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Premium member Presentation Transcript HEMODIALYSIS AND PERITONEAL DIALYSIS : HEMODIALYSIS AND PERITONEAL DIALYSIS PRESENTED BY : KIRAN RANDHAWA ARMY COLLEGE OF NURSINGINTRODUCTION: 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 HEMODIALYSISPERITONEAL 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 DrainPERITONEAL DIALYSIS SYSTEMS : PERITONEAL DIALYSIS SYSTEMS Three types of PD currently being used are: Conventional dialysis Automated peritoneal dialysis Continuous ambulatory peritoneal dialysisAUTOMATED 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 cavityNURSING INTERVENTIONS : NURSING INTERVENTIONSBEFORE 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 patientCONT..: 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 positioningCONT…: 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 complicationsCOMPLICATIONS: COMPLICATIONS Exit site infection Peritonitis Outflow problems Hernias Lower back problems Bleeding Pulmonary complications Protein lossHEMODIALYSIS: 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 patientCONT…: CONT… Reflush the dialyser Remove needle and apply pressure to the access If access is catheter then clamp and remove from catheter lumenNURSING INTERVENTIONS: NURSING INTERVENTIONSBEFORE THE PROCEDURE: BEFORE THE PROCEDURE Explain the procedure Measure weight Monitor vital signs Maintain sterility Position the patient Prepare the accessINTRAPROCEDURE: INTRAPROCEDURE Protect yourself and co-workers Check in between for complications Be alert for air embolism and pressure alarmsPOST 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 imbalancesCOMPLICATIONS: COMPLICATIONS Hypotension Muscle cramps Loss of blood Hepatitis Sepsis Disequilibrium syndromeSUMMARIZATION: SUMMARIZATION Introduction Definition General principles of dialysis Types of dialysis Peritoneal dialysis Introduction Dialysis solutions Cycles Peritoneal dialysis systemSlide 37: Placement of catheter Nursing interventions Before the procedure During the procedure After the procedure Complications Advantages & disadvantagesSlide 38: Hemodialysis Introduction HD access site Dialysers ProcedureSlide 39: Nursing interventions Before the procedure During the procedure After the procedure complications Advantages & disadvantagesBIBLIOGRAPHY: 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: – 1290-1295Slide 42: THANKS You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.