DIALYSIS

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Description

Renal Dialysis is a procedure which is used to remove waste or eliminate waste from the blood stream. The process is carried out when the kidney function is lost (renal failure).

However, dialysis can also be indicated in conditions such as academia, an abnormal rise of electrolytes (calcium and potassium) and cases of intoxication (a condition which arises from acute poisoning due to a dialyzable substance).

The procedures are categorized as follows:

- Haemodialysis: in this procedure, a dialyzer which has a semi permeable membrane is used which filters the blood and sends purified blood back to the body. Blood and dialysate: a fluid is used in this process move in opposite directions of the membrane and via the process of diffusion the urea and waste are removed from the blood. This procedure is considered to be the most effective.

- Peritoneal Dialysis:Peritoneal Dialysis is a procedure in which makes use of the peritoneal membrane which is also called the peritoneum. The water and waste move through the semi-permeable membrane to the dialysate which is then removed from the body. 

- Hemofiltration: In this procedure, the dialysis involves the procedure and pumping of the blood flow through the dialyzer. However this procedure does not require any dialysate. Some pressure is used to enhance the flow of water across the semi-permeable membrane, with the dissolvable impurities moving along with the water.


The secondary processes carried out in renal failure are:

- Hemodiafiltration: This procedure involves the principles of both haemodialysis and hemofiltration thereby ensuring an efficient process.

- Intestinal Dialysis: This procedure of dialysis involves the intake of huge quantity of soluble fibres or non-soluble solutions at periodic intervals which improve the bacterial growth in the colon thereby increasing the amount of nitrogen to be expelled in the faecal waste. Patients suffering from kidney stones or nephrolithiases can also undergo this procedure.

There are 3 types of machines:

- Coil Dialyzer: The dialyzer consists of long membrane tubes between support screens and a wound around a core.

- Parallel Plate Dialyzer: Sheets of membrane are placed between the supporting plates.

- Hollow Fiber Dialyzer: Several fibres along with polyurethane are used at the ends to provide support. The output results in high efficiency and low resistance to the flow of fluid.


Pre procedure

The patient is advised adequate rest before The procedure.

-  along with that The patient is recommended to consume a renal diet advised by a clinicalnutritionist wherein all foods should be low in protein and potassium.

- Therefore, The patient has to avoid pulses and certain foods high in potassium such as banana.

- also, fluid retention is monitored to note The rise in pressure


During Procedure

The first stage of the renal transplant procedure involves 3 sessions over a 3 day period. 

- As soon as the patients body has been adjusted to a fixed dialysis pattern, the procedure can be changed as per the schedules as to when the patient would like to be admitted.

- In peritoneal dialysis the procedure can be performed by the patient at home itself.

- After receiving the peritoneal dialysis catheter a constant contact must be made with the PD nurse in order to get the catheter changed at regular intervals.

- A dialysis catheter is a thin tube which has two lumens ? Venous and Arterial.

- The arterial dialysis withdraws the blood from patients body to the dialyzer while the purified blood is returned to the patients body via the venous lumen.

The catheters are either tunneled catheters or non tunneled catheters. 

Tunneled catheters are used in cases where there is an immediate need for dialysis. 

Non-tunneled catheters are used in cases when dialysis is required for a prolonged time period (Cases of renal failure).


Post procedure

The healthcare team needs to consistently monitor the dietary intake of the patient along with checking the fluid retention and the blood pressure


Risk Complication

Nausea, fever and body pains are observed as a complication of dialysis.
- Precaution of a proper diet along with a proper prescribed course of medication is necessary.


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