Procedure & Complication
of Haemodialysis
Haemodialysis
Medical procedure to remove fluid
& waste products from blood & to correct electrolyte
imbalance.
done using a haemodialysis machine & dialyzer
also called as ‘artificial kidney.’
Indications For Dialysis
Acidosis ( pH< 7.1)
Electrolyte imbalance ( K+ > 6.5 mEq/ L)
GFR <10ml/min
Overload of fluids ( pulmonary oedema)
Uremic symptoms (↑ed level of nitrogenous waste
products)
Principle Of Haemodialysis
[Link] : Passive movement of solute
across a semipermeable membrane
[Link] : Solute + fluid removal
across semipermeable membrane down a pressure
gradient
Haemodialysis Apparatus
a. Dialyzer
b. Dialysate
c. Blood delivery system
Dialyzer(Artificial Kidney)
Plastic chamber – contains bundles of
capillary tube through which blood circulates
while dialysis solution travels outside the
bundle in opposite counter current direction.
Diffusion & ultrafiltration happens here.
Membranes using in dialyser
-Cellulose
-Substituted Cellulose-
cellulose acetate
-
Hemophan
-Sy
nthetics-
polyacrylonitrile,
polysulfone,polymethyl
methacrylate
Dialysate
Solution used in dialysis which has same solute concentration as those in plasma.
Water used in the dialysate is purified by reverse osmosis.
Contents of dialysate
Na+ - 136-140mmol/L
K+ - 0-
4mmol/L Mg2+ -0.25-
0.75mmol/L
HCO3- 27-40mmol/L(buffer)
Dextrose- 0-5.5mmol/L
Blood Delivery system
Blood Pump – moves blood from access
site through the dialyzer &
back to the patient
Blood flow Rate – 250-500 ml/min
Acess for Haemodialysis
1. Arterio venous fistula ( AVF )
2. Arterio venous graft ( AVG )
3. Cuffed tunneled dialysis catheter
4. Temporary access sites
a. Internal jugular vein
b. Femoral Vein
c. Subclavian Vein
Arterio-Venous Fistula
o Subcutaneous anastomosis of an artery to an
adjacent native vein
o Takes 6 weeks for development(arterialization of
vein)
o Both the dialysis needles are inserted into
the native vein
Types
Radiocephalic (first choice)
Brachiocephalic (second choice)
Brachiobasilic (third choice)
Arterio Venous Graft
Procedure
Blood Flow Rate- 300-500 ml/min
Dialysate - 500-
800ml/min
Usually done – 3 times a week & each
dialysis lasts for 4 hours.
Complications Of Haemodialysis
Hypotension (25-55%)
Cramps (5-20%)
Nausea and vomiting (5-15%)
Headache (5%)
Chest pain (2-5%)
Back pain (2-5%)
Itching (5%)
Fever and chills (<1%)
Hypotension
Causes Large weight gain
Volume Related Short dialysis
High dialysis solution
temperature
Inadequate Vasoconstriction Antihypertensives
Eating during treatment
Cardiac Factors
Diastolic
Arrhythmia
Muscle Cramps
Predisposing Factors
Hypotension
Hypovolemia
Leads to vasoconstriction cause
muscle hypoperfusion leading to
muscle cramps
High filtration Rate
Low sodium dialysis
solution
Nausea & Vomitting
due to hypotension
Headache
Common
Chestpain & Back pain
Itching
precipitated by dialysis. May be due to hypersensitivity reaction to
dialyzer
Fever & Chills
Less Common But Serious Complications
Disequilibrium Syndrome
set of systemic & neurologic symptoms with characteristics
electroencephalographic findings occur either during / following dialysis
• Early Manifestation- Nausea , Vomitting, Restlessness & headache
• Serious Manifestation- Seizure ,Obtundation, Coma
o Cause
Acute increase in brain water content
Dialyzer reactions
can be Anaphylactic type (type A) & nonspecific type (type B)
Arrhythmia
common in patients receiving digitalis & those with coronary artery
disease
Cadiac Tamponade
recurrent hypotension – sign of impending cardiac tamponade
Hemolysis
its a medical emergency. Can be due to obstruction/narrowing in the
blood line & if there is any problem with dialysis solution
Thank
you
