HEMODIALYSIS DIALYZER Prepared by Nizar Belal M. Said Supervised by Dr. Aidah Abu Elsoud Alkaissi Nizar Belal M Said

Equipments of Hemodialysis Vascular access AV-Fistula Nizar Belal M Said

Vascular access Central Venous Catheter Nizar Belal M Said

Dialysis machine Nizar Belal M Said

Dialysis solution (dialysate) Acetate NaHCO3 Nizar Belal M Said

Dialysis Machine Blood pump moves blood from It consists of: access site through the dialyzer and back to patient, the usual flow rate 200-300 ml/min, up to 600 ml / min for ultra high efficiency dialysis Dialysis solution delivery system Monitoring devices Nizar Belal M Said

Dialysis Machine Heating: Dialysis solution heated by the machine to 34-39°C prior to being pump to the dializer Venous air trap and air detector, which automatically clamps the venous blood line and shuts off the blood pump if air is detected Blood leak detector placed in the dialysate outflow line. When a leak develops through the dialyser membrane Nizar Belal M Said

Dialyzer Refered to as an artificial kidney Serves as a synthetic semipermiable membrane Replacing the renal glomeruli and tubules as the filter for the impaired kidney In hemodialysis, the blood, laden with toxins and nitrogenous wastes is diverted from the patient to a machine, a dializer, in which the blood is cleansed and then returned to the patient Nizar Belal M Said

Dialyzer It is a tube with four ports, two communicate with a dialysate compartment , and two with a blood compartment The semipermeable membrane separate the two compartments Nizar Belal M Said

Dialyzer The boundary area between the tow compartment is maximized by using a membrane divided into multiple hollow fibers or parallel plates Nizar Belal M Said

Types of Dialyzer 1. Flat-Plate Dialyzer The blood is routed between sheets of membranes laid on top of one another The dialyzer is configured so that blood and dialysis solution pass through alternate spaces between the membrane sheets Nizar Belal M Said

Types of Dialyzer 2. Hollow fiber The hollow-fiber artificial kidneys contain thousands of tiny cellophane tubules that act as semipermeable membrane The blood flows through the tubules, thousands of capillaries tightly bound in a bundle, while the dialysate circulates around the tubules The exchange of wastes from the blood to the dialysate occurs through the semipermeable membrane of the tubules Nizar Belal M Said

Advantages of hollow-fiber Dialyzer Performance (The results of activities over a given period of time) Biocompatibility refers to the ability of the dialyzer accomplish its objectives without causing hypersensitive, allergic, or adverse reaction The amount of blood is needed to “fill” will be 65-85 ml compared with plate dializer 70-100 ml The filling volume of hollow-fiber does not increase during application of a transmembrane pressure (TMP) compared wíth flat- plate dializer Nizar Belal M Said

Nizar Belal M Said

High Flux Dialysis Refers to a form of hemodialysis that was developed in recent years to improve the efficiency of dialysis It has succeeded in both improving the quality of dialysis and in shortening dialysis times Nizar Belal M Said

High Flux Dialysis What is the Evidence The essential element is the use of dialyzers that have larger pores for the removal both of uremic toxins and of fluid. Membrane are thin, have large pores and very lower resistances With high flux dialysis, BUN clearly is removed more quickly. But there is also now evidence that larger molecules may also play an important role in causing the uremic symptoms that are both annoying and dangerous to dialysis patients Such molecules are too big to be removed by conventional dialysis, but are removed with high flux dialyzers Nizar Belal M Said

Advantages of High Flux Dialysis For example, a molecule called beta 2 microglobulin, which can have a role in causing arthritis in dialysis patients, is removed only by high flux dialysis There are already reports of patients with less joint pain when switched from conventional to high flux dialysis Allows the accurate removal of very small volumes, as well as volumes up to four liters per hour, which can never be achieved with conventional dialysis Nizar Belal M Said

Reusing of dializer Because of the cost, hemodializer are commonly reused in dialysis centers With bleaching process to reuse high flux synthetic membrane dializer, clearance of large molecules is still possible, even the hemodializer is not new (Port et al 2001) Nizar Belal M Said

Possible disadvantage of high flux dialysis Pyrogen reactions, characterized by high temperatures in patients during dialysis treatments Caused by small pieces of dead bacteria that can be found in the dialysate Because high flux dialyzers have larger pores, the bacterial particles can pass more easily into the patient’s bloodstream, and that patients have more frequent pyrogen reactions. This observation remains to be confirmed Nizar Belal M Said

Nutritional & Fluid Therapy Restricting dietary protein: Decrease the accumulation of nitrogenous wastes Reduces uremic symptoms May even postpone the initiation of dialysis for a few months Restriction of sodium & potassium& fluids Nizar Belal M Said

Thank You Nizar Belal M. Said Nizar Belal M Said