Dialysis is a process by which the blood of a patient with renal failure can be purified by toxins removal and removal of extra water inside his body
How can the process of dialysis be performed?
Dialysis is the
process by which the blood of a patient with renal failure can be purified by
toxins removal as well as removal of extra water inside his body. Once the
diagnosis of end-stage kidney disease has been made, patient will be prepared
for dialysis. However, this preparation is advised to be as early as possible
before the general condition is deteriorated and the nutritional status became
very poor with loss of weight and cachexia.
Preparation for dialysis
A kidney failure patient should
have an access for dialysis that called “vascular access”. There are many types
of accesses according to how much time it can be available for dialysis, for
example, (1) temporary access, it can be used transiently until a permanent or
semi-permanent access became available, e.g., femoral catheter that can be
inserted under local anesthesia in the
femoral vein in your groin. (2) Semi-permanent access, e.g., an internal
jugular catheter that is a hard catheter that can be inserted in jugular vein
in the one side of your neck. (3) Permanent access, vascular surgeon may
connect a peripheral artery to a peripheral vein, so that the vein will be
arterialized i.e. can be pulsating, it is called arteriovenous fistula (A/V
fistula). By time the vein caliber will be larger in diameter and be ready to
supply an enough amount of blood for dialysis. Another permanent access that is
synthetic in nature, the A/V graft, it is a synthetic tube connecting the
artery side to the venous side. It provides the purpose like fistula but its
size will not enlarge.
Care of the A/V fistula
The dialysis patient should know
that his vascular access is very precious to his life, actually it is called
the “life line”. So, this life line should be kept with an extra care to be
ready at any time for the dialysis process. Several precautions should be kept
for a healthy functioning fistula:
1)
Keep
the arm of the fistula (usually right sided) only for dialysis, no intravenous
injections and no checking of blood pressure or any other intervensive
processes.
2)
Do
not carry heavy weights by this arm.
3)
Do
not depend on this arm by your head or other parts of the body during sleeping.
4)
Use
rubber ball for frequent grasp/release by this hand, so that peripheral
circulation could be activated with more blood flow through this fistula and
subsequent enlargement and more maturation.
5)
Locations
of bricking should be frequently changed to guard against aneurysmal
dilatation.
Dialysis frequency
Dialysis of patient’s blood is
called “hemodialysis”. It is performed three times per week with average four
hours each. This different from peritoneal dialysis (PD) that can be performed
via special machines. However, prolonged (continuous) types of hemodialysis may
be supplied in the CCU/ICU departments for critical cases only, where blood
pressure would be very low and the dialysis process should be performed very
smoothly.
When to stop dialysis?
Actually, when
a patient with kidney disease reached the last stage of kidney failure, he has
only TWO major options:
I.
Dialysis
either hemodialysis (HD) or peritoneal dialysis (PD), or,
II.
Kidney
transplantation.
However,
certain causes of renal failure would be transient or reversible (ARF, or acute
renal failure), in such a case, patients may be on dialysis for few days or
weeks until his kidney could be recovered. Some cases, however, can be
recovered after more than one year e.g. scleroderma renal disease.
On the other hand, if the kidney became very small on size or rudimentary, non-functioning, patient now is obliged to commence on dialysis, unless there is available kidney from a cadaver or some related body will offer him a kidney.
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