Definition
According to Price and Wilson (1995) Dialysis is a process by which solutes and water undergoes passive diffusion through a porous membrane from the liquid compartment to the other compartment. Hemodialysis and peritoneal dialysis are two main techniques used in dialysis. The basic principle of both techniques, namely diffusion of solutes and water from the plasma into dialysis solution in response to differences in concentration or pressure.
According Tisher and Wilcox (1997) hemodialysis solution and is defined as the movement of water from the patient's blood pass through a semipermeable membrane (dialyzer) into the dialysate. Dialyzer can also be used to remove most of the liquid volume. This transfer is done via ultrafiltration where the hydrostatic pressure causes a large flow of plasma water (with a little comparison solution) through the membrane. By enlarging the entrance to the vascular, antikoagulansi and dialyzer production of reliable and efficient, hemodialysis has become the dominant method in the treatment of acute and chronic renal failure in the United States (Tisher & Wilcox, 1997).
Hemodialysis requires a dialysis machine and a special filter called a dialyzer (a semipermeable membrane) that is used to cleanse the blood, the blood removed from the patient's body and circulated in a machine outside the body. Hemodialysis requires entry into the bloodstream, it made an artificial connection between an artery and a vein (arteriovenous fistula) through surgery (NKF, 2006).
The indications
Price and Wilson (1995) explains that there is no clear guidance based on blood creatinine levels to determine when treatment should begin. Most kidney experts make decisions based on the health of patients who continue to be followed closely as an outpatient patients. Treatment usually begins when the patient is no longer able to work full time, suffering from peripheral neuropathy or other clinical symptoms. Treatment usually also be initiated if serum creatinine levels above 6 mg / 100 ml in men, 4 mg / 100 ml in women and glomeluro filtration rate (GFR) of less than 4 ml / min. Patients should not be allowed to continue lying in bed or severe pain to daily activities is not done anymore.
According to the consensus of Nephrology Association of Indonesia (PERNEFRI) (2003) ideally all patients with Goal filtration rate (GFR) less than 15 mL / min, GFR less than 10 mL / min with symptoms of uremia / malnutrition and LFG less than 5 mL / min, although without symptoms can undergo dialysis. In addition to these indications is also mention of a specific indication that if there are complications such as acute pulmonary edema, hyperkalemia, metabolic acidosis, recurrent, and nefropatik diabetic.
Then Thiser and Wilcox (1997) mentions that hemodialysis is usually started when the creatinine clearance falls below 10 mL / min, is comparable with serum creatinine levels of 8-10 mg / dL. Patients who are the symptoms of uremia and mentally able to harm him also advisable to do hemodialysis. Furthermore Thiser and Wilcox (1997) also mentions that a relative indication of hemodialysis is azotemia symptomatic form of encephalopathy, and toxins that can be dialyzed. While the specific indication is uremia pericarditis, hyperkalemia, fluid overload unresponsive to diuretics (pulmonary edema), and acidosis that can not be overcome
Contra Indications
According Thiser and Wilcox (1997) contra indications of hemodialysis is hypotension unresponsive to presor, terminal stage of disease, and organic brain syndrome. Meanwhile, according PERNEFRI (2003) contra indications of hemodialysis is not possible to obtain vascular access in hemodialysis, vascular access is difficult, hemodynamic instability and coagulation. Hemodialysis other contraindications include Alzheimer's disease, multi-infarct dementia, hepatorenal syndrome, liver cirrhosis and malignancy-up with advanced encephalopathy (PERNEFRI, 2003).
The Purposes
The purpose of Hemodialysis, According to Havens and Terra (2005) the purpose of hemodialysis treatment, among others:
- Replaces the function of excretion of renal function, ie to remove the debris
- Metabolism in the body, such as urea, creatinine, and other metabolic wastes.
- Replaces the function of the kidneys in removing body fluids that should be removed as urine when the kidneys healthy.
- Improving the quality of life of patients suffering from renal impairment.
- Replaces kidney function while waiting for other treatment programs.
Hemodialysis process
A hemodialysis machine used for hemodialysis action serves to prepare dialysis fluid (dialysate), dialysate flow and blood flow through a semipermeable membrane, and monitoring functions including dialysate and corporeal blood circuit. Administration of systemic heparin anticoagulation complement. Blood and dialysate flows in the opposite side to obtain the maximum efficiency of removal solution. Dialysate composition, characteristics and size of the dialysis membrane in the tool, and the velocity of blood flow and affect the solution of the transfer solution (Tisher & Wilcox, 1997).
In the process of hemodialysis requires a hemodialysis machine and a filter as an artificial kidney called a dialyzer, which is used to filter and clean the blood of urea, creatinine and metabolic waste substances that are not needed by the body. To implement the required hemodialysis vascular access as the supply of blood to be entered into the hemodialysis machine (NKF, 2006).
An artificial kidney machine or hemodializer consists of a semipermeable membrane that is composed of two parts, parts for blood and other parts for the dialysate. Blood flows from the opposite direction to the direction of dialysate or in the same direction as the direction of blood flow. Dialyzer is a hollow fiber or capillary dialyzer is composed of thousands of fine fibers that are arranged parallel capillaries. Blood flows through the center of the small tubes, and the dialysate wet outside. Dialyzer is very small and compact because it has a large surface as a result of many capillary tube (Price & Wilson, 1995).
According PERNEFRI (2003) the time or duration of hemodialysis tailored to individual needs. Each 4-5 hour hemodialysis performed with a frequency of 2 times a week. Haemodialysis should ideally be 10-15 hours / week with QB 200-300 mL / min. Meanwhile, according to Corwin (2000) Hemodialysis takes 3-5 hours and is done three times a week. At the end of the interval of 2-3 days between hemodialysis, the balance of salt, water, and the pH is not normal anymore. Hemodialysis contributes cause anemia due to red blood cells partially damaged in the process of hemodialysis.
Price and Wilson (1995) explains that the dialysate at body temperature will increase the rate of diffusion, but the temperature is too high causing hemolysis of red blood cells that can cause the patient's death. Tear in the dialyzer membrane resulting in small or massive leaks can be detected by a photocell on the dialysate outflow. Maintenance Hemodialysis is usually performed three times a week, and duration of treatment ranged from 4 to 6 hours, depending on the type of system used and the state of dialysis patients.
Figure 2.1
Scheme of the process of hemodialysis
(National Kidney Foundation, 2001)
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