DIALYSISHEMODIALYSIS AND

PERITONEAL DIALYSIS

Dialysis Center

• Dialysis Center: A highly specialized program which provides facilities for the treatment of patients with irreversible renal insufficiencies. Treatment procedures require professional supervision by staff experienced in renal pathophysiology. The Dialysis Center may serve either or both inpatients and outpatients, depending upon the medical facility type, and may provide self-dialysis training for Peritoneal Dialysis in addition to on-site assisted dialysis.

IS A PERSON WHO HAS SUCCESSFULLY COMPLETED A CORE CURRICULUM AND CLINICAL CLASSES IN:(i) UNDERSTANDING THE PERSON WITH RENAL FAILURE,(ii) PRINCIPLES OF DIALYSIS,(iii) HEMODIALYSIS DEVICES,(iv) HEMODIALYSIS PROCEDURES,(v) DIALYZER REPROCESSING,(vi) WATER TREATMENT (vii) INFECTION CONTROL (viii) TESTING FOR PRESENCE OF DISINFECTANT IN THE REPROCESSED DIALYSER BEFORE RINSING AND ABSENCE OF DISINFECTANT AFTER RINSING ARE PREFORMED AND DOCUMENTED. (ix) EACH DIALYSER IS CLEARLY LABELLED AND IDENTIFIED TO BE REUSED BY THE SAME PATIENT.

DIALYSIS TECHNICIAN

HEMODIALYSISMAJOR COMPONENTS ARE:1.CIRCULATORY ACCESS.2.BLOOD PUMP3.DIALYZER4.METHOD FOR ANTICOAGULATION5.DIALYSATE DELIVERY EQUIPMENT6.MONITORING EQUIPMENT

CIRCULATORY ACCESS• ARTERIOVENOUS FISTULA IS USED TO

ACCESS CIRCULATION.FOR PATIENTS WITH INADEQUATE VESSELS, GRAFTS ARE USED TO CREATE GRAFT AV FISTULA.

• GRAFTS USED eg.BIOLOGIC,SEMIBIOLOGIC AND PROSTHETIC.

• OTHER MEANS TO ACCESS CIRCULATION IS THRU FEMORAL VEIN OR INTERNAL JUGULAR VIEN IN CASE OF ACUTE RENAL FAILURE AND EMERGENCY CASES.

AV FISTULA & ARTIFICIAL GRAFT

BLOOD PUMP AND DIALYZER

2.BLOOD PUMP:-IT IS A DEVICE USED TO ASSIST THE HEART IN PROPELLING THE BLOOD THRU THE TUBING AND DIALYZER.

3.DIALYZER:-IT CONTAINS A SEMIPERMEABLE MEMBRANE.BLOOD PUMPED THRU ONE CHANNEL OF DIALYZER IS CONTAINED ON ONE SIDE OF THE MEMBRANE,WHILE DIALYSATE PUMPED THRU ANOTHER CHANNEL OF THE DIALYZER IS CONTAINED ON OTHER SIDE OF THE MEMBRANE.

ANTICOAGULANT

BLOOD TENDS TO CLOT WHEN IT COMES IN CONTACT WITH FOREIGN SUBSTANCES SUCH AS DIALYZERS.TO PREVENT CLOTTING ANTICOAGULANT eg.HEPARIN IS USED.

TWO TYPES:-1.CONTINUOUS 2.INTERMITTENT1.CONTINUOUS:-INFUSING HEPARIN THROUGHOUT

DIALYSIS VIA INFUSION PUMP INTO THE ARTERIAL BLOOD LINE INLET OF THE DIALYSER.

2.INTERMITTENT:-ADMINISTER LOADING DOSE OF HEPARIN IN THE BEGINNING FOLLOWED BY SMALLER DOSES OF HEPARIN THROUGH DIALYSIS.

DIALYSATE DELIVERY SYSTEM

DIALYSATE: A SOLUTION OF WATER AND CHEMICALS USED IN DIALYSIS.DIALYSATE SHALL BE PROVIDED IN BOTH SINGLE PATIENT AND MULTIPLE PATIENT MIXTURES AS DETERMINED BY THE MEDICAL STAFF.

DIALYSATE IS PREPARED IN THE PREPARATION ROOM AND CONTAINS ELECTROLYTES.

THE SYSTEM PREPARES AND DELIVERS DIALYSATE OF REQUIRED CHEMICAL COMPOSITION TO THE DIALYZERS.

DIALYSATE CENTRAL DELIVERY SYSTEM DELIVERS THE DIALYSATE TO VARIOUS PATIENT STATIONS.

BATCH SYSTEM DELIVERS DIALYSATE TO THE SINGLE PATIENT STATION.

WATER TREATMENT

NECESSARY TO TREAT WATER BEFORE USING IT TO MAKE DIALYSATE.

TWO PROCESSES 1.REVERSE OSMOSIS 2.DEIONIZATION. • WATER TREATMENT:-DIALYSIS WATER TREATMENT IMPLIES

VARIOUS LEVELS OF PRE TREATMENT AND A FINAL PURIFICATION MODULE PRIOR TO DISTRIBUTION OF PURIFIED WATER THRU A HYDRAULIC CIRCUIT.

• DEIONISATION {DI] WATER:-WATER WHICH HAS BEEN TREATED TO REMOVE CONTAMINANTS.THIS SYSTEM REMOVES MOST MINERAL DEPOSITS,BUT MICROBIAL CONTAMINENTS MAY REMAIN.

• FEED WATER:-THE UNTREATED,POTABLE WATER AVAILABLE THROUGH OUT THE FACILITY THE FACILITY THROUGH ITS WATER SUPPLY SYSTEM.

• PERMEATE WATER:-FULLY TREATED PURIFIED WATERT,STORED IN A TANK,WHICH IS USED IN THE PREPARATION OF DIALYSATE.

• PRE-TREATED WATER:-PARTIALLY TREATED WATER,SOMETIMES AVAILABLE AS FEED WATER,WHICH HAS HAD SUBSTANTIAL REDUCTION OF MINERAL AND MICROBIAL PARTICLES.

• REVERSE OSMOSIS {RO} WATER:-USUALLY THE FINAL PURIFICATION MODULE IN THE TREATMENT SYSTEM,RO-BASED TREATMENT MODULES PRODUCE WATER OF OPTIMAL CHEMICAL AND MICROBIAL QUALITY.

• RO PURIFIES WATER FROM 99% OF BACTERIA PYROGENS AND 95% OF DISSOLVED ORGANICS AND DISSOLVED POLYVALENT INORGANICS.

DIALYSIS MONITORS

DIALYSIS MONITOR

MEASURES ARTERIAL PRESSURES,VENOUS PRESSURE,AIR IN THE BLOOD,VOLUME OF BLOOD TO BE DIALYSED.

FACTORS MONITORED IN THE DIALYSATE CHANNEL INCLUDE CONCENTRATION OF DIALYSATE,DIALYSATE FLOW RATE,DIALYSATE TEMPERATURE,DIALYSATE PRESSURE,BLOOD IN THE DIALYSATE.

DESIGN AND CONSTRUCTION

1.DIALYSIS UNIT SHOULD BE LOCATED AS TO BE AVAILABLE FOR BOTH INPATIENT AND OUT PATIENT USE.IT SHOULD BE NEAR ICU.

2. SEPARATE PREPARATION ROOM FOR PREPARING DIALYSATE AND ROOM FOR WASHING TUBINGS AND THE DIALYSER.

a. PATIENT AREA:-INDIVIDUAL CUBICLES SEPARATED BY NONFLAMABLE CURTAINS, FIXED NONCOMBUSTIBLE DIVIDING PARTITIONS OR MOVABLE SCREEN UNITS.

b. MAXIMUM AREA OF MULTI UNIT DIALYSIS ROOM 5000sq ft.c. EACH DIALYSIS UNIT SHALL HAVE THE CAPABILITY OF PROVIDING

EMERGENCY SERVICES.d. EACH TREATMENT AREA SHALL PROVIDE A MINIMUM OF 80 sq ft WITH

4 ft BETWEEN BEDS AND /or LOUNGE CHAIRS FOR EACH STATION.

e. FLOOR SPACES SHALL BE PROVIDED FOR A CENTRAL NURSES STATION WHICH HAS A DIRECT VISUAL OBSERVATION OF ALL PATIENTS.f. EACH UNIT SHALL BE DESIGNED TO PROVIDE VISUAL PRIVACY FOR PATIENTS BY USE OF CUBICLE CURTAINS.g. HANDWASHING FACILITIES SHALL BE LOCATED IN THE TREATMENT AREA.HAND WASHING SINKS SHALL HAVE FAUCETS THAT DISCHARGE AT LEAST FIVE INCHES ABOVE THE SPILL LEVEL OF SINK.SOAP DISPENSERS AND HAND DRYING APPARATUS SHALL BE PROVIDED.AERATORS ARE NOT ALLOWED.

h. SPACE SHALL BE PROVIDED IN THE WORK AREA FOR AN EMERGENCY “CRASH” CART.i. A JANITORS CLOSET SHALL BE PROVIDED EITHER WITHIN OR IMMEDIATELY NEXT TO THE UNIT.j. WORK AREAS SHALL BE DESIGNED AND MAINTAINED TO SEPARATE CLEAN AREAS FROM SOILED AREAS.k. A TOILET ROOM WITH A WATER CLOSET AND HAND WASHING LAVATORY SHALL BE PROVIDED.THE TOILET ROOM AND LAVATORY SHALL BE ACCESSIBLE FROM A WHEEL CHAIR. l. ADEQUATE SPACE SHALL BE PROVIDED FOR INSTRUMENT MAINTENANCE AND STORAGE OF EQUIPMENTS AND FOR PREPARATION AND TESTING OF DIALYSERS.

• m. A CONFERENCE ROOM SHALL SHALL BE IN OR NEAR THE UNIT.

• n. THERE SHOULD BE SPACE FOR RECORD STORAGE.• o. ADEQUATE LIGHTING SHALL BE PROVIDED FOR THE

UNIT.OXYGEN EQUIPMENT SHALL BE AVAILABLE TO THE UNIT.

• p. MECHANICAL VENTILATION AND AIR CONDITIONING SHALL BE PROVIDED THROUGHOUT THE UNIT.

• q. SOURCES OF ENTERTAINMENT AND EDUCATION FOR THE PATIENTS AND RELATIVES.

• r. ARRANGMENTS ARE TO BE MADE FOR STORING BLOOD.

• s. PROPER ARRANGEMENT FOR WASTE DISPOSABLE INCLUDING BLLO AND BLOOD PRODUCTS.

OXYGEN CYLINDERAMBU BAG AND OXYGEN MASKPULSE OXIMETERSUCTION EQUIPMENTELECTROCARDIOGRAPH AND ECG MONITOR.DEFIBRILLATOR.VENTILATORS AND MATERIALS FOR ENDOTRACHEAL INTUBATION

EMERGENCY EQUIPMENT INCLUDES

INFECTION CONTROL

• 1. ALL MEDICAL AND NURSING STAFF ARE TRAINED TO PRACTICE UNIVERSAL PRECAUTIONS IN THE DIALYSIS UNIT.

• 2. GLOVES ,APRONS,FACE MASKS ARE READILY AVAILABLE.• 3. ALL BLOOD STAINED SURFACE SHALL BE CLEANED WITH 1:100 SODIUM

HYPOCHLORITE IF THE SURFACE IS COMPATIBLE WITH THIS TYPE OF CHEMICAL TREATMENT.

• 4. ALL NEW DIALYSIS PATIENTS OR PATIENTS WHO RETURN TO THE DIALYSIS UNIT AFTER TREATMENT FROM HIGH OR UNKNOWN RISK AREAS ARE TESTED FOR TRIPLE H (AUSTRALIA ANTIGEN AND ANTI –HCV AND HIV 1&2).

• 5. HBsAg-POSITIVE PATIENTS,CARRIER OF HCV AND PATIENTS WITH UNKNOWN VIRAL STATUS INCLUDING HIV ARE DIALYSED USING DESIGNATED HEMODIALYSIS MACHINES.

SERVICE AREAS AND STAFF

1.NURSING STATION2.TOILET3.CLEAN LINEN STORAGE AREA4.CLEAN WORK ROOM 5.SOILED WORKROOM6.FACILITIES FOR STERILISATION7.EQUIPMENT STORAGE ROOM 8.PREPARATION ROOM9.OFFICE SPACE10.REFRIGERATOR AND WEIGHT

MACHINE.11.TREATMENT AREA.

1.NEPHROLOGIST2.DIALYSIS TECHNICIAN3.QUALIFIED NURSE 4.RESIDENT MEDICAL

OFFICER5.WARD BOYS AND AYAS6.INTENSIVIST.

THANK YOU

DR.AIJAZ MULANI