Before we proceed to the use of "blunt AVF needles", we need to revisit the use of sharp AVF needles in haemodialysis. We tend to take many things for granted when we cannulate a patient for haemodialysis treatment.
When a patient with a new AVF (ArterioVenous Fistulae) present him or herself before you for treatment what basic requirements are needed before you can proceed with the cannulation?
1. A order by the attending physician to proceed with the cannulation
2. A trained and competent treatment practitioner with good record of successful first time cannulation shall be assigned to carryout the cannulations.
3. The use of some form of restrain or tourniquet to sufficiently and uniformly engorged the intended vessel to be cannulated.
Having the basic requirements checked, now turn towards allying the patient's fear. Remember, words spoken without much thought may cause more anxiety and fear instead to alleviate it. Be very sensitive and take your time when choosing the appropriate words explaining the procedure.
Do not be in a rush as mistakes can occur when you are in a hurry. Choose the lest busy period of the week and day to introduce a new patient to his/her first haemodialysis treatment.
The first experience has a lasting impression, therefore you may want to use a smaller bore AVF needles for the first time cannulation. The idea of using a size smaller than usual is to ally fear and gives the patient confidence in the treatment pratitioner.
to be contd.....
Sunday, January 31, 2010
Friday, January 29, 2010
"Ouch"......
For haemodialysis dependent patients, an Arterio-Venous Fistulae (AVF) is the "lifeline" to having a good treatment outcome. There are other blood accesses but an AVF is the best. Ever since haemodialysis was introduced in Malaysia, sharp AVF needles has been in used since.
Many patients dread to come for haemodialysis treatment for the very simple reason of the pain involved during cannulation of the AVF needles. Every patient needs two cannulations of the AVF needles per treatment, three times per week and that will result in 312 cannulations over a period of one year. The degree of pain endured during each cannulation varies with patients themselves, site of cannulations and the treatment practitioner who does the cannulation.
Sharp AVF needles themselves can cause untold damages to the AVF and in the hand of unqualified treatment practitioners the damage is unimaginable. Stenosis, thrombosis, haemorrhages, infiltrations and aneurysms are some of the complications.
Many of these complications can arise from the "one site-itis" phenomena. Many trained and untrained treatment practitioners gave in to the demand of patients for same site cannulations as they are unable to explain the rationale to rotate cannulation sites and choose the easiest way of out of the situation.
Basically there are two methods of cannulations; "the step ladder" method and the "button-hole" method. If properly practiced, these methods can ensure the AVF serving the needs of the patient for many years to come. Due to the abuses and incompetence of qualified and unqualified treatment practitioners, patients suffer physically, emotionally and financially and sometime may lead to their untimely demise.
Over the last 25 years,"blunt AVF needles" has been used in the West with much success. Efforts are underway to introduce them in Malaysia and over the next few postings we shall explore the "blunt AVF needles" method......
Many patients dread to come for haemodialysis treatment for the very simple reason of the pain involved during cannulation of the AVF needles. Every patient needs two cannulations of the AVF needles per treatment, three times per week and that will result in 312 cannulations over a period of one year. The degree of pain endured during each cannulation varies with patients themselves, site of cannulations and the treatment practitioner who does the cannulation.
Sharp AVF needles themselves can cause untold damages to the AVF and in the hand of unqualified treatment practitioners the damage is unimaginable. Stenosis, thrombosis, haemorrhages, infiltrations and aneurysms are some of the complications.
Many of these complications can arise from the "one site-itis" phenomena. Many trained and untrained treatment practitioners gave in to the demand of patients for same site cannulations as they are unable to explain the rationale to rotate cannulation sites and choose the easiest way of out of the situation.
Basically there are two methods of cannulations; "the step ladder" method and the "button-hole" method. If properly practiced, these methods can ensure the AVF serving the needs of the patient for many years to come. Due to the abuses and incompetence of qualified and unqualified treatment practitioners, patients suffer physically, emotionally and financially and sometime may lead to their untimely demise.
Over the last 25 years,"blunt AVF needles" has been used in the West with much success. Efforts are underway to introduce them in Malaysia and over the next few postings we shall explore the "blunt AVF needles" method......
Sunday, January 24, 2010
Q&A No.1
Dear AK,
The following are suggestions from Mr. CS Soong.
"Just to add on to the question about the dialyser clotting problem-another option is pre clean cycle where the dialyser filled with disinfectant and allow to soak/dwell for about 2-3 hours before reconnect the dialyser to the reprocessor and complete the full reprocessing cycle. Other factors need to be considered and evaluated including:
1.) Patient’s factor e.g Hct, infection, chronic liver disease.
2.) Treatment factor e.g. type of dialyser, time, total fluid removal, etc.
3.) Medication factor e.g. Digitalis, tetracycline, etc.
Sometimes prescription of oral anti coagulant may be helpful e.g.tab cardiprin or tab aspirin but need to discuss with their doctor first."
Saturday, January 23, 2010
Q & A No 1
We have received a question from a reader:
".i one to ask some my patients, the dialyser cloted, after iuse above 8 time the dialyser i discard because can't pass test with renatron. Hep i used 2000iu started and 1000iu hourly and last hour no heparin. can i add more if not enough hep. or any suggestion can i do. Can you highlight for me. may centre i use for 15 times passed with renatron machine......"
Our reply:......
"Dear AK,
First and foremost, all dialysers are for "sinlge use" only.
Due to economic and other reasons, "reuse" is practiced. "Reuse" can be carried out either by manually reporcessing the dialysers or by using semi-automated or fully automated reprocessors.
The "reuse" protocol employed by each haemodialysis centre (HDC) shall be their management responsibility to ensure patient safety and best treatment outcome.
There are a number of tests being carried out on a dialyser while being reprocesed by a "Renatron", a fully automated reprocessor. Two major test which when either fails will not allow further processess to be carried out are the "Bundle Volume" test and "Pressure" test.
We shall assume that the test referred is the "bundle volume" test.
What it means is the volume within the "hollow-fibers" of the dialyser does not meet the volume set as a minimum standard. The minimum standard approved by AAMI is 80% of that of a new dialyser of the same make and size.
Failing to meet the minimum standard of 80% may be due to a number of reasons:
1. "Hyper-clotters"
2. Blood clots
"Hyper-clotters" are metabolic materials produce by certain dietary intake. If the failure is due to this then the patients needs to be counselled on his/her dietary intake.
If it is due to blood clots, due care must be given to the regime in giving anti-coagulant, in this case heparin. The recommended anti-coagulant regime is bolus dose of 50iu/kg is given at the begining of treatment followed by 10-20iu/kg per hour.
As per your question, the following is our suggestions:
1. You may want to increase you bolus dose by an incrementof 500iu up to 4000iu in addition to your 2000iu presently being given depending on the patient's body weight.
2. You may also want to increase your hourly dose by 500iu for the first 2 hours.
Adjustment to the administration of the 3rd hourly dose will depend on post treatment bleeding time.
Please note that due considerations must be given when handling patients with bleeding problems such as retinal bleeding, gastritis etc. and those on blood thinners such asprin etc.
Other suggestions are:
1. Instead of priming the "extra-corporeal" blood pathway with "heparinised saline" during the priming phase, you may want to prime with only Normal Saline. During the recirculation phase before connecting the patient, push in 2000iu of heparin and let it recirculate for at least 10 minutes before connecting to the patient.
This will help to heparinsed the internal pathway of the "extra-corporeal" blood pathway at a higher and more concrentrated heparin solution and prevent unnecssary clotting.
2. At the end of the dialysis while returning the "extra-corporeal" blood back to the patient, push in any remenant heparin not used into the "extra-corporeal" blood pathway. Ensuring that the heparin will reach the dialyser before the blood pump is switch off.
This will ensure any unused heparin is ustilised to prevent blood to clot in the"hollow-fibers" while waiting to be reprocessed, thus making full use of any extra heparin otherwise going to be discarded.
We welcome any other suggestions.....
".i one to ask some my patients, the dialyser cloted, after iuse above 8 time the dialyser i discard because can't pass test with renatron. Hep i used 2000iu started and 1000iu hourly and last hour no heparin. can i add more if not enough hep. or any suggestion can i do. Can you highlight for me. may centre i use for 15 times passed with renatron machine......"
Our reply:......
"Dear AK,
First and foremost, all dialysers are for "sinlge use" only.
Due to economic and other reasons, "reuse" is practiced. "Reuse" can be carried out either by manually reporcessing the dialysers or by using semi-automated or fully automated reprocessors.
The "reuse" protocol employed by each haemodialysis centre (HDC) shall be their management responsibility to ensure patient safety and best treatment outcome.
There are a number of tests being carried out on a dialyser while being reprocesed by a "Renatron", a fully automated reprocessor. Two major test which when either fails will not allow further processess to be carried out are the "Bundle Volume" test and "Pressure" test.
We shall assume that the test referred is the "bundle volume" test.
What it means is the volume within the "hollow-fibers" of the dialyser does not meet the volume set as a minimum standard. The minimum standard approved by AAMI is 80% of that of a new dialyser of the same make and size.
Failing to meet the minimum standard of 80% may be due to a number of reasons:
1. "Hyper-clotters"
2. Blood clots
"Hyper-clotters" are metabolic materials produce by certain dietary intake. If the failure is due to this then the patients needs to be counselled on his/her dietary intake.
If it is due to blood clots, due care must be given to the regime in giving anti-coagulant, in this case heparin. The recommended anti-coagulant regime is bolus dose of 50iu/kg is given at the begining of treatment followed by 10-20iu/kg per hour.
As per your question, the following is our suggestions:
1. You may want to increase you bolus dose by an incrementof 500iu up to 4000iu in addition to your 2000iu presently being given depending on the patient's body weight.
2. You may also want to increase your hourly dose by 500iu for the first 2 hours.
Adjustment to the administration of the 3rd hourly dose will depend on post treatment bleeding time.
Please note that due considerations must be given when handling patients with bleeding problems such as retinal bleeding, gastritis etc. and those on blood thinners such asprin etc.
Other suggestions are:
1. Instead of priming the "extra-corporeal" blood pathway with "heparinised saline" during the priming phase, you may want to prime with only Normal Saline. During the recirculation phase before connecting the patient, push in 2000iu of heparin and let it recirculate for at least 10 minutes before connecting to the patient.
This will help to heparinsed the internal pathway of the "extra-corporeal" blood pathway at a higher and more concrentrated heparin solution and prevent unnecssary clotting.
2. At the end of the dialysis while returning the "extra-corporeal" blood back to the patient, push in any remenant heparin not used into the "extra-corporeal" blood pathway. Ensuring that the heparin will reach the dialyser before the blood pump is switch off.
This will ensure any unused heparin is ustilised to prevent blood to clot in the"hollow-fibers" while waiting to be reprocessed, thus making full use of any extra heparin otherwise going to be discarded.
We welcome any other suggestions.....
Monday, January 18, 2010
At last all States.....
Finally all Private and NGO HDCs in all States and Federal Territory have been posted..... Please take note.....
Saturday, January 16, 2010
Two more States added.....
Pulau Pinang and Perak Darul Ridzuan are the lastest two states added to the List of Private and NGO Dialysis Centres......
Friday, January 15, 2010
This is the final part of the Introduction series.....
Normal Saline
Intravenous Normal Saline is a sterile solution having the same concentration of solutes and having equal osmotic pressure as that of blood. This is to mean that this solution is similar to the liquid composition of the human body and therefore it is safe to be introduced into the circulatory system of the body.
In haemodialysis, NS is use to flush and clean the "bloodline" sets and also the dialyser.It is used at the end of treatment to return extra-corporeal blood back to the patient. It is also use to correct any situation where over extraction of body fluids during treatment and also in administering large amount of medication.
Intravenous Normal Saline is a sterile solution having the same concentration of solutes and having equal osmotic pressure as that of blood. This is to mean that this solution is similar to the liquid composition of the human body and therefore it is safe to be introduced into the circulatory system of the body.
In haemodialysis, NS is use to flush and clean the "bloodline" sets and also the dialyser.It is used at the end of treatment to return extra-corporeal blood back to the patient. It is also use to correct any situation where over extraction of body fluids during treatment and also in administering large amount of medication.
Courtesy of Ain Medicare Sdn. Bhd
AVF Needles
These are used to deliver blood from the circulatory system for treatment and returned the "cleansed" extra-corporeal blood blood back to the patient.
The needle is 1 inch in length and has a 12 inches plastic tubing attached to it.It also has a pair of wings for firm handling when cannulating the patient.The larger the internal diameter of the needle will ensure a greater blood pump speed can be supported thus resulting in a better treatment outcome.
Transducer protector
It is a device to protect the transducer in the haemodialysis machine from being contaminated with blood or body fluids. This device is to monitor pressure with the extra-corporeal blood circuit during treatment. Any contaminated transducer protector needs to be change immediate or risk contaminating other patients.
Thursday, January 14, 2010
Additional feature.....
An additional feature added to the blog.....the list of Private and NGO Dialysis Centres in Malaysia is being uploaded in stages. Kindly let us know of any new changes or else we will update changes as per the latest Directory of Dialysis & Transplant Centres in Malaysia by The National Renal Registry.
Congratulations....
CONGRATULATIONS!!!
Dr Chew Thian Fook, ANS
Consultant Physician & Nephrologist
on the commencement of your private practice
at
KPJ Seremban Specialist Hospital
Best Wishes and Warmest Regards
MalaysianKidneySPA
Tuesday, January 12, 2010
Anti coagulation.....
Haemodialysis requires blood to circulate outside the body (known as extra corporeal ) in order for the blood to be "processed". The natural clotting mechanism of the blood will start to kick in once the blood leaves the body. If this problem is not taken care of, the precious extra corporeal blood will clot in the bloodlines and dialyser.
To ensure a smooth flow of the extra corporeal blood during haemodialysis treatment, some form of anti-coagulantion agent must be introduced into the circulatory system. There are a number of anti coagulation agent which can be used but "heparin" is the most commonly employed. "Heparin" is usually obtained from 2 sources, bovine and porcine. Due to religious sensitivity in Malaysia, the "heparin" obtained from bovine source is preferred.
The dosage of anti coagulation needed will depend generally on the size and weight of the patient and the need to maintain an activated clotting time of 200 - 250 seconds (normal being 90 - 140 seconds). There are various ways of administering "heparin", the treatment provider know what is best for his/her patient after a couple of treatments.
"Heparin" in the right dosage is tool but too much or too little creates problems.....
To ensure a smooth flow of the extra corporeal blood during haemodialysis treatment, some form of anti-coagulantion agent must be introduced into the circulatory system. There are a number of anti coagulation agent which can be used but "heparin" is the most commonly employed. "Heparin" is usually obtained from 2 sources, bovine and porcine. Due to religious sensitivity in Malaysia, the "heparin" obtained from bovine source is preferred.
Courtesy by Ain Medicare Sdn. Bhd.
The dosage of anti coagulation needed will depend generally on the size and weight of the patient and the need to maintain an activated clotting time of 200 - 250 seconds (normal being 90 - 140 seconds). There are various ways of administering "heparin", the treatment provider know what is best for his/her patient after a couple of treatments.
"Heparin" in the right dosage is tool but too much or too little creates problems.....
Sunday, January 10, 2010
"A little bit of soap........"
Dialysate, the “soap” of haemodialysis is made up of a "concentrate" combination of certain essential electrolytes and filtered water. This is the vehicle which carries away metabolic waste products and excess water from the blood to be discarded and at the same time maintaining a correct balance of essential electrolytes in the blood.
The compositions of the “concentrate” include sodium, chloride, magnesium, potassium, bicarbonate of which sodium and chloride concentration is similar to that of human plasma. The bicarbonate level is usually higher than that of plasma so to correct the acid base imbalance of the blood.
It is important to ensure that certified “concentrate” that conform to the authorities requirement be used at all times. This is because "concentrate" prepared in non clean environment can cause bacteria to grow and these bacteria and dead ones which then formed endotoxins causes complications such as infections and chronic inflammation to tissues such as the heart.
Courtesy by Ain Medicare Sdn. Bhd.
It is important to ensure that certified “concentrate” that conform to the authorities requirement be used at all times. This is because "concentrate" prepared in non clean environment can cause bacteria to grow and these bacteria and dead ones which then formed endotoxins causes complications such as infections and chronic inflammation to tissues such as the heart.
There are many formulations of “concentrate” in the market, selecting the most appropriate “concentrate” is essential to have the best outcome. Never mismatch your “concentrate” as it may result in undesirable consequences.
Saturday, January 9, 2010
H2O......
Water is an important element of our being. Too little or too much water can be detrimental to our well-being. As for ESRF patients, water can be a poison as well as a savior.
Too much water can cause complications such as Congestive Cardiac Failure, Pulmonary Edema, and many others. On the other hand, water is essential to ensure a proper haemodialysis treatment can be carried out. Water is the vehicle to transport metabolic waste products and excessive water away from the blood and removed.
To prepare water for haemodialysis treatment, the water needs to be process to ensure it is clean and safe due to the close proximity it will have with the patient’s blood.
Tap water contains insoluble particulates such as iron and silica, soluble organic compounds such as chloramines and soluble inorganic compounds such as calcium and magnesium salts, not forgetting bacteria and pyrogen. All these can cause complications to the patient.
The present preference of a water filtration system is the Reverse Osmosis (RO) system due to the cost and availability factors. Tap water with all its impurities needs to undergo a pre RO preparation. Insoluble particulates are removed by multimedia filter; soluble organic compounds are absorbed by a carbon filter; soluble inorganic compounds are treated by a softener. All these processes are to ensure the feed water to the RO system will ensure high grade product water for the treatment proper.
RO systems which consist of a high pressure pump and semi-permeable membranes produces water 98% pure of dissolved solids and of bacteria and pyrogen. It is always ideal to have a post RO bacterial filter in place to ensure the RO water is safe from any breaches. An interesting point to note each single treatment uses more than 120 litres of RO water whereas we drink 2 litres per day.
A proper maintenance of this system is crucial. Without water no haemodialysis.
Read more http://www.beai.org/waterindial.html
Too much water can cause complications such as Congestive Cardiac Failure, Pulmonary Edema, and many others. On the other hand, water is essential to ensure a proper haemodialysis treatment can be carried out. Water is the vehicle to transport metabolic waste products and excessive water away from the blood and removed.
To prepare water for haemodialysis treatment, the water needs to be process to ensure it is clean and safe due to the close proximity it will have with the patient’s blood.
Tap water contains insoluble particulates such as iron and silica, soluble organic compounds such as chloramines and soluble inorganic compounds such as calcium and magnesium salts, not forgetting bacteria and pyrogen. All these can cause complications to the patient.
The present preference of a water filtration system is the Reverse Osmosis (RO) system due to the cost and availability factors. Tap water with all its impurities needs to undergo a pre RO preparation. Insoluble particulates are removed by multimedia filter; soluble organic compounds are absorbed by a carbon filter; soluble inorganic compounds are treated by a softener. All these processes are to ensure the feed water to the RO system will ensure high grade product water for the treatment proper.
RO systems which consist of a high pressure pump and semi-permeable membranes produces water 98% pure of dissolved solids and of bacteria and pyrogen. It is always ideal to have a post RO bacterial filter in place to ensure the RO water is safe from any breaches. An interesting point to note each single treatment uses more than 120 litres of RO water whereas we drink 2 litres per day.
A proper maintenance of this system is crucial. Without water no haemodialysis.
Read more http://www.beai.org/waterindial.html
Friday, January 8, 2010
"Johnny No.5".....
Haemodialysis machines has three major functions; to regular blood flow out and back to the body, preparing an electrolyte bath called “dialysate” and to regulate removal of access of bodily fluid.
The blood out side the body is know as “extra corporeal” blood and this blood is channeled through a set of plastic tube to the dialyser and another set of tube returning it to the body. The flow of blood is regulated by a pump of the machine.
The dialysate or electrolyte bath is a mixture of three components; an acid component, a bicarbonate component and highly filtered water. These two concentrated solutions (acid and bicarbonate components) of the dialysate contain certain electrolytes such as sodium, calcium and potassium. The highly filtered water is filtered via a filtration system usually by reverse osmosis method. These will ensure a proper balanced composition of the patient’s blood to prevent complications during treatment while metabolic waste products are readily removed.
The dialysate is channeled to the “dialyser” and filled the dialyser, soaking the hollow-fibers filled with blood. Micro exchanges occur; metabolic waste products and excess water will move from the blood to the dialysate and removed while electrolytes imbalance in the blood is corrected.
The haemodialysis machines can create a negative pressure in the dialysate circuit in order to regulate the amount of water to be removed from the circulatory system via the dialyser. It is pertinent that this function is accurate or else good treatment outcome may not be achieved and complications sets in.
There are many other safety functions built into these machines to ensure patient safety during treatment. These include “blood leak” detector, “air bubble” detector, temperature regulator and others. More innovative gadgets and functions are added with the introduction of new haemodialysis machines.
While seeking new and latest innovations, basic principles of treatment and care must not be overlooked. Each patient is different from the next, their needs are different…..
The blood out side the body is know as “extra corporeal” blood and this blood is channeled through a set of plastic tube to the dialyser and another set of tube returning it to the body. The flow of blood is regulated by a pump of the machine.
The dialysate or electrolyte bath is a mixture of three components; an acid component, a bicarbonate component and highly filtered water. These two concentrated solutions (acid and bicarbonate components) of the dialysate contain certain electrolytes such as sodium, calcium and potassium. The highly filtered water is filtered via a filtration system usually by reverse osmosis method. These will ensure a proper balanced composition of the patient’s blood to prevent complications during treatment while metabolic waste products are readily removed.
The dialysate is channeled to the “dialyser” and filled the dialyser, soaking the hollow-fibers filled with blood. Micro exchanges occur; metabolic waste products and excess water will move from the blood to the dialysate and removed while electrolytes imbalance in the blood is corrected.
The haemodialysis machines can create a negative pressure in the dialysate circuit in order to regulate the amount of water to be removed from the circulatory system via the dialyser. It is pertinent that this function is accurate or else good treatment outcome may not be achieved and complications sets in.
There are many other safety functions built into these machines to ensure patient safety during treatment. These include “blood leak” detector, “air bubble” detector, temperature regulator and others. More innovative gadgets and functions are added with the introduction of new haemodialysis machines.
While seeking new and latest innovations, basic principles of treatment and care must not be overlooked. Each patient is different from the next, their needs are different…..
Thursday, January 7, 2010
Blood what......?
Blood access is a passage to the blood circulatory system of the human body. It may be a temporary or permanent in nature.
Intravenous line is a form of temporary access where intravenous fluid such as Normal Saline or medication can be introduced into the blood circulatory system. An access by a catheter (a tube-like) may be of a temporary or long term usage and this has many uses in the many disciplines in medical practice.
However, in haemodialysis a blood access is basically of a long term nature. It has to be repeatedly used again and again, day after day to gain access to good blood flow in order to carryout treatment.
Blood access for haemodialysis can be divided in 3 basic types;
1. catheter
2. arteriovenous (AV) graft
3. arteriovenous (AV) fistula
The catheter is a tube insert into one of the selected major veins and can be used as a short-term measure and in some case as a permanent access. It has a greater tendency to get infected therefore limiting its usage. Cleanliness is of utmost importance. No needles required.
The arterioveous (AV) graft is a tube surgically inserted to connect an artery to a vein. This method is employed under certain circumstances such as where veins are small and not able to sustain a good blood flow sufficient for haemodialysis treatment. The cost of having an AV graft is costly and needed qualified and experienced staff to handle it. Needling is required.
Arteriovenous (AV) fistula is surgically created by making a passage between an artery and a vein. This method is commonly employed for the simple reason that is the best and cheapest. This method has been described as the “Gold Standard” of blood access in haemodialysis. Needling is required.
Care of a blood access is crucial in haemodialysis as it is the “lifeline” to staying alive for the patient. A good needling practice is pertinent in ensuring a good and lasting AV graft or AV fistula. Basically there are two methods for needling; "step ladder" method and "buttonhole" method. Both methods has its own advantages and disadvantages, the point is whichever method is employed it must serve to the best interest of the patient and provide the best outcome.
Intravenous line is a form of temporary access where intravenous fluid such as Normal Saline or medication can be introduced into the blood circulatory system. An access by a catheter (a tube-like) may be of a temporary or long term usage and this has many uses in the many disciplines in medical practice.
However, in haemodialysis a blood access is basically of a long term nature. It has to be repeatedly used again and again, day after day to gain access to good blood flow in order to carryout treatment.
Blood access for haemodialysis can be divided in 3 basic types;
1. catheter
2. arteriovenous (AV) graft
3. arteriovenous (AV) fistula
The catheter is a tube insert into one of the selected major veins and can be used as a short-term measure and in some case as a permanent access. It has a greater tendency to get infected therefore limiting its usage. Cleanliness is of utmost importance. No needles required.
The arterioveous (AV) graft is a tube surgically inserted to connect an artery to a vein. This method is employed under certain circumstances such as where veins are small and not able to sustain a good blood flow sufficient for haemodialysis treatment. The cost of having an AV graft is costly and needed qualified and experienced staff to handle it. Needling is required.
Arteriovenous (AV) fistula is surgically created by making a passage between an artery and a vein. This method is commonly employed for the simple reason that is the best and cheapest. This method has been described as the “Gold Standard” of blood access in haemodialysis. Needling is required.
Care of a blood access is crucial in haemodialysis as it is the “lifeline” to staying alive for the patient. A good needling practice is pertinent in ensuring a good and lasting AV graft or AV fistula. Basically there are two methods for needling; "step ladder" method and "buttonhole" method. Both methods has its own advantages and disadvantages, the point is whichever method is employed it must serve to the best interest of the patient and provide the best outcome.
Wednesday, January 6, 2010
Tuesday, January 5, 2010
Dialyser.....
Haemodialysis as a treatment option for End Stage Renal Failure (ESRF), the treatment process requires a number of components such as dialysis machine, RO system, disposables such as dialyser, bloodlines sets, AVF needles and pharmaceutical products such as Heparin solution and intravenous Normal Saline.
So what is a dialyser....?
Dialyser is basically a filter. It filters the metabolic waste products such as urea and creatinine and also excess water from the body of the patient. In access, these metabolic waste products causes complications and mayresult in death. The dialyser contains a number of parts; the outer casing, the end caps and hollow fibers. The outer casing and end caps are made of polycarbonate and the hollow-fibers are made from semi-pearmeable membrane eith from Cellulosic or semi-synthetic / synthetic materials.
The dialyser performance is determined by its semi-permeable membrane "clearance" which being the ability to remove metabolic waste products of a certain molecular weight and size range such as urea and creatinine and has the ability to retain needed peptides and protein which is of the larger molecular weight and size range in the blood.
The general consideration for selection of dialysers for patients are based on a number of fundamental requirements:
1. The treatment needs of the patient.
2. The bigger the surface area of the semi-permeable membrane the better.
3.The higher level of "clearance" of the low molecular weight waste products the better and the removal of higher molecular weight waste products if possible such as Beta2 Microgobulin.
4.Having the best "blood bio-compatibility" semi-permeable membrane is desirable for long term outcome results.
The other considerations are......
1. To have a smallest of extra-corporeal blood volume possible during treatment.
2. To ensure the patient does not have dialysis disequilibrium syndrome (DSS) or similar effects.
The preferred immediate post treatment outcome is to have a patient who is feeling much better than when he arrives, having normal vitals signs and able to carry out his daily activities with restriction.
The prefered long term treatment outcome is able to return to normal life with minimal complications and hospitalizations.
So what is a dialyser....?
Dialyser is basically a filter. It filters the metabolic waste products such as urea and creatinine and also excess water from the body of the patient. In access, these metabolic waste products causes complications and mayresult in death. The dialyser contains a number of parts; the outer casing, the end caps and hollow fibers. The outer casing and end caps are made of polycarbonate and the hollow-fibers are made from semi-pearmeable membrane eith from Cellulosic or semi-synthetic / synthetic materials.
The dialyser performance is determined by its semi-permeable membrane "clearance" which being the ability to remove metabolic waste products of a certain molecular weight and size range such as urea and creatinine and has the ability to retain needed peptides and protein which is of the larger molecular weight and size range in the blood.
The general consideration for selection of dialysers for patients are based on a number of fundamental requirements:
1. The treatment needs of the patient.
2. The bigger the surface area of the semi-permeable membrane the better.
3.The higher level of "clearance" of the low molecular weight waste products the better and the removal of higher molecular weight waste products if possible such as Beta2 Microgobulin.
4.Having the best "blood bio-compatibility" semi-permeable membrane is desirable for long term outcome results.
The other considerations are......
1. To have a smallest of extra-corporeal blood volume possible during treatment.
2. To ensure the patient does not have dialysis disequilibrium syndrome (DSS) or similar effects.
The preferred immediate post treatment outcome is to have a patient who is feeling much better than when he arrives, having normal vitals signs and able to carry out his daily activities with restriction.
The prefered long term treatment outcome is able to return to normal life with minimal complications and hospitalizations.
Sunday, January 3, 2010
Looking for Staff
Tired of looking for State Registered Nurses (SRN) and Medical Assistants (MA) for your Dialysis Centres or Hospitals.....Look no further, advertise here for free and let us help you .....
Terms & Conditions:
1. It is free of charge.
2. Period of advertising - 60 days
3. Can reapply after end of any period of advertising.
4. Send all relevant information to: tandauchin@gmail.com.
5. T&C subject to change without prior notice.
Saturday, January 2, 2010
What is in the name.....
The name “Malaysian KidneySPA” was chosen for this blog for the following reasons; dedicated to the men and women whom have toiled and sweated out to serve those in need:
Malaysian : This blog is dedicated to all ESRD patients and all the practitioners in the profession of providing Renal Replacement Therapy in Malaysia and also indirectly to those around the world.
Kidney : Kidneys are a vital organ but is only appreciated after it fails.
S : The Specialists (Medical Practitioners) whom have dedicated their lives to the well-being of ESRD patients.
P : The Paramedics (Treatment Practitioners) whose dedication in ensuring the best treatment being carried out for best outcome for the patients.
A : The Associates being the aides, assistants, technicians and all those who are involved in whatever supporting way in ensuring the well-being of these patients.
Special note: The colour GREEN was chosen to give support for the Global Climate Change Initiative. Go GREEN and save the world.
Friday, January 1, 2010
Why was this blog started.......
Since 1986 when I was first introduced to haemodialysis as a treatment option to End Stage Renal Failure at Hospital Sultanah Aminah, Johor Bahru, Malaysia, I have been a firm believer that knowledge gained must be shared for the benefit of others.
Recently, I was introduced as to how one can start a blog. Then the idea of having a common platform, where knowledge can be easily accessible and shared among peers who wish to seek and share knowledge is so exciting and compelling.
A platform where new ideas and updates can be shared instantaneously at a click of the mouse. Questions and problems are put forth, anonymously if need so, by those who are in need of assistance, with answers and solutions from peers whom share the same passion of sharing and helping.
It is my earnest wish that this blog can help to improve the knowledge of practitioners and the quality of care and ultimately better patients' treatment outcome.
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