1. Dialysis Allam Rizqallah The Palestinian Kidney Transplant Center S.A.H1/2/2005

2. Dialysis Is a process where by the solute composition of solution A is altered by exposing solution A to a second solution B through semipermiable membrane. Is a process where by the solute composition of solution A is altered by exposing solution A to a second solution B through semipermiable membrane.

3. Physiologic principles 1. Diffusion the movement of small molecular weight solutes ( waste products ) through semipermiable membrane. the movement of small molecular weight solutes ( waste products ) through semipermiable membrane. 2. Ultra filtration:- Performed for the purpose of removing water accumulated either by ingestion of fluid or metabolism of food through semipermiable membrane

5. The purpose of flow is to maximize the concentration difference of waste products between blood & dialysate in all parts of dialyser. The purpose of countercurrent flow is to maximize the concentration difference of waste products between blood & dialysate in all parts of dialyser.

6. H.D Equipments 1. Dialyser. 2. Dialysis solution. 3. Extracorporeal circuit. 4. Dialysis machine. 5. Vascular access.

7. Hemodialysis Process

8. Dialyser

9. Dialysis solution

10. Extracorporeal circuit

11. Dialysis machine

12. Vascular access Temporary 1. Subclavian catheter. 2. Jugular catheter. 3. Femoral catheter.

14. Vascular access – cont’d Permanent Permanent Arteriovenous fistula Arteriovenous fistula ( A.V.F ). ( A.V.F ). Arteriovenous graft. Arteriovenous graft.

15. A.V.F

16. Arteriovenous graft

18. A.V.F Subcutaneous anastomosis of artery to vein Subcutaneous anastomosis of artery to vein Safe & long lasting permanent access. Safe & long lasting permanent access. Avoid …… Avoid …… 1. Measuring B/P. 2. Withdrawing blood samples. 3. Wearing tight clothes. 4. Carrying heavier materials.

19. H.D Carried in hospitals only. Carried in hospitals only. 3 session/week, 4 hrs /session. 3 session/week, 4 hrs /session. Nursing care is observation & intervention. Nursing care is observation & intervention. Heparin 5000 i.u / session total. Heparin 5000 i.u / session total. Blood is returned back to patient after terminating dialysis. Blood is returned back to patient after terminating dialysis.

20. Complications during H.D Hypotension. Hypotension. Muscle cramps. Muscle cramps. Chest pain. Chest pain. Itching. Itching. Nausea & vomiting. Nausea & vomiting.

21. Thank you Allam Rizqallah The Palestinian Kidney Transplant Center S.A.H S.A.H1/2/2005