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…..
Friday, January 8, 2010
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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