Basic Hemodialysis Training_Arman Ngojo
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BASIC HEMODIALYSIS TRAINING Prepared by: Armando Darino Ngojo Senior Engineer, Biomedical & Facility
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Transcript of Basic Hemodialysis Training_Arman Ngojo
BASIC
HEMODIALYSIS TRAINING
Prepared by: Armando Darino NgojoSenior Engineer, Biomedical & Facility
Aims
To provide basic understanding about the Hemodialysis Machine
To perform and understand the basic technical troubleshooting steps and PPM tasks
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Objectives
- as a result of completing this module, the biomedical technician / engineer should be able to understand the concept of the Hemodialysis Unit including its applications and basic maintenance tasks.
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What is Hemodialysis?
The process of removing waste products &
excess fluid from the body such as: potassium and urea as well as free water from the blood when
the kidneys are in renal failure
And it also involves partial replacement of
Kidney’s function
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What Kidneys do?
Remove waste products from the body
Remove drugs form the body Balance the body's fluids Release hormones that regulate
blood pressure Produce an active form of vitamin D Control the production of red blood
cells NGOJO 5
Kidney Failure
Acute Renal Failure (ARF)
Chronic Renal Failure (CRF)
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How Kidney failure treated?
Hemodialysis
Peritoneal Dialysis
Kidney transplantation
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Definition of Hemodialysis
means Blood
“Hemo”
“Dialysis”
means To pass through
(Filtering)
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Principles Involved
Diffusion
Osmosis
Ultrafiltraion
Convection
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Diffusion
A flow of solutes from an area of higher concentration to a lower solute concentration across a semipermeable membrane.
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Osmosis
The movement of water through a membrane from lower to a higher water concentration area.
Only in Peritoneal Dialysis
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Ultrafiltration
The movement of fluid through a membrane caused by a pressure gradient
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Convection
The movement of solutes with a water flow
Only during Isolated Ultrafiltration (ISO-UF) NGOJO 13
Hemodialysis (HD)
The transport of uremic wastes by diffusion
The process in which of particles move across a semipermeable membrane from the area of higher concentration (Blood) to the area of lower concentration (Dialysate)
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Preparation & Handling of Fresh Dialysate
Monitoring Systems
Handling of Used Dialysate & Ultrafiltrate
R.O.water
Drain
Dialyser
Patient
Hydraulics
Basic Hemodialysis Setup
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Fresenius 4008S HD machine
Monitoring System
Extracorporeal System
Hydraulic System
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Bbraun Dialog +
Monitoring System
Extracorporeal System
Hydraulic System
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Hemodialysis Flow
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Hemodialyser Artificial Kidney Containing of bundle of thousands of
hollow fibres Separated by two compartments (Blood & Dialysate)
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Hollow fiber dialyzer - A plastic cylinder containing a bundle of thousands of tiny hollow cellophane-like fibers
Separated by two compartments
(Blood & Dialysate)
Hemodialyser
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Dialysis Membrane
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Efficiency of Dialysis
Dialysate flow
Blood flow
Counter Flow
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Dialysate
To remove waste products To normalize the electrolytes by
removing some ions To normalize the pH by adding some
buffer To maintain all vital substances
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Types of Dialysate
Acetate
Bicarbonate
Acid Concentrat
e
Bicarb Concentra
te
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Dilution ratio
1:35.83 (1 : 34 : 1.83) 1:34
1 denotes Acid part
34 denotes Water part
1.83 denotes Bicarb part
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Ion composition of Bicarb Dialysate
Sodium 138.00 mmol/l
Potassium 2.00 mmol/l
Calcium 1.75 mmol/l
Magnesium 1.00 mmol/l
Chloride 109.50 mmol/l
Acetate 3.00 mmol/l
Bicarbonate 32.00 mmol/l
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Measurement Technique
Patient
HD machine
Dialysate Out
Dialysate In
CD Cell 110
CD Cell 7
Dialyser
Blood In
Blood Out
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Prescription In the North America and UK, 3-4 hour
treatments (sometimes up to 5 hours for larger patients) given 3 times a week are typical.
Twice-a-week sessions are limited to patients who have a substantial residual kidney function.
Four sessions per week are often prescribed for larger patients, as well as patients who have trouble with fluid overload.
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Side-effects and complications
Hemodialysis often involves fluid removal (through ultrafiltration-(occurs at the barrier between the blood and the in the renal corpuscle or Bowman's capsule in the kidneys
. ) because most patients with renal failure pass little or no urine.
Side effects caused by removing too much fluid and/or removing fluid too rapidly include low blood pressure, fatigue, chest pains, leg-cramps, nausea and headaches.
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Access
In hemodialysis, three primary methods are used to gain access to the blood:
an intravenous catheter
an arteriovenous (AV) fistula
or a synthetic graft.NGOJO 30
Fistula Needles
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Fistula Needles
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Arterial/venous ports
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Blood linesArterial line Venous
line
connectors Venous drip chamber
ArterialDrip chamber
portsclamp
clamp
redblue
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Tunnelled catheter access
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non-tunneled catheters
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non-tunneled catheters, ...
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Patient Connections
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Cont….
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Cont…
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Cont…
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Equipment
The newest dialysis machines on the market are highly computerized and continuously monitor an array of safety-critical parameters including :
blood and dialysate flow ratesdialysis solution conductivity temperature, and pH and analysis of the dialysate for evidence of
blood leakage or presence of air.
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Dialysis Machine
The dialysis machine is about the size of a dishwasher. This machine has three main jobs:
pump blood and watch flow for safety
clean wastes from blood watch your blood pressure and the
rate of fluid removal from your body NGOJO 47
Equipment
Any reading that is out of normal range triggers an audible alarm to alert the patient-care technician who is monitoring the patient.
Manufacturers of dialysis machines include companies such as:
Fresenius, Gambro, Baxter, B. Braun, and Bellco.
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Fresenius 4008 Cleaning MenuProgram
No.Description Solution
Display during cleaning program
RinsePgm 1Pgm 2
RinseRinse endless
RO waterRO water
-R--R endless-
Hot Rinse
Pgm 1Pgm 2Pgm 3
Hot rinseHot rinse without Cooling rinseIntegrated hot rinseIntegrated hot rinse with cooling rinse
RO waterRO waterRO waterRO water
-F-HR-C-F-HR--IHR--IHR-C-
Disinfection
Pgm 1Pgm 2Pgm 3Pgm 4
DisinfectionHot disinfectionDisinfection + Hot rinseHot disinfection + Hot rinse
Puristeril 340CitrostrilPuristeril 340Citrostril
-F-D-M--F-HDIS-M--F-D-M-HR--F-HDIS-M-HR-
Pgm 5 Cleaning (front supplied) Sporotal 100(Hypochlorite)
-F-D(F)-M-
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Maintenance Schedule
S.No. Description 4008B 4008S/H Solution
1. End of treatmentPgm No.1 in Rinse Menu Rinse R.O.Water
2. End of the dayPgm No.2 in Disinfection Menu Hot Disinfection Citrostril
3. End of the weekPgm No.4 in Disinfection Menu
Hot Disinfection + Hot Rinse Citrostril
4.
End of unknown patient dialysis treatment(HIV, Hep B, Hep. C)
Pgm No.5 in Disinfection Menu
Cleaning (Front supplied)
Hemoclean
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Thank You
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