hemodialysis and peritoneal dialysis

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HEMODIALYSIS AND PERITONEAL DIALYSIS :

HEMODIALYSIS AND PERITONEAL DIALYSIS PRESENTED BY : KIRAN RANDHAWA ARMY COLLEGE OF NURSING

INTRODUCTION:

INTRODUCTION Clinically, dialysis is a technique in which substances move from the blood through a semi permeable membrane and into a dialysis solution (dialysate). It is used to correct fluid & electrolyte imbalances and to remove waste products in renal failure.

DEFINITION:

DEFINITION Dialysis is the movement of fluid and molecules across a semi permeable membrane from one compartment to another.

GENERAL PRINCIPLES OF DIALYSIS:

GENERAL PRINCIPLES OF DIALYSIS DIFFUSION : It is the movement of solutes from an area of greater concentration to an area of lesser concentration. OSMOSIS : It is the movement of fluid from an area of lesser to an area of higher concentration.

PRINCIPELS CONTD….:

PRINCIPELS CONTD…. ULTRA FILTRATION : (water and fluid removal) results when there is an osmotic gradient or pressure gradient across the membrane.

TYPES OF DIALYSIS :

TYPES OF DIALYSIS PERITONEAL DIALYSIS HEMODIALYSIS

PERITONEAL DIALYSIS :

PERITONEAL DIALYSIS Peritoneal dialysis removes toxins from the blood of a patient with acute or chronic renal failure who doesn’t respond to other treatments. In PD, the patients peritoneal membrane is used as a semi permeable dialyzing membrane.

DIALYSIS SOLUTION:

DIALYSIS SOLUTION Dialysis solutions are available commercially in 1 or 2 liters (sometimes large or small) with glucose concentration of 1.5%, 2.5%, & 4.25%. The electrolyte composition is similar to that of plasma.

CYCLES:

CYCLES The three phases of the PD cycle are: Inflow Dwell Drain

PERITONEAL DIALYSIS SYSTEMS :

PERITONEAL DIALYSIS SYSTEMS Three types of PD currently being used are: Conventional dialysis Automated peritoneal dialysis Continuous ambulatory peritoneal dialysis

AUTOMATED PERITONEAL DIALYSIS:

AUTOMATED PERITONEAL DIALYSIS An automated device called a cycler is used to deliver the dialysate for APD. The automated cycler times & controls the fills, dwell & drain phases. The machine cycles 4 or more exchanges per night with 1-2 hours per exchange.

CONTINUOUS AMBULATORY PERITONEAL DIALYSIS:

CONTINUOUS AMBULATORY PERITONEAL DIALYSIS Instillation of 2 litres of dialysate fluid into peritoneal cavity Leave for equillibration period Drain the dilysate fluid back from peritoneal cavity

NURSING INTERVENTIONS :

NURSING INTERVENTIONS

BEFORE THE PROCEDURE:

BEFORE THE PROCEDURE Explanation about procedure Explain him about catheter insertion & its purpose. Record the patients vital signs.

CONT..:

CONT.. Ask the patient to void Warming of dialysate Preparation of articles Sterile techniques Position the patient

CONT..:

CONT.. Connect one infusion line to catheter, prime the tubing with solution, keeping the clamps closed. To test the catheters patency, open the clamp on infusion line & rapidly instill 500ml of dialyzing solution.

DURING THE PROCEDURE:

DURING THE PROCEDURE Vital signs Complications -respiratory distress -peritonitis Observe outflow Check tubings for clots Frequent positioning

CONT…:

CONT… Frequent positioning Encourage deep breathing and coughing.

POST PROCEDURE :

POST PROCEDURE Weigh the patient periodically Change dressings everyday Check for fluid imbalance I / O chart Maintain nutritional balance Check for complications

COMPLICATIONS:

COMPLICATIONS Exit site infection Peritonitis Outflow problems Hernias Lower back problems Bleeding Pulmonary complications Protein loss

HEMODIALYSIS:

HEMODIALYSIS Hemodialysis removes toxic wastes & other impurities from the blood of a patient In hemodialysis blood is removed from the patients body through a surgically created access site pumped through a filtration exit to remove toxins & then returned to the body.

PROCEDURE:

PROCEDURE Prepare access Flush the lines with NS Add heparin to blood Counter flow -blood flow rate 200-500 ml/min -dialysate flow rate 300-900 ml/min Return of blood to patient

CONT…:

CONT… Reflush the dialyser Remove needle and apply pressure to the access If access is catheter then clamp and remove from catheter lumen

NURSING INTERVENTIONS:

NURSING INTERVENTIONS

BEFORE THE PROCEDURE:

BEFORE THE PROCEDURE Explain the procedure Measure weight Monitor vital signs Maintain sterility Position the patient Prepare the access

INTRAPROCEDURE:

INTRAPROCEDURE Protect yourself and co-workers Check in between for complications Be alert for air embolism and pressure alarms

POST PROCEDURE:

POST PROCEDURE Monitor site for bleeding Do not use the same arm with access for other procedure Maintain nutritional balance Maintain I/O chart Monitor fluid imbalances

COMPLICATIONS:

COMPLICATIONS Hypotension Muscle cramps Loss of blood Hepatitis Sepsis Disequilibrium syndrome

SUMMARIZATION:

SUMMARIZATION Introduction Definition General principles of dialysis Types of dialysis Peritoneal dialysis Introduction Dialysis solutions Cycles Peritoneal dialysis system

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Placement of catheter Nursing interventions Before the procedure During the procedure After the procedure Complications Advantages & disadvantages

Slide 38:

Hemodialysis Introduction HD access site Dialysers Procedure

Slide 39:

Nursing interventions Before the procedure During the procedure After the procedure complications Advantages & disadvantages

BIBLIOGRAPHY:

BIBLIOGRAPHY Dirksen S.R & Lewis S.M,”Medical surgical nursing”, Ed – 6 th ,Eleiveir publications,Pp-1228-1236 Roman Marlene,”Hand book of medical surgical nursing”,third Ed – 3 rd ,Springhouse Publications.

CONTD…..:

CONTD….. Smeltzer S.C,Bare .B,”Textbook of Medical Surgical Nursing”, Ed –10 th ,Lippincott williams & wilkins, Pp:-1285-1294 Black J.M, & Hawks J.H,”Medical surgical nursing” Ed-7 th , vol-1, Elsevier India Private Ltd.Pp: – 1290-1295

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THANKS