Anda di halaman 1dari 7

Kidney Machine

The kidneys have important roles in maintaining health. When healthy, the kidneys
maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride,
calcium, phosphorus, magnesium, sulfates). Those acidic metabolism end products that the body
cannot get rid of via respiration are also excreted through the kidneys. i.e., the kidneys remove
toxins from our blood and maintain its correct pH, fluid and electrolytes levels.
If kidneys don't work properly, harmful substances build up in the body, blood pressure
can rise, and too much fluid can collect in the body's tissues, which leads to swelling, called
edema. When kidneys fail to work properly, a kidney transplant is the best option. However, for
patients who are not transplant candidates, or for patients waiting for a donor kidney, or for the
patients suffering from acute disturbance in kidney function (acute kidney injury, previously
acute renal failure), doctors can use the process of dialysis to perform the functions normally
performed by the kidneys.
Types of Dialysis
There are three primary and two secondary types of dialysis: hemodialysis (primary),
peritoneal dialysis (primary), hemofiltration (primary), hemodiafiltration (secondary), and
intestinal dialysis (secondary).
Among them hemodialysis and peritoneal dialysis, are the two main types of dialysis
techniques that remove wastes and excess water from the blood in different ways.
Hemodialysis Machine
Dialysis also called hemodialysis, is the most common treatment for kidney failure. A
dialysis machine is an artificial kidney designed to remove impurities from your blood. During
dialysis, physicians use the dialysis access to remove a portion of your blood to circulate it
through the dialysis machine so it can remove impurities and regulate fluid and chemical
balances. The purified blood is then returned to you, again through the dialysis access.
Creating the dialysis access (access portal) is a minor surgical procedure. There are two
types of portals placed completely under the skin:
1. Fistula: Vascular surgeon constructs by joining an artery to a vein. It is usually placed in the
nondominant arm. Normally, blood is pumped under high pressure through arteries away from
the heart. Blood returns under low pressure through veins back to the heart. An AV fistula is like
a shortcut, creating very high blood flow through the vein. Over weeks the vein dilates and the
wall of the vein thickens. This process is called maturation.
An AV fistula takes longer to be ready for dialysis but will achieve higher flow rates, will have a
lower rate of infection and a lower rate of failure. Patients with an AV fistula also have an
improved chance of survival compared to other methods of hemodialysis access.
In the weeks after surgery, the fistula begins to mature. The vein increases in size and may look
like a cord under your skin. The whole process of maturation, which is a beneficial feature that
permits the blood flow to increase in the fistula, typically takes 3 to 6 months. Some fistulas may
take as long as a year or more to develop fully, but this is unusual. Once matured, a fistula should
be large and strong enough for dialysis technicians and nurses to insert the large dialysis needles
easily. If it fails to mature in a reasonable period of time, however, you may need another fistula.

2. Graft: is a man-made tube, consisting of a plastic or other material, that your vascular
surgeon inserts under the skin to connect an artery to a vein. It is similar to an AV fistula, except
an artificial graft (a tube made out of Teflon) is used to connect an artery to a vein. The graft is
tunneled underneath the skin, so nothing sticks out of the patient.

An AV graft can be used approximately three weeks after it's inserted. As with an AV
fistula, hemodialysis access is achieved by way of two inserted needles. One needle drains blood
out of the patient and into the dialysis machine so the blood can be filtered. The second needle
returns the filtered blood back to the patient.
For both fistulas and grafts, the connection between your artery and vein increases blood
flow through the vein. In response, your vein stretches and becomes strengthened. This allows an
even greater amount of blood to pass through the vein and allows your dialysis to proceed
efficiently. In the weeks after surgery, the fistula begins to mature. The vein increases in size and
may look like a cord under your skin. The whole process of maturation, which is a beneficial
feature that permits the blood flow to increase in the fistula, typically takes 3 to 6 months. Some
fistulas may take as long as a year or more to develop fully, but this is unusual. Once matured, a
fistula should be large and strong enough for dialysis technicians and nurses to insert the large
dialysis needles easily. If it fails to mature in a reasonable period of time, however, you may
need another fistula.A graft placed between an artery and vein can usually be used for dialysis
within 2-6 weeks, when it is healed sufficiently.
Usually fistulas are preferred to grafts, however, because fistulas are constructed using
your own tissue, which is more durable and resistant to infection than are grafts. However, if
your vein is blocked or too small to use, the graft provides a good alternative.
Working

Dialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid
across a semi-permeable membrane. The patient's blood is pumped through the blood
compartment of a dialyzer, exposing it to a partially permeable membrane. The dialyzer is
composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semipermeable
membrane. A semipermeable membrane is a thin layer of material that contains various sized
holes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks
the passage of larger substances (for example, red blood cells, large proteins).
Diffusion describes a property of substances in water. Substances in water tend to move
from an area where they are in a high concentration to an area of low concentration. Blood flows
by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by
the opposite side.
Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer
membrane. This usually is done by applying a negative pressure to the dialysate compartment of
the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to
dialysate, and allows the removal of several litres of excess fluid during a typical 3 to 5 hour
treatment. The cleansed blood is then returned via the circuit back to the body.

Peritoneal dialysis (PD)


Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease.
The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and
dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are
exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and
flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via
regular exchanges throughout the day (continuous ambulatory peritoneal dialysis). PD is used as
an alternative to hemodialysis though it is far less commonly used in many countries. It has
comparable risks but is significantly less costly in most parts of the world, with the primary
advantage being the ability to undertake treatment without visiting a medical facility. The
primary complication of PD is infection due to the presence of a permanent tube in the abdomen.
Method
Dialysis process

Hookup

Infusion

Diffusion (fresh)

Diffusion (waste)

Drainage
The abdomen is cleaned in preparation for surgery, and a catheter is surgically inserted
with one end in the abdomen and the other protruding from the skin.

Before each infusion the
area must cleaned. The dwell remains in the abdomen and waste products diffuse across the
peritoneum from the underlying blood vessels. After a variable period of time depending on the
treatment (usually 46 hours), the fluid is removed and replaced with fresh fluid. This can occur
automatically while the patient is sleeping (automated peritoneal dialysis, APD), or during the
day by keeping two liters of fluid in the abdomen at all times, exchanging the fluids four to six
times per day.
The fluid used typically contains sodium, chloride, lactate or bicarbonate and a high
percentage of glucose to ensure hyperosmolarity. The fluid used for dialysis uses glucose as a
primary osmotic agent. The amount of dialysis that occurs depends on the volume of the dwell,
the regularity of the exchange and the concentration of the fluid. The high concentration of
glucose drives the exchange of fluid from the blood with glucose from the peritoneum. The
solute flows from the peritoneal cavity to the organs, and thence into the lymphatic system.

Anda mungkin juga menyukai