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06-05-2009, 09:22 AM
Peritoneal dialysis
Advantages it’s a:
Natural membrane able to remove the middle molecule substances
No heparin use.
No haemodynamic changes.
Disadvantages Infection peritonitis.
Delayed response, also it’s time consuming.
Injury of viscous organ.
Indication:

Bleeding tendency.
Diabetic nephropathy (some prefer Peritoneal Dialysis in diabetic nephropathy)
Hypotension (it is usually does not lead to hemodynamic disturbances)

Contraindication:

· Urgent case.(Haemodialysis is preferred)
· Ascites
· Peritoneal adhesions.


Techniques
Haemodialysis:
© (2-3) sessions /wk.
© Session (4-6 hrs)

nephron arterial lineNpatient
= dialyzer V
= hollow pump
fibre - ve pr.


Blood input.
Dialysate & blood
become in contact
through semipermeable
Out put membrane with
exchange accord. To
concentration gradient
Input through the membrane
dialysate of hollow fibres.
fluid blood
dialyzer out put
= hollow fibre

Connection of pt to haemodialysis machine


üA-V fistula: between Radial a. & Cephalic V.

to avoid venous pr. ­
collapse of the veins & muscular veins
when they subjected to the will developed
–ve pr. of the machine
Arterilization of vein
which become ready for connection
üAcute cases:
Connect pt from big vein to with stand the -ve pr of the machine,We use femoral vein by femoral V – catheter, also internal Jugular or subclavian veins can be used.
This is a transient measure till the fistula developed then we can connect patient from the fistula.
Complications of H. dialysis:

˛ Infection (hepatitis ) ˛ bleeding (heparin).
˛ Brain edema ˛ Hypotension.
˛ Air embolism ˛ Dialysis Dementia.
˛ Atherosclerosis ˛ Inf. Endocarditis.
˛ Pseudogout ˛ Serositis Ascites.
˛ Depression ˛ Pruritis