Hemodialysis is an extracorporeal dialysis method in Hemodialysis patients, with chronic renal failure. It allows you to remove protein and mineral catabolism products and excess water consumed. 3.5 – 5 hours Hemodialysis patients, in which the main mechanism of substance exchange in the dialyses is diffusion occurring through the semi-permeable dialysis membrane, is considered “classical” hemodialysis. Classic hemodialysis has many of its varieties. Extracorporeal dialysis methods also include hemofiltration and hemodiafiltration, which are increasingly used not only in acute renal failure (ONN) but also in chronic renal failure (PNN). (1,2)
Hemofiltration (HF) is an extra corporeal procedure used in Hemodialysis patients,with chronic renal failure only in a continuous manner in the form of continuous arteriovenous or Veno venous hemofiltration (CTŻH, CŻŻH). (3, 4, 5)
Intermittent haemofiltration is used in Hemodialysis patients with acute renal failure. According to the definition, the procedure “involves the simultaneous removal of 40 – 70 l of plasma water together with dissolved organic and inorganic compounds (convection process) and reinfusion of an equivalent volume of sterile fluid with a properly selected composition.” (6)
Hemodiafiltration (HDF) dialysis
Hemodiafiltration (HDF) dialysi is a technique that has many benefits for Hemodialysis patients, being treated for chronic renal failure. (7)
There are groups of patients for whom this procedure is particularly indicated. These are patients with concomitant circulatory diseases, hypertension, high body weight and if they have contraindications for a permanent kidney transplant or the waiting period will be longer than 2 years. Hemodiafiltration gives many benefits to patients. It is hemodynamically stable, it has better anemia control and better fluid elimination. It also has a beneficial effect on lipid metabolism and generates less pro-inflammatory factors and cytokines during surgery.
Hemodiafiltration also has fewer side effects than other renal replacement therapy techniques. Hemodiafiltration is a convergence in which diffusion as in hemodialysis and convection as in hemofiltration are combined. It is also used in the treatment of acute renal failure and can be used in the form of continuous methods as continuous arteriovenous hemodiafiltration and venous venous hemodiailtration (CTŻHDF, CŻŻHDF). (8)
Therapeutic plasmapheresis may also be used to treat chronic renal failure. Plasmapheresis is a procedure that removes plasma with a simultaneous exchange for fresh frozen plasma, multi-electrolyte fluid, a solution of human albumin using a specific filter.
- Plasmaferase removes soluble factors such as immune complexes, proinflammatory cytokines, autoantibodies that can damage the basal membrane of the glomeruli of the cell. Thanks to plasmapheresis, the glomerular hardening and stromal fibrosis are slowed down. Thus, kidney function is improved. In nephrology, therapeutic plasmapheresis is mainly used for glomerulonephritis and renal transplant rejection. Information on hemofiltration, hemodiafiltration and therapeutic plasmapheresis come from the book “Diagnosis and treatment of kidney diseases – guidelines, recommendations and standards of conduct” ] B. Rutkowski and S. Czekalski.
A patient with chronic renal failure must be prepared for hemodialysis long before it begins. The reason is the need for vascular access to effective hemodialysis. (9)
- Detailed information on vascular access comes from the book “Diagnosis and treatment of kidney disease – guidelines, recommendations and standards of management” . A fistula should be formed when creatinine clearance is <25 mg / min. This is because after producing a fistula, you should wait from one month to several in the case of a primary fistula and 6 weeks in cases of artificial fistula until it can be used for hemodialysis.
- There are three types of fistulae used for hemodialysis. The first type that NKF DOQI is recommended is a primary fistula, made from the patient’s own vessels. In the case of a primary fistula, they are produced radially – radially near the Hemodialysis patients wrist and at the height of the ulna using the brachial artery and arm veins. It is recommended to start the fistula production as low as possible and to produce it in the elbow flexion as soon as possible. Patient’s vessels are saved in this way, which he may need in the future (10).
- If the Hemodialysis patients cannot have a primary fistula from his own vessels, artificial polytetrafluoroethylene is used. In emergency cases, catheters inserted into large venous vessels are used for hemodialysis. However, they cannot be used for more than 3 weeks because of the risk of infection that increases with time when the catheter is used. When the catheter needs to be used for a longer period of time and a primary or artificial fistula cannot be produced, a permanent catheter is used (11).
- However, they cannot be used for more than 3 weeks because of the risk of infection that increases with time when the catheter is used. When the catheter needs to be used for a longer period of time and a primary or artificial fistula cannot be produced, a permanent catheter is used. However, they cannot be used for more than 3 weeks because of the risk of infection that increases with time when the catheter is used. When the catheter needs to be used for a longer period of time and a primary or artificial fistula cannot be produced, a permanent catheter is used.
It differs from other catheters in the material from which it is made and in the presence of a dacron cuff, which allows the catheter to grow into the subcutaneous tissue. A permanent catheter can be maintained for up to several years.
Complications after a fistula for hemodialysis and temporary catheters are divided into early and late. Information on complications and how to care for vascular access comes from the publication
Early complications after fistula include postoperative wound infections, edema on the limb with fistula, lack of blood flow in the fistula, which is manifested by lack of tinnitus, limb ischaemia and the presence of collateral circulation in the fistula. (12)
Late complications after fistula include primarily infections, aneurysms and pseudoaneurysms, and fistula clotting. Early complications after establishing a temporary catheter for hemodialysis include: pneumothorax, air embolism, pleural bleeding, pericardium, mediastinum after perforation of the subclavian vein or jugular vein or bleeding into the retroperitoneal spaces after puncture of the femoral vein. Arrhythmias may also occur, and incorrect placement of the hemodialysis time catheter may cause that the blood supply will be inappropriate, thus endangering the Hemodialysis patients life.
Late complications of the temporary hemodialysis catheter are infection, atresia or thrombosis of the catheter as well as perforation of the vessel.
“Care for the catheter exit site involves changing the dressing around the catheter. It should be done daily and before each dialysis. Because the skin around the catheter should be dry, it is recommended to change the dressing after each bath. You can also apply ointments with antibacterial agents to the skin around the mouth of the catheter.”
- The patient’s primary fistula care recommendations cover many issues. The Hemodialysis patients should not bear weights over 3 kilograms in his hand with a fistula. He should also not sleep on the limb on which the fistula was formed and have his blood pressure measured. The patient should be aware of possible complications and be able to recognize them. To this end, the condition of the fistula must be monitored. After completing dialysis, dressings can be removed at the earliest after 12 hours. The patient is also not allowed to perform dressings that would inhibit blood flow in the limb on which the hemodialysis fistula was made.
- Patient care during Hemodialysis consists primarily of constant monitoring of the patient’s state of health. Information on patient care during dialysis comes from the publication “Renal replacement therapy in nursing practice” edited by B. Rutkowski. It is the nurse’s responsibility to record patient vital signs on the dialysis card at least once an hour. At least one nurse must be present at all times during the dialysis session. It is unacceptable to leave patients alone. The nurse prepares and administers drugs and performs other medical procedures ordered by the doctor. He also provides first aid in the event of acute complications in a Hemodialysis patients who is undergoing hemodialysis.
- There are a variety of acute complications that can occur during hemodialysis. Among them we distinguish hypotension and interdialysis hypertonia, itching of the skin, muscle cramps, and fever reactions. Electrolyte disturbances such as hyperkalaemia and hypokalaemia may occur.
There may also always be an air embolism. If it occurs, discontinue dialysis, give the Hemodialysis patients oxygen and apply Trendelenburg position.
- Abdominal pain, shortness of breath, coronary pain, anxiety and cold, wet skin may indicate the occurrence of haemolysis. In these cases, dialysis should also be interrupted, oxygen administered and the Hemodialysis patients monitored. Your first dialysis syndrome may occur during your first hemodialysis session. We divide this syndrome into anaphylactic and non-specific reactions. In the case of an anaphylactic reaction in the patient, we will observe, among others, symptoms such as a decrease in blood pressure, rapid shortness of breath, laryngeal edema, urticaria, abdominal pain and anxiety.
- In such a case, hemodialysis should be discontinued, the Hemodialysis patients should be given oxygen for breathing, his condition should be monitored and medication prescribed. In the case of a non-specific reaction, cough, slight itching, tightness of the chest and pain in the sacrolumbar region may occur. In this case, there is no need to stop the procedure. It can be resumed after the patient has been given oxygen. Monitor his condition and give medicines according to a doctor’s order. In the case of a non-specific reaction, cough, slight itching, tightness of the chest and pain in the sacro-lumbar region may occur. In this case, there is no need to stop the procedure. It can be resumed after the Hemodialysis patients has been given oxygen. monitor his condition and give medicines according to a doctor’s order.
- In the case of a non-specific reaction, cough, slight itching, tightness of the chest and pain in the sacro-lumbar region may occur. In this case, there is no need to stop the procedure. It can be resumed after the Hemodialysis patients has been given oxygen.
The patient’s blood pressure should also be monitored continuously. The patient may also develop dialysis hypoxemia, i.e. an increase in oxygen pressure.