Hemodialysis: Definition, Types, Procedure, Diagram, Treatments, Procedures

Definition Of Hemodialysis

Hemodialysis is a medical process that removes waste, salts, and fluids from the blood if the kidneys can no longer perform this action naturally. It is very vital in patients with end-stage renal disease to maintain a good balance within the body to prevent further complications.

Overview Of Renal Function

The kidneys filter the blood and remove waste and excess substances to formulate urine. In renal failure, this accumulation builds up with toxins and fluid, leading to life-threatening conditions. Therefore, in such cases, interventions like hemodialysis become essential.

Hemodialysis Procedure

The process of hemodialysis involves several steps that are quite critical to effectively and safely treat patients with kidney failure.

Assessment Before Hemodialysis

• A detailed medical evaluation is carried out to determine the conditions or needs of a patient.

• Blood tests to determine waste products, electrolytes, and other relevant factors.

• The physical examination is to assess their general health and detect any possible complications.

Creation Of Vascular Access

• Fistula: An artery is joined to a vein, usually in the arm; a strong blood vessel is created that can be regularly pierced with a needle.

• Graft: In this, with the help of a synthetic tube, an artery is connected to a vein, in case it is not suitable to have a fistula.

• Catheter: A tube is placed in a large vein, typically in the neck or chest, for short-term or emergency access.

The Hemodialysis Session

• The patient arrives at a dialysis centre, checks in, and gets weighed to assess fluid gain since the last session.

• Needles are inserted into vascular access; bloodlines are connected to the dialysis machine.

• The blood is drawn out of the patient's body into the dialyser.

• It flows through semi-permeable membranes that filter waste and excess fluid from the blood.

• A special fluid called dialysate flows counter to the blood to remove unwanted substances from it.

• The cleaned blood is returned to the patient's body.

• This process is continued till the recommended time for dialysis, which usually is 3-5 hours.

Monitoring And Adjusting Parameters During Hemodialysis

• Vital Signs Monitoring: Blood pressure, heart rate, and temperature are monitored at regular intervals.

• Blood Flow Rate: The correct rate of blood flow through the dialyzer.

• Dialysate Composition: The concentration of the electrolytes in the dialysate would be varied based on the patient's requirements.

• Ultrafiltration Rate: This is concerned with the volume of fluid that is removed from the patient's blood.

• Symptom Monitoring: Keep an eye on discomfort or complications, such as cramps, nausea, and hypotension, and act as appropriate.

Care After Hemodialysis

The care after hemodialysis includes the following:

Recovery And Management Post-Treatment

• Vital Signs Check: The blood pressure and heart rate of the patient are checked once brought off the machine.

• Fluid Management: Advising fluid intake to prevent overloading between dialysis treatment sessions

• Nutritional Counseling: Dietary advice to ensure adequate balance and health.

Commonly Seen Post-Dialysis Symptoms And Their Management

• Fatigue: Resting before suggesting a rebuilding of activity slowly

• Muscle Cramps: Stretching and hydration, other medications if needed

• Hypotension: Moving slowly, avoiding dizziness, and monitoring fluid intake.

• Nausea: Administer anti-nausea medications and provide dietary interventions that will prevent further problem behaviours.

Types Of Hemodialysis

There exist two main types of hemodialysis, each suited best for individual patient's needs and conditions.

In-Center Hemodialysis

• Conducted at a dialysis clinic and managed by health care staff.

• Typically conducted 3 times a week, with each session lasting from 3 to 5 hours.

• Patients come, get attached to the dialysis machine by vascular access, and the treatment is performed.

Advantages

• Medical supervision continuously, with health care staff available at all times.

• Availability of specialised equipment and resources.

• Social interaction with other patients undergoing treatment.

Disadvantages

• The fixed schedule with a high frequency of visits to the centre.

• The daily routine is interfered with and flexibility is low.

• Possible risk of catching infections from a clinical setup.

Home Haemodialysis

• Under home conditions, it is performed after receiving extensive training.

• Requires a dedicated space for setting up dialysis equipment.

• These can be done more frequently with reduced periods.

• Good quality training by the health care team is linked to the operation of a dialysis machine, infection control measures, and response during emergencies.

• Caregiver training sessions, if required.

Advantages

• It offers flexibility in scheduling the periods of dialysis at times that best suit individual lifestyles.

• Travel time is reduced hence the ease of treatment at home.

• More frequent treatments may mean better outcomes.

Disadvantages

• Initial set-up costs of equipment and adapting the home.

• The burden of daytime treatments and adherence to rigorous protocols.

• Social isolation compared with that in-center dialysis.

Medical Considerations

Hemodialysis needs careful medical consideration. Before hemodialysis is initiated, it has to be determined that it would be a suitable treatment for the patient.

Medical Conditions That Require Hemodialysis

• End-stage renal disease (ESRD) with kidney function below 10-15%.

• Severe electrolyte imbalance; for example, hyperkalemia.

• Fluid overload uncontrolled by medical management.

Symptoms That Indicate The Need For Hemodialysis

• Severe fatigue or weakness.

• Nausea and vomiting are persistent.

• Dyspnea due to fluid retention.

Possible Complications During And After Hemodialysis

• Hypotension during rapid fluid removal by ultrafiltration.

• Muscle cramps and nausea during treatment.

• Infection in the site of vascular access

• Cardiovascular complications, such as heart disease or stroke.

• Access site problems, including fistula or graft failure

• Bone and mineral disorders, including osteoporosis.

Advances In Hemodialysis

Hemodialysis is an ever-evolving and rapidly changing field, with new technologies and research emerging incessantly.

Technological Advancements

• More efficient dialysis machines with improved filtration capacity.

• Wearable and portable devices for dialysis provide more mobility and ease to the patient.

Future Directions

• Nanotechnology applications in enhancing membrane efficiency in dialysis.

• Bioengineering solutions towards artificial kidneys.

• Gene therapy approaches in the treatment of underlying genetic causes of kidney diseases.

• Research in the field of stem cells to regenerate a kidney for use in tissue engineering applications.

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