end-stage renal disease
DESCRIPTION
TRANSCRIPT
MICHELLE WILKINSRN/CNERENAL UNIT SEPT 09
WORKING ALONGSIDE ESRD
HAEMODIALYSIS FOCUS
OVERVIEW
• Renal Function
• Haemodialysis – on paper
• Haemodialysis – the reality
• Conclusion
KIDNEYSTo excrete:Metabolic wastes
To regulate: Body water volume electrolyte balance/acid base balance
Metabolic: Activate Vit D. Renin production. Epoetin production.
Remember Renal function
=
Remove & Regulate
KIDNEY FAILURE
• Toxins - ↓ efficiency of blood clearance
• Assessed by measuring urea and creatinine• Urea- Is a waste product produced by the
liver (subjective symptoms)• Creatinine is a substance created by the
muscles
HAEMODIALYSIS (Blood = filtration)
•Removal of excess water - ultrafiltration •Reversal of Metabolic acidosis - buffer system
•Removal of waste products - diffusion
HAEMODIALYSISTo excrete:
Metabolic wastes √To regulate: Body water volume electrolyte balance/acid base
balance √
Metabolic: Activate Vit D. Renin production. Epoetin
production. X
HISTORY:•1924: George Haas (German) 1st successful human dialysisDialysis - 15 minutes – “no complications occurred”
•1943: WJ Kolff and H Berk (Netherlands) developed 1st practical human HD machineA rotating drum artificial kidney (30-40m cellophane tubing in a stationary 100-litre tank)
Kolff made clinicians interested in treatment of uraemia
1943 1990,s
HOW DOES HAEMODIALYSIS WORK?
•The process of dialysis occurs using a dialysis machine
•Blood from the client is pumped through an artificial kidney (filter) on the machine
•Dialysis fluid (dialysate) / ultrapure H20 / bicarbonate buffer
ACCESS
ARTERIOVENOUS FISTULA- (AVF)- Vein and artery joined together surgically
allowing arterial blood to flow through the vein causing venous engorgement and enlargement
- Matured for use at approx 6 weeks- Gauge of needles 17,16,15,14- Use of local anaesthetic
Brachial vein
Brachial artery
ACCESS SURGERY
A NEEDLED AV FISTULA
Aneurysed area
Venous site
Arterial Site
PTFE/GRAFT• Alternative option to AVF re poor forearm veins PTFE/Teflon material - inserted and joined at the side of the vein or artery, to minimize the interference with blood flow through the native vessels.• Useable at 2 weeks• 2ND choice to AVF ( lifespan)
CENTRAL VENOUS CATHETERS
• FEMORAL LINE – acute/urgent temporary access – no > 72hrs insitu
• INTERNAL JUGULAR (IJ) CATHETERS - temporary access – usually no > 2 weeks insitu
• TUNNELED CUFFED CATHETER- are used for longer term treatment ( new start without vascular access / issues with vascular access / vascular system unsuitable for creation of AVF or graft / waiting for AVF/ graft to mature)
•CXR post insertion• Extension sets / guidewires
Tunnelled Central Venous Catheters
IJ Placement
Finished Look
Dressing & Safety Label
LIVING WITH HAEMODIALYSIS
• Life style changes• Complications- Bp changes - Fluid overload - Hyperkalaemia - Access - Infection• Decisions for some to continue treatment?
THE LIFE OF A DIALYSIS PATIENT
Dialysis pts do not lead a normal life:
• HD minimum of 3x weekly tied (literally) to a machine• APD tied nightly to a machine• CAPD - repetitive ritual of exchanges• Choices removed• Dependent on a procedure/others
STRESSORS & SUPPORTS
• Medication intake routine• Diet, fluid restrictions• Dialysis & Illness• Losses- job, freedom, life term• Sexual dysfunction• MDT • Personality & Mental status• Family/friend supports
FOR EXAMPLE…
•ESRD DUE TO DIABETES
•FAMILY MAN
•LIVES RURAL/TRAVELS TO DIALYSIS
•NON-COMPLIANCE WITH MEDS
CONCLUSION POTENTIAL PERCEPTIONS:
• Clients will/should want to comply to dialyse 3x week – dialyse vs. die
• Clients / family may have to travel many kilometres for treatment but this is paid for – they are lucky
• Non-compliance means not interested in own wellbeing / not wanting to take part in their own care – true/false?
Vs. PT PERCEPTION
• “When I first got the letter telling me I needed dialysis. I tried to hide it. I felt like I was half a person, I was disabled. I wanted to just give up. I didn’t want to depend on a machine. I didn’t know what to do.”
• “When I found out I had a kidney problem and required dialysis; I was more shattered than anything else. I was frightened. I ran away for as long as I could.”
• “It was a shock finding out I had kidney failure. I was too sick at that point to try to run away from it. I didn’t want to go on dialysis. It’s terrible to have renal failure.”
“I felt we would never cope with the complicated machine, but the renal nurses teaching soon got us feeling more confident every session. When it was time for us to go it alone, panic struck at the beginning we were constantly (it seemed) phoning with queries, & they told us what to do and it always worked. Now dialysis is no longer something to dread, but has just become a way of life”
PROGRESSING TO…
REALITY
Outsiders potential perception vs. patient potential perception =
Can be so different - highlights the need to sit down with your clients / work with them and really understand what barriers they encounter and how they are feeling
REFLECTION
• Renal Function
• Haemodialysis – on paper
• Haemodialysis – the reality
LIVE TO DIALYSE vs. DIALYSE TO LIVE
REFERENCES• Dr Andy Stein & Janet Wild, RGN, 2007 Kidney Failure Explained- Third Edition
2007, chapters 1, What is Kidney Failure, pg’s 1-11, chapter 2, Toxin ‘Clearance’ pages 12-18, chapter 10 Haemodialysis, pg’s 66-84
• Website www.kidneypatientguide.org.uk• Shih, Li Chin 2009 Impact of Dialysis on Rurally Based Mäori Clients and Their
Whänau – Facing Fear Pg 40 • History of Dialysis -
http://www.discoveriesinmedicine.com/Apg-Ban/Artificial-Kidney.html• Photographs – dialysis machine/ AVF/ CVL – results of my newly acquired IT
skills• Acknowledgements to Lisa Harvey Jack (CNM) , Rey Tuando, Imelda Aying for
support and use of resources'