11/30/2015 1 Dialysis C. Jamaris 2 Goals of Dialysis •Remove end products (waste) of protein metabolism –urea–creatinine •Maintain a safe concentration of electrolytes •Correct acidosis and replenish the body’s bicarbonate levels •Remove excess fluidand electrolytes 3 Principles of Dialysis •Ultrafiltration is removal of fluid from the blood using either osmotic or hydrostatic pressure •Diffusion is the passage of particles from an area of higher concentration to lower concentration •Osmosis is movement of fluid across semi-permeable membrane from an area of lesser to greater osmolality 4 Principles of Dialysis •Semi permeable membrane an artificial or actual membrane for exchange of solutes. •Dialysate is an electrolyte solution is used on both sides of the semi-permeable membrane –Solutes particles move towardthe solution of lower solute concentration –water moves toward the solution of higher solute concentration.
Subscribe to view the full document.
11/30/2015 2 5 Types of Dialysis Peritoneal Dialysis: involves instillation of fluid into the peritoneal cavity. The peritoneum serves as the filtration membrane. –Continuous ambulatory peritoneal dialysis(CAPD) –Automated Peritoneal –Continuous cyclic peritoneal –Intermittent peritoneal Hemodialysis: shunts the blood from the body through a dialyzer and back into circulation. Vascular access is needed. CRRT Continuous Renal Replacement Therapy Vascular access needed 6 Peritoneal Dialysis •Intact peritoneal membrane w/o adhesions, infection, surgery •An alternate/slower method of removing fluid. •Occurs by means of a transfer of fluid and solutes from the blood stream through the peritoneum. •Uses repeated cycles of instilling dialysate into the peritoneal cavity, allowing it to dwell in the peritoneal space, then draining the fluid thus removing the waste products 7 Peritoneal Access Tenchkoff, Bent Neck Curl, or Disk •A catheter is inserted under sterile technique through the abdomen and left in place. •The catheter requires a few weeks to develop fibrous tissue into the cuff to anchor and seal to prevent bacterial migration 8 Catheter Insertion •Sterile procedurs as infection is a great risk. •The catheter has to “season” prior to use- this allows fibrous tissue to grow around the catheter and decrease risk of bacterial invasion or back leakage.