HEMODIALYSIS MACHINE, DIALYSATE CHEMISTRY, & DIALYSIS WATER TREATMENT

Engr. APOLLO M. ARQUIZA

TOPIC OUTLINE
WHAT IS HEMODIALYSIS MACHINE? WHAT ARE THE BASIC FUNCTIONS? BASIC PARTS DEFINITION & HOW IT FUNCTIONS? WHAT ARE THE TWO TYPES OF DELIVERY SYSTEM? WHAT IS AN EXTRACORPOREAL CIRCUITS?

DEFINITION
HEMODIALYSIS
IS A PROCESS OF REMOVING TOXIN FROM THE BLOOD THRU DIFFUSSION, OSMOSIS, & ULTRAFILTRATION.

DIALYZER
IT IS A SEMIPERMEABLE MEMBRANE- describes a membrane or tissue that

allows some types of particles to pass through, but not others.

IS A DEVICE USED IN DIALYSIS TO SEPARATE TOXIN AND WATER FROM THE BLOOD. IT HAS TWO COMPARTMENT TO SEPARATE BLOOD AND DIALYSATE CALLED BLOOD AND DIALYSATE COMPARTMENT

HEMODIALYSIS MACHINES
IT IS A SOPHISTACED ELECTRONICS DEVICE THAT IS USED IN CONJUCTION WITH A DIALYZER TO PERFORM HEMODIALYSIS PROCEDURE

Diffusion is the natural tendency of molecules to flow from higher concentrations to lower concentrations.

Osmosis the flow of one constituent of a solution through a membrane while the other constituents are blocked and unable to pass through the membrane

Bypass vs Isolate
Normal Dialysis Dialysate Bypass Dialysate Isolate

ARTERIAL

ARTERIAL

ARTERIAL

DIALYSATE Toxin removal + UF

UF ONLY NO Toxin removal

NO UF NO Toxin removal

VENOUS

DIALYSATE INFLOW

VENOUS

VENOUS

6-9

BASIC FUNCTIONS OF HEMODIALYSIS MACHINE

HEMODIALYSIS MACHINE MIXED ELECTROLYTE BALANCE BATH CALLED DIALYSATE BATH THE MACHINE PUMP BLOOD FROM THE PATIENT TO THE DIALYZER AND BACK TO THE PATIENT BODY AT A PRESCRIBED RATE

PERFORMS ACCURATE ULTRAFILTRATION RATE

MONITOR AND GUARD IMPORTANT PARAMETERS TO ASSURE PATIENTS SAFETY.

PARTS OF HEMODIALYSIS MACHINES

I.V. POLE SIGNAL / STATUS LAMP MONITOR AND CONTROL PANEL HEPARIN INFUSION PUMP BLOOD PUMP BLOOD PUMP MANUAL HANDLE BLOODLEAK DETECTOR VENOUS PRESSURE PORT ARTERIAL PRESSURE PORT AIR BUBBLE LEVEL DETECTOR & LINE CLAMP DIALYSATE BYPASS CONNECTOR DILYSATE SUPPLY COUPLER (BLUE) DIALYSATE RETURN COUPLER (RED) CONCENTRATE SUCTION PORT (ACID) BICABONATE SUCTION PORT (BICARB)

PARTS OF HEMODIALYSIS MACHINES

ACID & BICARB RINSE PORT DIALYZER HOLDER DISINFECTANT PORT WATER SUPPLY HOSE DRAIN HOSE HYDRAULIC PART CAGE ELECTRONIC PART CAGE MAIN POWER SWITCH

Leak Detector
Effluent From Dialyzer

To Heat Xchanger
Lamp

Photoresistor

2 TYPES OF DELIVERY SYSTEM

TWO STREAM PROPORTIONING RATIO

TYPES OF DELIVERY SYSTEM

THREE STREAM PROPORTIONING RATIO

THE EXTRACORPOREAL CIRCUIT

The area involve in the extracorporeal circuit are the patient blood access, bloodlines, blood pump, arterial pressure, heparin infusion pump, dialyzer blood compartment, venous pressure, blood detector, tube detector, air bubble detector, & tube clamp

THE EXTRACORPOREAL CIRCUIT

It is a circular path of blood situated or happening outside the body with the flow route from the patient then back to the patient

WHAT IS DIALYSATE TYPES OF DIALYSATE CONSTITUENTS COMPARISON Dialysate composition Proportioning ratio Estimating conductivity

AN ELECTROLYTE-BALANCED SOLUTION THAT BATHES AROUND THE DIALYZER FIBERS CARRIES AWAY TOXINS AND FLUID REMOVED FROM THE BLOOD ELECTROLYTE LEVELS MAY DIFFER FROM BLOOD LEVELS CAUSING ADJUSTMENT OF THESE ELECTROLYTES IN THE PATIENT PREVENTS THE REMOVAL OF ESSENTIAL ELECTROLYTE PRESSURE ARE APPLIED IN THE DIALYSATE COMPARTMENT CAUSING REMOVAL OF FLUID

2 TYPES OF BATH
ACETATE BATH
IS A BUFFER USED FOR ACID/BASE CORRECTION IN DIALYSIS PATIENTS RARELY USED ANYMORE IT IS PROPORTIONED WITH 1 PART ACETATE AND 34 PARTS TREATED WATER

BICARBONATE BATH
TWO SEPARATE CONCENTRATES ARE USED A ACIDIFIED CONTAINS MOST OF THE NA, CA, MG, K, & CL B BICARBONATE - IT CONTAINS SODIUM (NA) AND BICARBONATE (HCO3) MORE COMPLEX DELIVERY SYSTEM (PROPORTIONING)

ADVANTAGES OF ACETATE
CHEMICALLY STABLE

NOT PRONE TO BACTERIA CONTAMINATION

WIDE VARIETY OF FORMULAS AVAILABLE

DELIVERY ARE MORE SIMPLER AND LESS COSTLY THAN BICARBONATE

DISADVANTAGES OF ACETATE
ACETATE MUST BE CONVERTED TO BICARBONATE BY THE BODY BEFORE IT CAN BE USED PATIENTS BICARBONATE LEVEL USUALLY DECREASES AS BICARBONATE DIFFUSES ACROSS THE MEMBRANE CARBON DIOXIDE LEVEL DECREASES AS IT ALSO DIFFUSES ACROSS THE MEMBRANE, AND ALSO DURING THE REACTION TO PRODUCE MORE BICARBONATE PATIENTS OXYGEN LEVEL DECREASES DUE TO LOWER RESPIRATOTRY RATE BECAUSE OF DECREASED CARBON DIOXIDE LEVELS PATIENTS TOLERANCE TO FLUID REMOVAL IS REDUCED

ADVANTAGES OF BICARBONATE
DOCTORS CHOICE OF TREATMENT LESS PATIENT COMPLICATIONS PATIENTS TOLERANCE TO FLUID REMOVAL IS INCREASED PREVENT BICARB DIFFUSSION ACROSS THE MEMBRANE DO NOT DECREASE PATIENTS OXYGEN LEVEL

DISADVANTAGES OF BICARBONATE
SUCEPTIBLE TO BACTERIAL CONTAMINATION LIQUID BICARB IS NOT STABLE AFTER 24 HOURS CAREFUL MIXING PROCESS OF POWDER BICARB SO AS NOT TO LOOSE CO2 FROM THE SOLUTION

MANY FORMULATION OF ACIDIFIED SO EXTREME CARE MUST BE USED TO ENSURE THAT THE CORRECT PROPORTIONING SYSTEM IS USED

SODIUM POTASSIUM CALCIUM MAGNESIUM BICARBONATE GLUCOSE/DEXTROSE

 OCCASIONALY, A DOCTOR MAY REQUIRED TO ADD CERTAIN ELECTROLYTE TO THE CONCENTRATES TO RAISE THE LEVEL OF A PARTICULAR ION USUALLY K, Ca, or Mg CARE MUST BE USED TO PUT THE ADDITIVES IN THE CORRECT CONCENTRATE SO AS NOT TO CAUSE PRECIPITATION

 1:34:1.83 OR 36.83X 1:32.775:1.225 OR 35X 1:42.28:1.72 OR 45X

CONDUCTIVITY MEASUREMENTS

the ability of a substance to transmit electricity A simple test to assure correct proportioning

ESTIMATING FINAL CONDUCTIVITY

ADD NA=140,CA=3.5,K=2,MG=1 (140+3.5+2+1=146.5) SUBTRACT 6 FROM THE SUM (146.5-6 =140.5) DIVIDE THE DIFFERENCE BY 10 (140.5/10=14.05) QUOTIENT IS THE ESTIMATED COND. (14.05 mS/cm)

WATER FOR DIALYSIS

WATER DEFINITION
WATER IS CALLED THE UNIVERSAL SOLVENT- IN ITS PURE STATE, IT HAS A VERY HIGH ENERGY WHICH HAS THE CAPABILITY TO DISSOLVE THE QUANTITY OF MATERIAL UNTIL THE SOLUTION REACHES THE POINT OF SATURATION. WATER - IS VERY ESSENTIAL FOR ALL LIFE. WATER IN DIALYSIS, IT IS ONE MAJOR COMPONENT TO PERFORM THE PROCEDURE.

THE HEART AND BLOOD OF DIALYSIS, NO WATER NO DIALYSIS CAN BE PERFORMED.

WATER EVAPORATES IN THE ATMOSPHERE FROM THE SURFACE SUPPLIES. THE EVAPORATED WATER THEN CONDENSES IN THE COOLER AIR AND RETURNS TO EARTHS SURFACE AS RAIN,SNOW, OR OTHER PRECIPITATION. IT DISSOLVES GASSES SUCH AS CARBON DIOXIDE, OXYGEN,, AND NATURAL AND INDUSTRIAL EMISSIONS SUCH AS NITRIC AND SULFURIC OXIDES, AS WELL AS CARBON MONOXIDES. AS THE PRECIPITATION NEARS THE GROUND IT CONTINOUS TO PICK UP MANY ADDITIONAL CONTAMINANTS SUCH AS AIRBORNE PARTICULATES, SPORES, BACTERIA, AND EMISSIONS FROM OTHER COUNTLESS SOURCES.

Water Exposure
NORMAL PERSON EXPOSURE
14 L PER WEEK

HEMODIALYSIS PATIENTS
360 L PER WEEK NON-SELECTIVE ACROSS THIN DIALYSIS MEMBRANE NO RENAL EXCRETION

MECHANISM

SELECTIVE ACROSS GI TRACT EXCRETED BY KIDNEYS

ELIMINATION

MEDICAL AND EQUIPMENT CONCERN

TO PREVENT HARM TO THE PATIENT
1. TO ELIMINATE BLOOD HEMOLYSIS 2. TO ELIMINATE POTENTIAL PYROGENIC REACTIONS. 3. TO ELIMINATE OTHER SIDE EFFECTS CAUSE BY WATER CONTAMINATION.

PREVENTING DAMAGE TO DIALYSIS EQUIPMENT

HARD WATER CAN CAUSE PRECIPITATES OR SCALE WHICH CAN CLOGGED UP DIALYSIS MACHINES COMPONENTS.

WHAT IS WATER TREATMENT WHAT SOURCE DO I HAVE ? HOW MUCH VOLUME DO I NEED ? WHAT QUALITY OF WATER I WANT TO HAVE ? WHAT EQUIPMENT DO I NEED ? WHAT MATERIALS DO I NEED ? HOW I WILL SET IT UP ? HOW CAN I MAINTAIN THE QUALITY OF WATER ?

 Any procedure or method used to alter the chemical composition of a water supply. Water purity used in hemodialysis should satisfy specific needs and standards to prevent toxicity either in the acute or chronic conditons

GROUNDWATER

IT IS THE RAIN WATER THAT PERCOLATES DOWN THROUGH THE POROUS UPPER CRUST OF THE EARTH. IT IS FILTERED BY THAT PROCESS. IT DISSOLVES MANY GEOLOGIC MINERAL FORMATIONS SUCH AS CALCIUM, MAGNESIUM, IRON SULFATES AND CHLORIDES. THIS MINERAL-BEARING WATER IS STORED IN A NATURAL UNDERGROUND FORMATIONS CALLED AQUIFERS. THESE ARE THE SOURCE OF WELL WATER.

SURFACE WATER IT IS THE

RAIN WATER THAT GOES DOWN TO THE OCEANS, LAKES RIVERS, AND MAN-MADE RESERVOIRS. IT CONTAINS LESS MINERAL CONTAMINATION BUT IT HOLDS A HIGHER LEVELS OF ORGANICS AND UNDISSOLVE PARTICLES.

1. MICROORGANISM & BACTERIA CONTAMINATION 2. ENDOTOXINS CONTAMINATION 3. SUSPENDED SOLIDS 4. DISSOLVE ORGANICS COMPOUNDS 5. SPECIFIC IONIC CONTAMINANTS

 QUALITATIVE IDENTIFICATION IS USED TO DESCRIBE THE VISIBLE OR AESTHETIC CHARACTERISTIC OF WATER.

TURBIDITY TASTE COLOR ODOR

QUANTITATIVE IDENTIFICATION IS A MORE DEFINE WAY IN IDENTIFYING WATER IMPURITIES.

pH TOTAL DISSOLVE SOLIDS (TDS) CONDUCTIVITY STANDARD PLATE COUNT (SPC) MOST PROBABLE NUMBER (MPN) DIRECT COUNT LIMULUS AMOEBOCYTE LYSATE (LAL) CHEMICAL/PHYSICAL TEST

 IT IS USED TO ASSURE SUFFICIENT SUPPLIES OF WATER.

IT ALSO SERVES AS A PROTECTION TO THE PUMPS AND REVERSE OSMOSIS.

 IT IS USED TO PROVIDE NECESSARY FLOW AND PRESSURE REQUIRED BY THE PRE TREATMENT EQUIPMENT AND REVERSE OSMOSIS

 IT IS USED TO REMOVE PARTICULATES MATTER FROM THE SOURCE WATER. IT IS LOCATED AFTER THE BOOSTER PUMP IT IS THE FIRST PRE TREATMENT EQUIPMENT IN DWTS

IT IS USED TO REMOVE CHLORINE, CHLORAMINE AND DISSOLVED ORGANIC COMPOUNDS FROM WATER THRU ADSORPTION. IT ALSO IMPROVES THE TASTE AND ODOR OF THE WATER IT IS LOCATED AFTER THE MULTI MEDIA & BEFORE OR AFTER THE WATER SOFTENER IT CONTAINS GRANULAR ACTIVATED CARBON

IT IS USED TO REMOVE CALCIUM AND MAGNESIUM (CAUSES OF WATER HARDNESS) THRU ION EXCHANE FROM THE SOURCE WATER . THRU ION EXCHANE IT IS LOCATED EITHER BEFORE OR AFTER THE CARBON IT CONTAINS INDUSTRIAL GRADE ION EXCHANGE RESIN

 IT IS USED TO REMOVE CARBON FINES AND OTHER PARTICULATES MATTER BIGGER THAN 5 MICRON IN SIZE BEFORE ENTERING THE REVERSE OSMOSIS. NORMALLY, IT IS INSTALLED IN THE REVERSE OSMOSIS.

AAMI recommendations for Ultraviolet Disinfection

The low pressure mercury lamp should emit a light wave-length of 254 nm and provide a dose of radiant energy of 30 milliwatt-sec/cm2 for the destruction of bacteria. The UV should be equipped for the anticipated maximum flow rate and have a monitor for on-line radiant energy output that activates an audible and visual alarm indicating the need for lamp replacement. It is recommended that UV be followed by ultrafiltration (UF) as the destruction of bacteria may increase endotoxin levels.

Ultrafiltration
Ultrafiltration It reject contaminants in the range of 1000 Da ton 0.1 particles such as organics, bacteria, pyrogens - due to large pore size, UF needs low operating pressures Microfiltration : absolute filters (0.1 - 2)

IT IS USED TO PROVIDE NECESSARY FLOW AND PRESSURE REQUIRED BY THE DIALYSIS MACHINES AND ANCILLARY EQUIPMENT

It circulates the water to all the plumbing loop back to the storage tank to prevent water stagnant water

1. DIRECT FEED

2. RECIRCULATION WITH STORAGE TANK

3. CONTINUOS FLOW SYSTEM

CLOSING THOUGTHS