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Hemodialysis I: Introduction01:25

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
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Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
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Hemodialysis access techniques.

D D Bell1

  • 1University of Southern California, Los Angeles, California.

Surgical Technology International
|May 8, 2015
PubMed
Summary
This summary is machine-generated.

Advancements in hemodialysis technology allow longer patient survival. Arteriovenous fistulas offer ideal long-term vascular access, but expanded PTFE grafts are crucial when fistulas are not suitable.

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Area of Science:

  • Nephrology
  • Vascular Surgery

Background:

  • Hemodialysis technology and vascular access techniques have advanced, enabling patients to remain on chronic hemodialysis for extended durations.
  • The arteriovenous fistula (AV fistula) is the preferred method for long-term vascular access due to its high patency rates, often exceeding five and ten years.
  • However, only 15% of chronic renal failure patients are candidates for autogenous AV fistulas, particularly the acutely ill.

Purpose of the Study:

  • To review the role of arteriovenous fistulas and expanded polytetrafluoroethylene (ePTFE) grafts in long-term hemodialysis vascular access.
  • To highlight the selection criteria and outcomes associated with different vascular access modalities.

Main Methods:

  • Review of current literature on hemodialysis vascular access.
  • Analysis of patency rates and patient candidacy for AV fistulas versus ePTFE grafts.

Main Results:

  • Autogenous arteriovenous fistulas, surgically created at the wrist, mid-forearm, or antecubital fossa, require adequate arterial flow and suitable superficial arm veins for success.
  • Properly selected and constructed AV fistulas demonstrate excellent primary patency rates.
  • Due to limited candidacy for AV fistulas, particularly in hospitalized patients, arteriovenous placement of ePTFE grafts has become a primary option for long-term access.

Conclusions:

  • While AV fistulas are ideal, their limited applicability necessitates alternative solutions.
  • Expanded polytetrafluoroethylene grafts are a vital and widely used alternative for achieving long-term hemodialysis access when AV fistulas are not feasible.