial and venous needle should be
placed 5 cm apart
• Don’t pull or push the needle blindly
• Ask for assistance if cannulations
attempt had failed for 2/3 times
32. Membranes
• FLUX PROPERTY: the efficiency with
which a membrane clears water and
solutes
• Cellulose membrane- low flux
• Modified cellulose membrane : low/high
flux
• Synthetic membrane: low/high
33. Preparation of the dialyzer
• Air must be completely removed from
the dialyzer and the bloodlines
• Removal of the chemical or the
sterilizing agent is essential
• Minimum of 1 lr of saline for flushing in
c/o ETO sterilization
34. Dialysate
• The fluid which is pumped on the
opposite side of the semi permeable
membrane to the patients blood
• It is prepared by mixing a concentrated
electrolyte solution with a
buffer(bicarbonate) & purified water.
36. Anticoagulation
• Heparin in the beginning 2000- 5000U
or 50 U/Kg and then as a continuous
infusion at 1000- 1500U/hr till 15-60
mts before the end of dialysis
• Heparin free dialysis if bleeding
disorder is there.
