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