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RENAL REPLACEMENT
THERAPY
BY
PRAVEENAMSC NURSING
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MEANING OF RENAL REPLACEMENTTHERAPY
Renal replacement therapy is a term used toencompass life supporting treatments for renal
failure.
Procedures which temporarily or permanently
remedy insufficient cleansing of body fluids by the
kidneys.
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TYPES OF RENAL REPLACEMENT
THERAPY
It includes:
Hemodialysis
Peritoneal dialysis
Renal transplantation
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HISTORY OF DIALYSIS
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Dr Wilhem (Pim) Johan Kolff (19112009) and his rotating drum(1943) in 1999
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FUNCTIONS OF DIALYSIS
Dialysis replaces three main kidney functions:
1. Removing wastes from the blood,
2. Removing excess fluid from the blood,
3. Keeping electrolytes in balance.
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PRINCIPLES USED IN DIALYSIS
Scientific Principles of dialysis include the
following:
Solutions
Semi permeable membranes
Transport mechanisms
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Solutions and Membranes
Solutions:
Solvent is a fluid (water)
Solute is a substance that can be dissolved in
a solvent
Semi-Permeable membranes:
A thin layer of material with pores or openings
that allow some substances to pass throughfreely, while keeping other substances out.
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Transport Mechanisms
Necessary to move fluid and solutes through the
semi-permeable membrane
Mechanisms used in dialysis
Diffusion
Osmosis
Filtration
Ultra filtration
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Diffusion
Movement of dissolved particles (Solutes)
across a semipermeable membrane from an
area HIGHER solute concentration to an area
of LOWER solute concentration
Removes waste products from the blood
BUN and Creatinine
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Osmosis
Movement ofFLUID across a semipermeable
membrane from an area ofLOWER solute
concentration to an area ofHIGHER soluteconcentration.
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Filtration
Process of passing fluid through a filter or semi
permeable membrane.
Regulates fluid balance in the blood
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Ultrafiltration
Controlled fluid removal by manipulation ofhydrostatic pressure. Ultrafiltration uses both
positive and negative pressure:
Positive pressure = pressure exerted by the
blood flowing through the dialyzer
Results from blood being pushed by blood pump
Negative pressure = pressure applied to the
dialysateside by the machine
Pulls excess fluid from blood compartment to
dialysate compartment --- drain
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Indications for dialysis:The decision to initiate dialysis in patients with renal failure
depends on several factors. Acute indications:
Metabolic acidosis
Electrolyte abnormality
Fluid overload Complications ofuremia
Intoxication, that is, acute poisoning with a dialyzable
substance.
Chronic indications for dialysis: Symptomatic renal failure
Lowglomerular filtration rate (GFR)
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HEMODIALYSIS
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Principles of hemodialysis:osmosis and diffusion
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Prescription
A prescription for dialysis by a nephrologist will
specify various parameters for a dialysis
treatment.
Frequency
Length of each treatment
Blood and dialysis solution flow rates
Size of the dialyser
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Access
An intravenous catheter
An arteriovenous (AV) fistula
A synthetic graft.
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Catheter access::--
Catheter access, consists of a plastic catheter
with two lumens which is inserted into a large
vein to allow large flow of blood to be withdrawnfrom one lumen, to enter the dialysis circuit, and
to be returned via the other lumen.
Catheters are usually Non tunnelled and
Tunneled
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Tunneled catheter
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Advantages ofAV fistula
Lower infection rateHigher blood flow rate
Lower incidence of thrombosis
Complications ofAV fistula
Steal syndrome
Aneurysms
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AV graft
AV grafts are
much like fistulas
in most except
that an artificialvessel is used to
join the artery
and vein.
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Grafts are inserted when the patient's native
vasculature does not permit a fistula.
They mature faster than fistulas, and may beready for use several weeks after formation.
AV grafts are at high risk to develop
narrowing.
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Types of Hemodialysis
Conventional hemodialysis,
Daily hemodialysis, and
Nocturnal hemodialysis
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Conventional hemodialysis:
3 times a week
3-4 hours for each treatment
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Advantages and disadvantages of
hemodialysis
Advantages
Low mortality rate
Better control of bloodpressure and abdominalcramps
Less diet restriction
Better solute clearanceeffect for the daily
hemodialysis: bettertolerance and fewercomplications with morefrequent dialysis.
Disadvantages
Restricts independence.
Requires more supplies.
Requires reliable technologylike dialysis machines
The procedure iscomplicated and requiressound knowledge
Requires time to set up andclean dialysis machines, andexpense with machines andassociated staff.
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Complications ofHemodialysis
Technical complications
Fluctuations in blood pressure
Cardiac dysrthymias Air embolism
Hemorrhage
Restless legs syndrome Pyrogenic reactions.
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Nursing care for hemodialysis patient
Hemodialysis Vascular Access
Hemodialysis adequacy
Hemodialysis treatment and complications Medication management and infection
control practice
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PERITONEAL DIALYSIS
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Peritoneal dialysis involves repeated
cycles of instilling dialysate into the
peritoneal cavity, allowing time for
substance exchange, and then removing
the dialysate.
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Uses
Patients with cardio vascular diseases
patients with diabetes
Patients with bleeding disorders
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Contra indications
Hypercatabolism
Poor peritoneal membrane
Obesity History of ruptured diverticula
Abdominal diseases, respiratory diseases
Recurrent episodes of peritonitis Abdominal malignancies
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Types of peritoneal dialysis:
Continuous ambulatory peritoneal dialysis
Automated peritoneal dialysis
Continuous cyclic peritoneal dialysis Intermittent peritoneal dilaysis
Nightly intermittent peritoneal dialysis
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Advantages and Disadvantages:
simple to set up +
perform
easy to use
hemodynamic stability
no anti-coagulation
bedside peritoneal access
unreliable ultrafiltration
slow fluid + solute
removal
drainage failure, leakage
catheter obstruction
respiratory compromise
hyperglycemia
peritonitis
advantages disadvantages
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Complications of peritoneal dialysis:
Peritonitis
Catheter related complications-displacement
and obstruction Dialysis related complications-pain,
hypotension, weight gain.