Satellite healthcare Hemodialysis Machine

What does the Hemodialysis machine do?

1. Mixes (proportions), warm, and circulates dialysate 2. Circulates patients' blood through the dialyzer 3. Monitors patient safety factors Blood compartment alarm and dialysate compartment alarm

The ration of water to acid to bicarbonate

42.4:1:1.6

Acid concentrate contains

Acidifier: acetate is used for chemical stability Sodium Chloride Potassium Chloride Magnesium Chloride Calcium Chloride Glucose (not electrolyte)

What safety checks the machine is equipped to perform?

Blood circuit and dialysate circuit

Complications of improperly mixed dalysate

Hemolysis or crenation

how do we check conductivity?

Machine displays the conductivity and measured during the entire treatment Independent meter check (pHoenix meter)

What is conductivity and why do we check ?

Sodium is a major electrolyte in the interstitial fluid dialysate must contain sodium to prevent depletion of sodium from the patient the conductivity setting of the dialysis machine directly corresponds to the level of sodium in the dialysate a constant volatage is applied across two electrodes 1 cm apart in the dialysate flow if the concentration of electrolytes changes, the voltage will change

Volummetric UF Control

The dialysis machine removes water from the patient and measures it with volumetric UF control

Transducer

a device in the machine that turns air pressure into electronic signal it is deep inside the machine the signal displays venous pressure arterial pressure and TMP (blood compartment alarm)

transducer protector

a filter that protects the transducer from blood, the transducer protector must be kept dry to work properly

Blood circuit

air detector arterial pressure venous pressure TMP PHT (pressure holding test)

internal transducers protectors

are hydrophobic (water repellent), so blood cannot pass all the way through only the technical department can access them

blood leak detector

checks for blood in dialysate shines beam of light across dialysate drain tubing looking for blood audio and visual alarm blood pump stops ultrafiltration stops

Symptoms of hemolysis

chest pain or back pain dyspnea (shortness of breath) hypotension nausea/vomiting pain and/or burning at venous needle site feeling hot if dialysate is overheated dysrhythmias cardiac arrest

what are the signs of hemolysis ?

clear blood cranberry juice or cherry pop color blood may appear translucent

dialysate circuit

dialystate temperature dialysis conductivity blood leaks into the dialysate dialyzer clearance (optional software)

external transducers protectors

external wet transducers protectors can cause pressure reading errors and TMP alarms the biggest risk of wet transducer is infection *change them right away *inspect the back of the external transducer protector for contamination if there is fluid in the monitor line if the back is wet, the machine needs to be inspected by technical department

what is the symptoms of hypokalemia

fatigue weak muscles change in heart rhythm

Improperly mixed dialysate such as too dilute, a hypotonic solution can cause a condition called

hemolysis

heparin pump

heparin is an anticoagulant and it prevents clotting in the extracorporeal blood circuit it allows for intermittent or continuous infusions

what are the causes of crenation?

hypertonic dialysate machine malfunction resulting in blood contact with hypertonic dialysate (dialysate made with less water)

What are the causes of hemolysis?

hypotonic dialysate (diluted with too much water) overheated dialysate chemical exposure such as bleach excessive negative arterial pressure

extracorporeal circuit

it carries the blood from the patient's access to the dialyzer and back to the access

Transmembrane pressure (TMP)

it governs how much water is forced across the membrane Currently machine calculate the TMP, when the desired water removal and treatment time the machine displays the TMP

level detector/ venous line clamp

it is the patient's last line fo defense against air in the blood complications level detector continuously monitors the blood level and the presence of air in the venous chmaber the venous line has to be placed in the vvenous line clamp in order to work

3K bath

less potassium is removed and slower

blood flow rate

machine displays the blood pump setting the BFR is prescribed by the physician the quality and condition of the vascular access has to be taken into consideration when priming the system, there is an expected blood flow rate

pH of dialysis

measured independently with a pH Meter prior to every treatment pH range must be between 6.9 to 7.6

how do we monitor that properly mixed dialysate is getting to the patient?

monitoring the conductivity and pH of the dialysate prior to every treatment

blood pump

moves blood from the patient's arterial access through the tubing to the dialyzer and then back to the venous access the speed of the roller head control the BFR pump is calibrated for specific tubing diameter blood flow rate is prescribed by physician

symptoms of crenation

nausea headache profound thirst hypernatremia (high sodium level) hypercalcemia (high calcium level) convulsions coma death

Hypokalemia

not enough potassium in the blood Due to diarrhea, vomitting

How do we prevent hemolysis and crenation?

perform all machine checks and respond to machine alarms as they occur check conductivity prior to treatment with an independent meter use isotonic (same concentration) priming solution, 0.9% sodium chrloride test bypass mechanism alarm prior to treatment test for disinfectants prior to first use of machine daily

Who prescribe the dialysate?

physician

Hemolysis

rupture of red blood cells resulting in the liberation of hemoglobin, potassium and other cell contents in to the serum

optical detecot

senses blood in the line if treatment starts without venous bloodline placed in the optical detector the machine will trigger an audible alarm noblood sense

crenation

shriveling of red blood cells

Bicarbonate concentrate contains

sodium bicarbonate sodium chloride

What is dialysate?

solution used to clean the patient's blood made of an acidified salt solution referred to as acid concentrate, bicarbonate concentrate and RO water contains essential electrolytes to ensure patient's electrolytes are not depleted during dialysis *electrolyte levels of dialysate are close to serum levels to avoid too rapid of a change that would harm the patient

1K bath

take more potassium and faster

Blood tubing

takes blood from the patient's access (arterial) to the dialyzer and back to the patient access (venous) approximately 160 to 250 mL of blood outside the patient's body at any time Smooth on the inside to reduce clotting and formation of air bubbles

ultrafiltration(UF) control

taking excess water out of the blood is a key part of dialysis UF occurs when pressure on the blood side of the membranes higher than on the dialysate side the blood side is always positive, the dialysate pressure can be positive or negative

conductivity

the amount of electrical current conducted through a dialysate and reflects electrolyte connection

UF volume (goal)

the amount of water that must be removed in a single treatment to return a patient to the target (or base) weight

UF rate

the speed at which that volume is removed

Temperature of dialysate

too hot that is warmer than 40 degree = hemolysis too cold = patient discomfort dialysate is kept at 37 degree for patient comfort and safety unless no physician order

Hyperkalemia

too much potassium in the blood due to diet with high potassium foods, GI bleed

what is the signs of crenation?

very dark blood

what is the symptoms of hyperkalemia?

weak muscles skipped heart beats change in heart rhythm belly cramps

venous line clamp/ optical detector

when air is sensed by the level detector, will trigger audible and visual alarm blood pump stops, venous line clamped automatically * the line clamp shuts, blood pump stops to prevent air infusion into patient