University of Southeastern Philippines

COLLEGE OF ENGINEERING
Iigo Street, Bo. Obrero, Davao City

DIALYSIS

Submitted by:
Hisoler, Bernie A.
Ruferos, Jason B.
ECE

Submitted to:
Engr. Joey Dela Cruz
Instructor
September 14, 2016

What is dialysis?
Dialysis is a process for removing waste and excess water from the blood and is used
primarily as an artificial replacement for lost kidney function in people with kidney failure.
Kidney
bean-shaped organs that serve several essential regulatory roles in vertebrates.

Their main function is to regulate the balance of electrolytes in the blood, along with
maintaining pH homeostasis. They also remove excess organic molecules from
the blood, and it is by this action that their best-known function is performed: the removal
of waste products of metabolism.

What does dialysis do?

removing waste, salt and extra water to prevent them from building up in the body

keeping a safe level of certain chemicals in your blood, such as potassium, sodium and
bicarbonate
helping to control blood pressure

Main Types of Dialysis

Hemodialysis

Peritoneal dialysis

Hemodialysis
Commonly called kidney dialysis or simply dialysis, is a process of purifying the blood of
a person whose kidneys are not working normally. This type of dialysis achieves the
extracorporeal removal of waste products such as creatinine and urea and free water
from the blood when the kidneys are in a state of renal failure. Hemodialysis is one of
three renal replacement therapies

Dialysate Circuit
In clinical settings, dialysate is usually premixed to the proper concentration for direct
use. In home units, to keep container size down, concentrated forms of dialysate are
often used and diluted with sterilized water in the machine. Thus, home units must
include water heaters, valves, pumps, and a variety of sensors to perform these extra
steps. To lower power consumption in home units, the dialysate preparation process is
often performed ahead of time, separately from dialysis.
Both types of machines include capabilities to add a bicarbonate buffer solution to the
dialysate. This subcircuit comprises additional pumps, valves, and sensors.

Disinfection Circuit
After the dialysis procedure, the machine must be cleansed and sterilized. Provisions
are made in the plumbing to close the circuit into a loop and run saline and/or sterilized
water through the system to flush away all impurities.
Special Requirements of Home Units
For general convenience, home systems are smaller and sometimes portable. Since
they require the additional function of dialysate preparation, the need for small, compact
design is increased over clinical machines.
Low power draw is also important in home dialysis units. Earlier systems often required
home rewiring to allow more than the typical 15A capability of a 110V AC branch circuit.
Today, low-power design can eliminate the need for these costly modifications.
The disinfection cycle at the end of therapy is also a power-hungry process. To
accomplish the heating required in a reasonable amount of time, batteries or
ultracapacitors are included to provide short-term high-power capability to supplement
line power as needed. When line-power usage drops below the 15A limit, the batteries or
ultracapacitors are recharged.
Mechanism
Pumps - Peristaltic pumps are commonly used for driving the various higher volume
fluids in the machine: blood, dialysate, water, and saline.
Valves - Several valves with electronic actuation are needed in the machine to allow
variable mixing ratios.

Sensors - Blood pressure at various points in the extracorporeal circuit, dialysate

pressure, temperature, O2 saturation, motor speed, dialyzer membrane pressure
gradient, and air are all monitored for proper values during dialysis.
Cleaning System - Between patient sessions, any reused components must be
sterilized. One approach is to heat water or saline to a high sterilizing temperature and
then run it through the machine, both through the extracorporeal circuit and through the
dialysate circuit. Whatever cleaning mode is used, the machine may require additional
driving and monitoring for proper operation.

Processing
Microcontrollers - Because of the large number of input signals to be monitored and the
large number of pumps and other mechanisms to be controlled, many of these functions
are performed with dedicated microcontrollers for that portion of the system.

Fail-safe Circuitry - ICs with self-test and fault-reporting capabilities are very useful for
maintaining patient safety under single-fault conditions. Additional monitoring circuitry is
commonly used to monitor power-supply voltages, while watchdog circuits are used to
ensure that microprocessor operation remains within bounds. Both audible and visible
alarms are provided to alert users when a warning is needed or a fault condition has
occurred.

Power Supply
Due to the long duration of the dialysis process, all dialysis equipment is AC-line
powered. Standard AC-DC converters meeting medical safety standards are employed.

Due to the variety of components requiring power, a variety of voltage rails are needed
at different power levels. A power system with multiple-output switching regulators is
needed with a significant amount of linear regulation at the load for noise-sensitive
precision circuits.
Battery Management
home-use dialysis machines need to include batteries (or ultracapacitors) to supplement
the power supply's output power when heating water for sterilization. These must be
charged whenever possible and fuel gauged to indicate when enough capacity is
available to proceed with the water sterilization process.
Hemodialysis Process
Most people need three sessions of haemodialysis a week, with each session lasting
around four hours. This can be done in hospital, or at home if you've been trained to do it
yourself.
Two thin needles will be inserted into your AV fistula or graft and taped into place. One
needle will slowly remove blood and transfer it to a machine called a dialyser or dialysis
machine.
The dialysis machine is made up of a series of membranes that act as filters and a
special liquid called dialysate.
The membranes filter waste products from your blood, which are passed into the
dialysate fluid. The used dialysate fluid is pumped out of the dialyser and the filtered
blood is passed back into your body through the second needle.
During your dialysis sessions, you will sit or lie on a couch, recliner or bed. You will be
able to read, listen to music, use your mobile phone or sleep.
Haemodialysis isn't painful, but some people feel a bit sick and dizzy, and may have
muscle cramps during the procedure. This is caused by the rapid changes in blood fluid
levels that occur during the treatment.
After the dialysis session, the needles are removed and a plaster is applied to prevent
bleeding. If you were treated in hospital, you can usually go home shortly afterwards.
How long do hemodialysis treatments last?
how well your kidneys work

how much fluid weight you gain between treatments

how much waste you have in your body
how big you are
the type of artificial kidney used
Usually, each hemodialysis treatment lasts about four hours and is done three times per

week.
A type of hemodialysis called high-flux dialysis may take less time. You can speak to
your doctor to see if this is an appropriate treatment for you.
Laboratory Monitoring
Your blood will be monitored regularly as a dialysis patient. Blood is drawn during your
treatment from the tubing that connects your access to the machine. The results of your
lab work will tell how well you are being dialyzed and guide your nephrologist in
adjusting your treatment parameters, diet, and medications.

Fluid and diet restrictions

If you're having haemodialysis, the amount of fluid you can drink will be severely
restricted.
This is because the dialysis machine won't be able to remove two to three days' worth of
excess fluid from your blood in four hours if you drink too much. This can lead to serious
problems where excess fluid builds up in your blood, tissues and lungs.
The amount of fluid you're allowed to drink will depend on your size and weight. Most
people are only allowed to drink 1,000-1,500ml (two to three pints) of fluid a day.
You'll also need to be careful what you eat while having haemodialysis because minerals
such as sodium (salt), potassium and phosphorus that would normally be filtered out by
your kidneys can build up to dangerous levels quickly between treatment sessions.
You'll be referred to a dietitian so a suitable diet plan can be drawn up for you. Diet plans
differ from person to person, but it's likely you'll be asked to avoid eating foods high in
potassium and phosphorus and to cut down the amount of salt you eat.
Hemodialysis Machine Price
A new machine can cost anywhere from $10,000 to $15,000. You can find used
equipment priced at $7,000 and below.
Most dialysis supplies cost between $10 to $35 for items such as bandages, antiseptic,
tubing and other products.
Maintenance
Verify that no dialysate spills or leaks are visible in the hydraulics or on the bottom of the
cabinet. Clean and dry any spills found and correct the source.
Verify that all cables are properly routed to prevent pinching or chaffing.
Verify that all covers are replaced and that all cover screws and mounting hardware has
been replaced.
Different brands
Nxstages System One
System One is a portable hemodialysis system designed for home use. Home
hemodialysis with System One is a more convenient way of receiving hemodialysis. Instead of
going to a dialysis center three times a week for treatments, home hemodialysis offers the
convenience of treatments in the comfort of your own home.
Nxstages System One
SIMPLE
Has a simple user interface that is easy to understand and use
A standard electrical outlet and a faucet or undersink connection are all
that are required to operate the System One
Easy-to-use drop-in cartridge allows for easy wipe-down after each use

Flexible

System One is the first and only device cleared for home nocturnal
hemodialysis that allows you to reclaim your life by treating during the day
or while you sleep
Option to use bagged dialysate or the PureFlow SL system that prepares
dialysate from drinking-quality tap water

DIAMAX
Touchscreen and mobile
This dialysis machine is designed to give the best treatment possible. With a large touch
display and a single needle system it is easy to use. UF and conductivity profile with a
hot rinse at 83 degrees centigrade. With a multilingual system and maintenance friendly.
Peritoneal dialysis

Automated peritoneal dialysis (APD) how the machine works

Rather than performing manual peritoneal dialysis exchanges several times throughout the day, a
patient can do automated peritoneal dialysis while they sleep. Automated peritoneal dialysis is
done using a machine that fills your peritoneal cavity with fresh dialysis solution, also called PD
fluid or PD solution, and after a specified dwell time, drains the solution with waste out of your
body and then fills your peritoneal cavity with new dialysis solution. The average treatment time
for automated peritoneal dialysis is 9 hours at night while you sleep, but your doctor will
prescribe what is best for you.
APD equipment and supplies
Aside from the APD machine, there is required equipment and supplies that help you perform
peritoneal dialysis treatments:

Mask You are required to wear a mask when you set up the APD machine and when
you connect and disconnect from the dialysis machine. The mask should be over your
mouth and nose. Wash your hands after you put your mask on so you do not contaminate
your tube connections. Always wearing your mask correctly and washing your hands are
important for success. This will limit the opportunities for bacteria to enter your body.
Large bags of PD fluid (PD solution) Each PD fluid bag is filled with about 6 liters of
PD fluid. Two or three bags are generally used through the night. The PD fluid bags are
hooked up to a cassette in front of the cycler machine, which has a tube that is connected
to the persons peritoneal catheter. The catheter leads into the abdomen (peritoneal
cavity), and during each exchange some of the fluid will flow from the bags into the
abdomen and then later be drained out of the body. The PD solution dwells inside the
peritoneal cavity, collecting the wastes and extra fluid from the body which is then
drained out after each cycle is completed.
Drain bag The drain bag is one of two options used to remove the PD fluid from the
peritoneal cavity. The drain bag is attached to a cassette that warms the fluid, sending it
through tubes connected to the cassette into a persons peritoneal cavity. The bag is clear
so that the person may examine the waste and fluid that has been drained from the body.
The used PD fluid should be clear, like urine. If it is cloudy, that can be an early sign of
infection. Peritoneal dialysis patients who see this are recommended to call their PD
nurse so they can receive treatment right away.

Drain line The second option for draining PD solution is a drain line. The drain line
can be from 12 to 24 feet long in order to reach the bathroom for disposal in either the
toilet, sink or shower area.

Cassette and tubing The various tubes used to perform APD are gathered into one area
of the cycler that keeps everything organized called the cassette or organizer. There are
tubes that lead from the cassette to each dialysis solution bag (there can be from one to
four bags used for each treatment depending on the patients prescription). The PD
catheter is attached to a tube on the cassette as well. There is another tube that attaches
from the cassette to the drain bag or drain line.
The APD machine is programmed to drain the solution through the PD catheter to the
drain tube (or drain line). Once the draining is finished, new dialysis solution is released
from a dialysis solution bag to the peritoneal catheter that leads to the peritoneal cavity
where the solution will dwell for a certain time based on the patient's prescription. This
process will repeat until the APD treatment is completed for the night.

Documenting your APD treatment Documenting your treatment is also important.

This allows your doctor and nurse to see how you are doing at home and help adjust your
treatment to be just right for you. There are different ways to do this depending on the
dialysis system you use. Your training nurse will help you understand what needs to be
documented.

Automated peritoneal dialysis (APD) machines on the market

The peritoneal dialysis machines have been designed to be user-friendly and generally use
similar equipment and supplies to perform APD. Before you receive a cycler, you will go
through peritoneal dialysis training with a PD nurse. Here is a description of two automated
peritoneal dialysis cyclers.
1. Baxters HOMECHOICE Automated PD System Like many household electronic equipment, the Baxter HOMECHOICE plugs into a
regular electric outlet. The system will tell you on the display screen to Press Go to
Start. Once you program your prescription numbers into the machine, the
HOMECHOICE will remember the information for each time you use it. You may be
prompted to type in your total fluid volume, therapy time and fill volume, among other
things. A patient can have one to four bags of dialysis solution attached to the machine
for the treatment in one night, depending on your prescription.
Baxters HOMECHOICE is 20 inches long, 13 inches high and 24 inches wide. It weighs
25 pounds.
2. Fresenius Medical Care NA Newton IQ cycler - The Fresenius Newton IQ is also
plugged into an electrical outlet. The machine requires the patient or nurse to enter the
patients entire prescription into the cycler for the first time. This machine remains
programmed for future use, until the prescription is changed and needs to be re-entered. A

patient may manually enter numbers such as number of fills, dwell time and drain time,
among other information. After the numbers are entered, the Newton IQ will ask about
other information, including if the PD solution bags need to be pre-warmed or if you
would prefer the instructions in English, Spanish or French.
Newton IQ sits 10 inches high and the machine is 22.5 inches long and 20 inches wide.
This cycler also weighs 25 pounds.
Both the Baxter HOMECHOICE and Fresenius Newton IQ cyclers have colorful buttons next to
a clear display screen that walks you through each step of preparation. Each machine comes with
a booklet or hand out to help guide you through set up in case there is something you are
unfamiliar with on the display screen. It is recommended to call the manufacturer first, Baxter or
Fresenius, in case of major machine issues. It is best to call the manufacturer when the problem
occurs so that they can better assist you with trouble-shooting the problem. Both manufacturers
have 24-hour per day hotlines to help assist you with any cycler problems. Your PD
healthcare team is also on hand to help you with any questions.
Adjusting to the APD machine
Both APD machines are meant for night time use or during the day for people who work at night.
While you are asleep, the cycler helps you dialyze safely and efficiently. It may take time to
adjust to using the automated peritoneal dialysis machine.

Noise APD machines do not make much noise. If they do, its just a slight humming
sound. You may be able to hear it while it is plugged in and turned on. Patients have said
the noise is minimal and not disruptive to falling asleep.
Alarms Rarely do the alarms go off on the machine, but when they do, it is usually
because you may be sleeping in a position that is blocking the flow of dialysate. Many
times, shifting to a different position will alleviate this problem. The display screen
indicates why the alarms are sounding so you can correct the matter, turn off the alarms
and resume dialyzing.

Emergencies Emergencies can happen, which is why the APD machines are
designed to alert you if there is a problem. For example, if the electricity were to go out,
the cycler automatically goes into a shut down mode for up to two hours. If the electricity
goes on before two hours are up, the cycler will continue to dialyze from where it left off.
You will have been trained on how to do manual peritoneal dialysis exchanges in the
event the electricity is off indefinitely or for an extended period. Emergency scenarios
will be discussed with your PD nurse in your PD training sessions.

Care partner optional A person on automated peritoneal dialysis may opt to have a
care partner, but it is not usually necessary. The cycler is simple enough to set up and
use so that a PD patient does not need assistance from a care partner.

Getting up during the night If there is a need to get up in the middle of the night
during APD, you can usually stay attached and dialyze, as the tube is relatively long. You
can also detach from the cycler and when you come back the APD machine will

remember where you left off. Your PD training nurse will give you instruction on how to
perform this procedure safely.
APD patient benefits
Many patients appreciate that using the automated peritoneal dialysis machine during the night
helps free up their day. The APD cycler option has given many patients the ability to travel,
since it is portable. Many people are able to work outside their home without having to perform
manual peritoneal dialysis several times a day, although it is possible to do manual peritoneal
exchanges at work. Some patients performing automated peritoneal dialysis also report feeling
better and get better results on their lab tests.