Haemodialysis is an artificial process to provide someone’s kidney functions externally via a machine called dialysis machine. Therefore Haemodialysis is very important process to maintain kidney functions in patients with Chronic Kidney Diseases and some acutely ill patients.
Why do we do dialysis in patients?
Your kidney have very important set of functions to maintain balance between lots of body functions. This includes excretion of waste products, removal of excess water from the body, maintain electrolyte balance, maintain acid base balance and etc.
If someone fail to maintain these kidney functions, they will be facing lot of problems
Eg:
- Accumulation of water in the lungs (Pleural effusion)
- Accumulation of water in abdomen (Ascites)
- Excess Potassium in the serum (Hyperkalemia)
- Reduced pH in the blood (Acidosis)
As most of above issues are life threatening timely dialysis is very important.
How need hemodialysis?
As mentioned, there are two groups of patients who need dialysis.
- Patients with Chronic Kidney Diseases (CKD)
- Acutely ill patient with Acute kidney injury (AKI)
Dialysis of CKD patients
Hemodialysis is one of the very important option in management of CKD patients. It will help to maintain most of the kidney functions.
This will ensure;
- Removal of excess fluid from the body
- Remove excess Potassium from the plasma
- Maintain acid base balance
Dialysis of AKI patients
There are patients who get Acute Kidney Injuries (AKI) following different incidents. Viper bites, Sepsis, Leptospirosis are some of them. In such situations some patients undergo urgent haemodialysis.
How to dialysis a patient?
When we say dialysis most of the time it represents hemodialysis than the peritoneal dialysis.
When we do haemodialysis, the basic of this process is to take blood out of the body, purify it and re transfuse into the body. But this is very complicated process than this.
Steps of hemodialysis
- Prepare the dialysis machine
- Heparinize the vascular set properly
- Connect the patient through Vascular access to the dialysis machine
- Adjust all parameters of dialysis including UF, BFR, Heparin dose and etc
- Let blood go through the semipermeable membrane of the dialyzer
- Re transfuse blood to the patient
- Reinfuse the blood after completion of procedure
- Disconnect the Vascular line
- Await for hemostasis
Important parts of Dialysis procedure
What is dialyzer?
As I mentioned, dialysis is an artificial process. So to give you kidney functions artificially, there should be an artificial kidney. Dialyzer is the one doing the function of an artificial kidney in the dialysis machine.
The dialyzers are made of synthetic semi permeable membranes. These membranes are capable of providing selective permeability to some of the molecules while others do not get it.
So dialyzer is the most important part of the haemodialysis machine.
Vascular access
When you want to undergo haemodialysis, you need to have an access point. This may be a AV Fistula, AV Graft, Perm Cath or Temporary Catheter. So each have different abilities. You should select your vascular access depending on your future dialyzing plan, vascular structure and lots of other factors.
However if you are undergoing an urgent haemodialysis, you have to use a temporary femoral or neck vascular catheter.
The vascular access will ensure the adequate blood supply to the dialysis machine. Also it will return all the purified blood to body.
Water supply
In a dialysis we are doing an invasive procedure to ensure the renal functions of the patient. However if we do not use proper water for this process, patients ended up with lot of complications. Sepsis is one of them.
Therefore we use a water plant with reverse osmotic systems.
This includes both filtering capacity of unnecessary particles and germs.
Complications of Haemodialysis
Although haemodialysis is a very important and effective treatment method, it may have lot of complications.
- Dialysis Disequilibrium Syndrome
- Hypotention during dialysis
- Hypoglycaemia
- Headache
- Fever
- Infections
- Bleeding from vascular access
Reference