DR.(LT. COL.)D. ACHARYA M.B.B.S.(KOLKATTA) M.S.(DELHI) P.G.D.H.H.M.(PUNE)

 DEALS WITH THE MEDICAL TREATMENT OF THE DISEASES OF THE KIDNEYS, URETER & URINARY BLADDER.  IT COMES UNDER THE PURVIEW OF THE SUPERSPECIALITY OF NEPHROLOGY.  AN IDEAL SUPERSPECIALIST –M.D.(MEDICINE) FOLLOWED BY D.M. IN NEPHROLOGY.  IN SOME CENTRES, THERE IS TRAINED MANPOWER IN THIS FIELD WHO ARE WORKING THERE BY VIRTUE OF SHEER EXPERIENCE, BUT NO D.M. DEGREE.  THERE IS PAUCITY OF TRAINED MANPOWER IN THIS FIELD IN INDIA.

 CURATIVE, PREVENTIVE & PALLIATIVE ROLE.  ESSENTIAL FOR PROLONGING LIFE.  DIALYSIS –MUST IN END STAGE RENAL DISEASE (ESRD).  INCIDENCE :260 CASES PER MILLION POPULATION PER YEAR.  MORTALITY RATES ARE VERY HIGH IN DEVELOPING COUNTRIES BECAUSE OF THE LIMITED AVAILABILITY OF DIALYSIS.

 IN INDIA, ARCHITECTS PLAN FOR DIALYSIS CAPABILITY ONLY IN THE RENAL DIALYSIS UNIT.  IN ANY MODERN HOSPITAL, THIS FACILITY IS USUALLY PROVIDED IN THE ICU OR IN CLOSE PROXIMITY TO ICU.  FACILTIES FOR KIDNEY TRANSPLANT HAS TO BE DESIGNED SPECIFICALLY & IN UNIQUELY SET OPERATING ROOMS.  THROUGH MECHANICAL, ELECTRICAL & PLUMBING IDENTIFICATION.  FOLLOW ALL OUTLINE SPECIFICATIONS.

 OVERALL CIRCULATION.  MOVT. OF SUPPLIES TO & FROM CSSD.  ZONING REQUIREMENTS.  REGULATE THE AIR FLOW.  STAFF CHANGE ROOMS.  SUITABLE FLOORING.  OTHER FINISHING MATERIALS FOR SUITABLE AREAS.  SPECIFIC ROOM SUPPORT SYSTEMS.

 ICU.  CLOSE TO ICU.  ACCESSIBLE FROM CASUALTY.  ACCESSIBLE FROM C.S.S.D.  PT. SHOULD BE EASILY SHIFTED TO OPERATING ROOMS.  WAITING AREA FOR PT.’S ATTENDENTS.

 DIALYSIS MACHINE.  IN SOME PTS. THE INABILITY TO OBTAIN VASCULAR ACCESS NECESSITATES A SWITCH FROM HAEMODIALYSIS TO PERITONEAL DIALYSIS.  THERE ARE THREE COMPONENTS FOR DIALYSIS- THE DIALYZER, THE COMPOSITION & DELIVERY OF THE DIALYSATE & THE BLOOD DELIVERY SYSTEM.

 INDIVIDUAL ROOMS WITH FULL HEIGHT GLASS WALLS BETWEEN THE ROOMS & CORRIDORS.  PRIVACY –FOR MALES & FEMALES – CURTAINS.  ENTRANCE DOORS SHOULD BE 1.21m. WIDE FOR EASY MOVT. OF BEDS & EQUIPMENTS.  MECHANICALLY OR ELECTRICALLY OPERATED BEDS WITH A LOCKING DEVICE & DETACHABLE SIDE RAILINGS.  ELECTRICAL OUTLETS FOR VARIOUS SERVICES.

 NURSES –IDEAL IS 1:1.  ALTERNATIVELY 1:3.  DIALYSIS TECHNICIAN –MAY BE ON CALL.  TRAINED R.M.O.’S.  MEDICAL SPECIALIST ON ROUNDS.  I.C.U. –M.O./IN –CHARGE.  NEPHROLOGIST HAS FINAL SAY ON MATTERS RELATING TO NEPHROLOGY /DIALYSIS UNITS.

 HANDS ON TRAINING FOR REGULAR M.O.’S OF THE HOSPITAL.  DIALYSIS TECHNICIAN SHOULD BE FAMILIAR WITH THE DIALYSIS MACHINE.  EITHER TECHNICIAN IS ON REGULAR ROLLS OR ON CALL BASIS.  LIST OF ALL PTS. OF ESRD UNDERGOING DIALYSIS SHOULD BE MAINTAINED.  DIALYSIS REGISTER IN ICU/NEPHROLOGY DEPTT. IS A MUST.

 ACCESSIBILITY OF CRASH CARTS FOR ANY SORT OF EMERGENCY.  ALL SUPPLIES NECESSARY TO RE-STOCK THE CARTS SHOULD BE IN ACLEAN UTILITY ROOM.  THERE SHOULD BE A SEPARATE DRUG CABINET OF THE UNIT.  ACCESS TO REGULAR SUPPLY OF DISTILLED WATER /WATER TREATED BY REVERSE OSMOSIS.  SOP’S FOR DIALYSIS PTS. HAS TO BE LAID OUT & IT HAS TO BE STRICTLY ADHERED TO.

 SOLUTE HCO3-DIALYSATE SODIUM(meq/L)…………………  POTASSIUM (meq/L)………………  CHLORIDE (meq/L)………………  CALCIUM (meq/L)………………  MAGNESIUM (meq/L)……………  ACETATE (meq/L)…………………  BICARBONATE (meq/L)…………  GLUCOSE (g/L)……………………

 PT. SATISFACTION LEVEL.  INCIDENCE OF COMPLICATIONS.  INCIDENCE OF POST DIALYSIS SIDE EFFECTS –ANAEMIA, NUTRITIONAL DEFICIENCIES.  INCIDENCE OF CROSS INFECTION(<2%)  PERCENTAGE OF PTS. WHO RECEIVED ADEQUATE DIALYSIS TREATMENT – CONFIRMED FROM REDUCTION OF LEVEL OF UREA & CREATININE(UPTO 65%) & BODY WEIGHT.

 ADEQUACY OF THE DELIVERED HAEMODIALYSIS DOSE AS MEASURED MONTHLY.  PT. SURVIVAL RATE –MAY BE > 10YRS.  PRITONEAL DIALYSIS DOSE (IF APPLICABLE) & TOTAL SOLUTE CLEARANCE MEASURED REGULARLY.  COST OF SERVICES.  UNLESS THE SERVICE IN THE DIALYSIS DEPTT. IS OF ACCEPTABLE STANDARDS, MOST OF THE PTS. MAY NOT PATRONIZE THE HOSPITAL AS THEY ARE AMBULATORY.

 PLEASE READ IN BRIEF ABOUT THE FOLLOWING ALTHOUGH IT IS NOT IN YOUR SYLLABUS BUT IT WILL BE USEFUL TO YOU DURING YOUR WORK IN HOSPITALS AFTER YOU GRADUATE:-  RENAL TRANSPLANT  NEPHRECTOMY  EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL).  TRANS URETHRAL RESECTION OF PROSTATE (TURP) & OPEN PROSTATECTOMY (KILLIAN’S)  DORNIER BASKET –LITHOTRIPTER.