Hemodialysis Unit

HEMODIALYSIS
ROCHI P. BENITO, RN MSN
Junior Assistant Manager
MANILA DOCTORS HOSPITAL

DESCRIPTIONS:
 Hemodialysis is the diffusion of
dissolved particles from one fluid
compartment into another across a
semipermeable membrane.
 The client’s blood flows through one
fluid compartment, and the dialysate
is in another fluid compartment

FUNCTIONS OF
HEMODIALYSIS:
 Cleanses the blood of accumulated waste
products
 Removes the by-products of protein
metabolism such as urea, creatinine, and
uric acid.
 Removes excessive fluids
 Maintains or restores the buffer system of
the body
 Maintains or restores electrolyte levels

PRINCIPLES OF
HEMODIALYSIS:
 Diffusion is the movement of particles
from an area of greater concentration to one
of lesser concentration
 Osmosis is the movement of fluids across a
semipermeable membrane from an area of
lesser concentration of particles to an area of
greater concentration of particles
 Ultrafiltration is the movement of fluid
across a semipermeable membrane as a
result of an artificially created pressure
gradient

DIALYSATE BATH:
 A dialysate bath is composed of water and
major electrolytes
 The dialysate need not be sterile because
bacteria are too large to pass through;
however, the dialysate must meet specific
standards, and water treatment systems
are used to ensure a safe water supply

NOSOCOMIAL INFECTION
ASSOCIATED WITH HEMODIALYSIS:
 Dialysis patient have a compromised immune
system and other disorder that place them at
risk for infectious diseases

 A typical hemodialysis system
consist of a water supply
 A system for mixing water and
concentrated dialysis fluid
 A machine to pump the dialysis
fluid through the artificial kidney
 Which we refer to as hemodialyser
or dialyser
Bacterial and chemical contaminant
in hemodialysis system

 The dialyser is connected to the patient
circulatory system, and the blood pump
through it to accomplished dialysis by
means of a membrane to removed
waste product from the patients blood
Bacterial and chemical contaminant
in hemodialysis system

BACTERIAL CONTAMINATION
OF WATER
 There are many situations where
certain types of gram negative bacteria
can persist and actively multiply in
aqueious environment associated with
hemodialysis equipment
 This may affect patient by septicemia or
endotoxemia.

 E.g. water borne bacteria
 Acinetobacter
 Aeromonas
 Serratia
 xanthomonas
OF WATER

WATER SUPPLY
1. Water treatment system – water used
for the production of dialysis fluid must
be treated to remove chemical and
microbial contaminants
e.g. reverse osmosis and water
softener

2. Distribution system - water that has
passed through the water system , may
be distributed to individual dialysis
machine where it is combined with
dialysate concentrate
 Routine disinfection of water or dialysate
should be performed at least weekly
 An ultrfilter distal to the storage tank is
recommended
WATER SUPPLY

3. Hemodialysis machine – to ensure
adequate disinfection of the machine .
The disinfectant must reach all parts of
the system’s fluid pathways
OF WATER

Disinfection of the
hemodialysis system
The total dialysis system (water treatment
system, distribution system, dialysis
machine) should be included in the
disinfection procedure.
 Chlorine-based disinfectant, such as
sodium hypochloride solution, are
convenient and effective in most parts of
the dialysis system

 Aqueious formaldehyde, peroxyacetic acid
or glutaraldehyde solution produces good
disinfection results.
OF WATER

Monitoring of water and
dialysis fluid
Water samples should be collected from a
source as close as to where water
enters the dialysate concentrate –
proportioning unit
 Water samples should be collected at least
monthly
 Dialysis fluid samples should be collected
during or at the termination of dialysis
from a sourece close to where the dialysis
fluid enters or leaves the dialyser.

Hemodialyser reuse
 Dialyser can be reuse if performed
according to strict and established
protocol.
 Reprocess hemodialysers constitute
high level rather than sterilization
 Peracetic acid and glutaraldehyde are
effective
 Also formaldehyde – need to exposed up
to 36 hours

Other Bacterial Infection
 Vascular access infection

INTERNAL AV FISTULA (Inside View)

INTERNAL AV GRAFT (Inside view)

The following precaution
should be used during care of
all dialysis patient

 Patient should have a specific station
assigned to them, like chairs and tables
should be clean after use
 Sharing of ancillary supply, like BP cuff,
scissors, thermometer, trays should be
avoided
 Non disposable items should be clean or
approximately disinfected between use
 Medications should be prepared and
distributed from centralized area.

 Clean and contaminated area should be
separated
 Separate handwashing area
 Disposal of blood and waste should be
separated
 pantry room should always be closed

 Non-disposable equipment should be
cleaned and disinfected or sterilized.
 Wear disposable gloves when touching
the patient.
 Also, wear mask, face shield or eye
wear during cleaning of the dialyser
 Special care should be taken to prevent
needle sticks injury. NEVER RECAP

 Staff Nurse should not smoke, eat or
drink in the dialysis treatment area
 The patient’s dialysis record should
include all mishaps, demographic data,
laboratory results, and all incidences,
like needle sticks injury.
 Also include the machine use
 And prophylactic measures

Prevention of Infection at
Hemodialysis
 Patient with infection shall be treated in
a separate room and uses a machine
designated only for patien with such
case
 Dialyser of the patient with hepatitis
shall be discarded after use

Hemodialysis
 Nurses caring for such patient should
adhere to standard precaution
 Proper disposal of waste and other
consumable shall be followed
 New patient shall undergo hepatitis
screening and other blood test

Hemodialysis
 All patient who have non-reactive anti-
Hbs result should received 3 doses of
hepatitis vaccine
 All regular patient should have their
hepatitis profile every 6 months
 Terminal cleaning of room should be
done

Hemodialysis
 Patient with HIV/AIDS shall be reported
to HACT for counselling

Hemodialysis Unit

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Hemodialysis Unit