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Renal Replacement Therapy (RRT) Choices available to patients who have failing kidneys Debbie Jones RN CNeph(C)

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Presentation on theme: "Renal Replacement Therapy (RRT) Choices available to patients who have failing kidneys Debbie Jones RN CNeph(C)"— Presentation transcript:

1 Renal Replacement Therapy (RRT) Choices available to patients who have failing kidneys Debbie Jones RN CNeph(C)

2 Objectives At the end of this presentation the learner will be familiar with: The stages of progressive renal failure The stages of progressive renal failure The renal replacement therapies available to patients in North Bay and surrounding district who have either acute or chronic kidney failure The renal replacement therapies available to patients in North Bay and surrounding district who have either acute or chronic kidney failure The types of accesses required for peritoneal and hemodialysis The types of accesses required for peritoneal and hemodialysis

3 Primary Functions of the Kidney Removal of metabolic wastes, drugs and other toxins Removal of metabolic wastes, drugs and other toxins Fluid Balance Fluid Balance Electrolyte Balance Electrolyte Balance Acid-Base Regulation Acid-Base Regulation Blood Pressure Control Blood Pressure Control Hormone Production ~ Erythropoietin, Vitamin D (Calcitriol), Renin Hormone Production ~ Erythropoietin, Vitamin D (Calcitriol), Renin “Master Chemists of the Body”

4 Sidney the Kidney

5 Stages Of Chronic Kidney Disease

6

7 Causes of Acute Kidney Failure: Pre-renal factors Intra-renal & Nephrotoxic factors Post-renal factors

8 Causes of Chronic Kidney Disease: Diabetes Diabetes Hypertension Hypertension Renal vascular disease (also generalized vascular disease) Renal vascular disease (also generalized vascular disease) Nephritis Nephritis Pyelonephritis & chronic UT I Pyelonephritis & chronic UT I Polycystic kidney disease Polycystic kidney disease Renal Neoplasms Renal Neoplasms Analgesic nephropathy Analgesic nephropathy Immunological disorders: Lupus, Goodpasture syndrome, scleroderma Immunological disorders: Lupus, Goodpasture syndrome, scleroderma Metabolic disorders: gout Metabolic disorders: gout Nephrotic Syndrome  primary or secondary Nephrotic Syndrome  primary or secondary

9 Does everyone understand how important we are? Kidneys Urine

10 Types of Dialysis Dialysis is a way to clean blood of wastes, fluids and salts that build up in the body when the kidneys fail. There are 2 kinds of Dialysis: Peritoneal Dialysis: Peritoneal Dialysis: Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and lines the abdominal wall. This takes place inside the body and requires placement of a catheter in the peritoneal cavity to allow fluid to be instilled and drained out. Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and lines the abdominal wall. This takes place inside the body and requires placement of a catheter in the peritoneal cavity to allow fluid to be instilled and drained out. Hemodialysis: Hemodialysis: Uses a dialyzer or artificial kidney to filter the blood. This takes place outside the body and requires some form of access to the circulatory system. Accomplished with the use of a sophisticated computerized control unit (dialysis machine ) Uses a dialyzer or artificial kidney to filter the blood. This takes place outside the body and requires some form of access to the circulatory system. Accomplished with the use of a sophisticated computerized control unit (dialysis machine )

11 Other choices kidney transplantation: kidney transplantation: To be placed on a transplant list the patient must be on some form of renal replacement therapy, whether it is peritoneal dialysis or hemodialysis To be placed on a transplant list the patient must be on some form of renal replacement therapy, whether it is peritoneal dialysis or hemodialysis Once a patient is accepted for transplant, the date of start of dialysis is the date they are active on the list Once a patient is accepted for transplant, the date of start of dialysis is the date they are active on the list If the patient has a living donor who has been accepted as healthy donor, it is possible to have a pre-emptive transplant, bypassing dialysis. If the patient has a living donor who has been accepted as healthy donor, it is possible to have a pre-emptive transplant, bypassing dialysis. No treatment or palliative care No treatment or palliative care

12 Peritoneal Dialysis Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and lines the abdominal wall. The membrane size is 1 – 2 m 2 and approximates the body surface area. Uses the following principles: Uses the peritoneal membrane as the filter. The membrane covers the abdominal organs and lines the abdominal wall. The membrane size is 1 – 2 m 2 and approximates the body surface area. Uses the following principles: Diffusion: movement of solutes across the peritoneal membrane from an area of higher concentration to an area of lower concentration Diffusion: movement of solutes across the peritoneal membrane from an area of higher concentration to an area of lower concentration Osmosis: movement of water across the peritoneal membrane from an area of lower solute concentration to an area of higher solute concentration. Osmosis: movement of water across the peritoneal membrane from an area of lower solute concentration to an area of higher solute concentration. Ultrafiltration: water removal related to an osmotic pressure gradient with the use of various concentrations of dialysate fluid Ultrafiltration: water removal related to an osmotic pressure gradient with the use of various concentrations of dialysate fluid

13 How does PD work? Fluid called DIALYSATE is put into the abdomen through a PD catheter. This fluid is left to dwell in the peritoneum for several hours. Fluid called DIALYSATE is put into the abdomen through a PD catheter. This fluid is left to dwell in the peritoneum for several hours. While in the abdomen, the fluid collects wastes that have been filtered through the peritoneal membrane. These wastes pass from the body when the fluid is drained. While in the abdomen, the fluid collects wastes that have been filtered through the peritoneal membrane. These wastes pass from the body when the fluid is drained.

14 Peritoneal Dialysis Performed daily, by the patient at home, more physiological Performed daily, by the patient at home, more physiological Allows for independence, patients can work or travel Allows for independence, patients can work or travel Fewer fluid and dietary restrictions Fewer fluid and dietary restrictions Often fewer medications or lower doses required Often fewer medications or lower doses required Residual renal function preserved Residual renal function preserved Ministry of Health funded home therapy Ministry of Health funded home therapy

15 Peritoneal Dialysis Patients must have a clean room to perform exchanges and a large enough area to store all supplies must have a clean room to perform exchanges and a large enough area to store all supplies no pets allowed in the room no pets allowed in the room must learn to monitor their own weight and blood pressures must learn to monitor their own weight and blood pressures must be able to follow important instructions to prevent infection in the peritoneum must be able to follow important instructions to prevent infection in the peritoneum must also be able to determine the choice of dialysate fluid and when to use it must also be able to determine the choice of dialysate fluid and when to use it

16 Peritoneal Dialysis

17 Peritoneal Dialysis Catheter

18 Types of Peritoneal Dialysis CAPD ~ Continuous Ambulatory Peritoneal Dialysis The blood is cleaned constantly by dialysate fluid while it is in the abdomen. The blood is cleaned constantly by dialysate fluid while it is in the abdomen. CAPD does not require the use of a machine, the exchanges are completed manually. CAPD does not require the use of a machine, the exchanges are completed manually. APD ~ Automated Peritoneal Dialysis Requires the use of a machine called a CYCLER Requires the use of a machine called a CYCLER The CYCLER is used during the night and is set to deliver the fluid in and out of the abdomen. The CYCLER is used during the night and is set to deliver the fluid in and out of the abdomen.

19 Hemodialysis Blood is circulated through an artificial kidney which has two compartments: Blood & Dialysate, separated by a thin semi-permeable membraneBlood is circulated through an artificial kidney which has two compartments: Blood & Dialysate, separated by a thin semi-permeable membrane Waste and excess water pass from the blood side to the dialysate side and is discarded in the drain The cleaned blood is returned to the patient.Waste and excess water pass from the blood side to the dialysate side and is discarded in the drain The cleaned blood is returned to the patient. It is diffusion-based mass transfer (BUN, Creat, lytes) & Pressure-driven water removal (ultrafiltration)It is diffusion-based mass transfer (BUN, Creat, lytes) & Pressure-driven water removal (ultrafiltration) usually done 3x /week ~ 4hrs M-W-F or T-Th-Satusually done 3x /week ~ 4hrs M-W-F or T-Th-Sat

20 Hemodialysis Hemodialysis treatments every other day are not as physiological as peritoneal dialysis Hemodialysis treatments every other day are not as physiological as peritoneal dialysis Requires a trip to the hospital up to 3 times weekly Requires a trip to the hospital up to 3 times weekly Patients can travel to other units but must be pre- arranged and space is not always available Patients can travel to other units but must be pre- arranged and space is not always available Patients are more restricted in dietary and fluid intake between treatments Patients are more restricted in dietary and fluid intake between treatments Medication requirements different than for those on peritoneal dialysis e.g. require more antihypertensive meds, higher doses of Erythropoietin Medication requirements different than for those on peritoneal dialysis e.g. require more antihypertensive meds, higher doses of Erythropoietin

21 Hemodialysis ~ The “Integra”

22 Hemodialysis Requires access to the blood stream Requires access to the blood stream Arterio – venous fistula Arterio – venous fistula Arterio – venous graft Arterio – venous graft Temporary catheter Temporary catheter Long – term catheter Long – term catheter

23 Hemodialysis ~ fistula

24 Hemodialysis ~ Graft

25 Temporary Hemodialysis Catheter Exit site at surface of the skin Tip located at junction of SVC and right Atrium Inserted in the jugular vein

26 Tunneled Hemodialysis Catheter Exit site Catheter tunnel Tip located at junction of SVC and right Atrium Inserted in the jugular vein Dacron cuff

27

28 Transplantation


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