Etiology
Severe renal malfunction and acute kidney ailment, results to kidneys losing their capability to filter and get rid of extra fluid and waste from the human body. Hemodialysis is a technique that uses artificial membrane known as a dialyzer to: get rid of body wastes, such as urea and creatinine from the blood; bring-back the appropriate balance of electrolytes in the human blood; and get rid of unnecessary fluid of the human body. (Hobbs, 1979). Hemodyalysis is among the three therapies that involve renal replacement, the other two are peritoneal and renal transplant dialysis. An alternative technique for extracorporeal filtering of blood elements such as cells or plasma is apheresis.(Ronco, 2002).
Hemodialysis can either be an inpatient or outpatient therapy. Regular hemodialysis is carried out within a dialysis outpatient medical facility; it can either be a devoted, erected on itself clinic or a purpose constructed room within a hospital. It is in rare cases hemodialysis is carried out at home. Treatments involving dialysis in a clinic are managed and initiated by well specialized staff comprising of technicians and nurses; dialysis medications at one’s residence can be self managed and initiated or carried out together with the help of a trained individual who is normally a member of a family.(Ronco, 2002).
Principle
Hemodialysis principle is similar to other techniques of dialysis, the process entails solute diffusion across a membrane that is semipermeable. Hemodialysis engages counter current flow, whereby the dialysate is streaming in the converse direction to the flow of blood in the circuit within the extracorporeal. The opposite flow of current retains the gradient concentration across the membrane at its optimum and raises the dialysis efficiency.(Wright, 1981).
Ultrafiltration or removal of fluid is attained by adjusting the hydrostatic pressure within the dialysate section, causing some dissolved solutes and free water to flow across the semi-permeable membrane on a formed pressure gradient.
The utilized dialysis solution can be a sterilized solution conforming with British Pharmacopoeia or containing mineral ions. Potassium, urea, phosphate and other waste materials diffuse into the solution of the dialysis. Nevertheless, chloride and sodium concentrations are similar those of usual plasma to avert loss. Higher concentrations of Sodium bicarbonate than plasma are added to eliminate blood acidity. A small quantity of glucose is also normally used. (Hemodialysis/Hemofiltration. ASAIO Journal, 44(2), 66A. 1998).
Prescription
When Nephrologist(a specialist in medical kidney) recommends hemodialysis, he/she will specify various factors for the treatment of dialysis. They include: frequency (the number of treatments for each week), flow rates of dialysis solution and blood, time period of each treatment, and also the dialyzer size. The components of the solution of dialysis are sometimes altered in terms of its bicarbonate, sodium and potassium contents. (Mann, 1995). To sum it all, the larger the size of the body of a person, the higher the levels of dialysis they will require. There is also an increasing interest in carrying out short hemodialysis at home on daily basis, which comprises of sessions ranging from 1.5 to 4 hours administered 5 to 7 times every week, normally at home. Nocturnal dialysis has also raised interest, where a patient is dialyzed normally at home for a period of 8-10 hours every night, and 3-6 nights every week. (Wright, 1981).
Complications and side effects
The process of hemodialysis normally involves the removal of fluids via ultrafiltration, since most patients suffering from renal failure pass no or little urine. The complications caused by eliminating a lot of fluid or extracting it too rapidly may include fatigue, low blood pressure, leg cramps, chest pains, headaches and nausea. The occurrence of these symptoms is normally in the course of treatment and they can carry on in post treatment, sometimes they are known as dialysis washout or dialysis hangover altogether. (Ronco, 2002). The extent of these symptoms is often proportionate to the speed and quantity of fluid elimination. Nevertheless, the implication of a given rate or amount of fluid elimination can differ highly from one individual to another and on a daily basis. These side implications can be averted and their severity reduced by restricting the intake of fluid between treatments or raising the dialysis dose. (Wright, 1981).
Because hemodialysis necessitate access to the human circulatory structure, patients going through hemodialysis may put their circulatory system at risk of microbes, this can result to sepsis. Sepsis is an infection that can affect the bones-osteomyelitis, or the valves of the heart-endocarditis. The infection risk differs in regard to the form of access utilized. Bleeding is also likely to happen, the risk also differs in regard to the form of access utilized.
Heparin is the mostly used anticoagulant in the process of hemodialysis, this is because it can be immediately reversed using protamine sulfate and it can be well tolerated. Allergy caused by heparin can less often be a major problem and can result low count of platelet. In such cases, another anticoagulant should be utilized. Dialysis can be carried out free of anticoagulation to patients with high bleeding risks. (Hobbs, 1979).
Syndrome of the first use is infrequent but the rigorous anaphylactic effect on the man-made kidney. Its symptoms may include wheezing, back pain, chest pain, sneezing, breath shortness, and sudden death. It can be as a result of residual sterilant within the man-made kidney or membrane material. Currently, the cases of syndrome of first use has reduced, since the use of steam sterilization, gamma irradiation and radiation of electron-beams is highly used rather than chemical sterilants, and the invention of fresh half-permeable membranes with high levels of biocompatibility. (Ronco, 2002).
Side effects of hemodialysis in the long term include neuropathy, various types of heart ailments, and amyloidosis. Raising the length and frequency of treatments have proved to enhance heart enlargement and fluid overload in such patients. (Wright, 1981).
Hemodialysis access
There are three different types of hemodialysis access:
Fistula.
It is developed by joining one of the patient’s arteries to one of his/her veins in the lower arm. A fistula enables a repeated means of access for every session of dialysis. It is likely to take several months for the formation of fistula to take place. Compared to other hemodialysis techniques, a fistula does not clot easily. (Hobbs, 1979). A fistula has proved to be the most durable and effective technique of dialysis. Side effects comprise thrombosis or formation of clot, and infection at the point of access.
Graft
It is an excess of vascular that utilizes synthetic tube placed under the skin in a patient’s arm (graft), it is normally used if the victim’s veins are very small. The tube then becomes a man-made vein that is used continuously for blood access and needle placement in the course of hemodialysis. A graft does not necessarily have to develop as a fistula, sometimes graft can be used 1 week after it has been implanted. Grafts have more trouble with infection or clotting compared to fistulas and they require to be replaced more frequently. Polytetrafluoroethylene graft is the frequent type of hemodialysis that is used. (Wright, 1981).
Venous catheter
A catheter or a tube may be temporarily used if a patient did not have time to have a permanent access. It is normally implanted in a groin, chest, neck or vein. Since it clogs and hence causing an infection, this form of catheter is not frequently utilized to create a permanent access. (Ronco, 2002).
Possible implications of the condition for training, education and work
People undergoing dialysis have exhibited lower performance, absenteeism, and decreased wellbeing in terms of psychology, in the workplace and also in education. Some of the significant implications include itchy skin and weight gain.
Itchy skin
Most people undergoing hemodialysis have itchy skin. This is caused by a potassium build-up in the body. Itching skin can cause low performance in the place of work, education and training. (Wright, 1981).
Weight gain
The fluid used in peritoneal dialysis has molecules of sugar. Some of it is absorbed in the patient's body. This increases the patient’s daily consumption of calorie amounting to hundreds each day. Weight gain can lead to poor performance at work since specialized dieting can lower the chemistry of the body and making the patient feel extremely ill. (Hobbs, 1979).
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