Hemodialisis (cuci darah) adalah sebuah terapi . Kata ini berasal dari kata haemo yang berarti darah dan dialisis yang berarti dipisahkan. Hemodialisis merupakan salah satu dari Terapi Penggganti Ginjal, yang digunakan pada penderita dengan penurunan fungsi gingjal, baik akut maupun kronik. Perinsip dasar dari Hemodialisis adalah dengan menerapkan proses dufusi dan ultrafiltrasi pada ginjal buatan, dalam membuang sisa-sisa metabolisme tubuh. Hemodialisis dapat dikerjakan untuk sementara waktu (misalnya pada Gagal Ginjal Akut) atau dapat pula untuk seumur hidup (misalnya pada Gagal Ginjal Kronik). Pada dasarnya untuk dapat dilakukan Hemodialisa memerlukan alat yang disebut ginjal buatan (dialiser), dialisat dan sirkuit darah. Selain itu juga diperlukan akses vaskuler.

http://id.wikipedia.org/wiki/Hemodialisis

Hemodialisis (HD) adalah cara pengobatan / prosedur tindakan untuk memisahkan darah dari zat-zat sisa / racun yang dilaksanakan dengan mengalirkan darah melalui membran semipermiabel dimana zat sisa atau racun ini dialihkan dari darah ke cairan dialisat yang kemudian dibuang, sedangkan darah kembali ke dalam tubuh sesuai dengan arti dari hemo yang berarti darah dan dialisis yang berarti memindahkan.

Indikasi HD

A. Segera

Encephalopathy, pericarditis, neouropati perifer, hiperkalemi dan asidosis metabolic, hipertensi maligna, edema paru, oligouri berat atau anuri.

B. Dini atau profilaksis

1. Sindroma uremia, penyakit tulang, gangguan pertumbuhan.

2. Laboratoriun abnormal : asidosis metabolic, azotemia (kreatinin 8 – 12 mg%, BUN 100 – 120 mg%, CCT kurang dari 5 – 10 mL.menit)

Komplikasi HD

Beberapa komplikasi selama dialysis (intra dialysis) tidak jarang ditemukan dan mengganggu kenyamanan pasien hemodialisis

1. Hipotensi

2. Kram otot

3. Mual dan muntah

4. Sakit kepala

5. Sakit dada

6. Sakit pinggang

7. Gatal-gatal

8. Febris

Follow up Jangka Panjang

Pengawasan jangka panjang setiap apsien HD reguler sangat penting karena HD reguler ini dapat mempengaruhi kualitas hidup optimal. Pengawasan tersebut berhubungan dengan aspek medis, social dan professional, psikologis.

1. Aspek medis

Gangguan endokrin, malnutrisi, defisiensi imun, anemia, gangguan system kardiovaskuler dan metabolisme.

2. Aspek social dan professional

Kehilangan jam kerja 10 – 12 jam per minggu, kehilangan pendapatan, biaya pengobatan yang tinggi, dsb.

3. Aspek psikologis

Sering terjadi perubahan kepribadian, cenderung depresi, dsb.

PROSES HEMODIALISA

I. Pra Hemodialisa

A. Hal-hal yang perlu diperhatikan sebelum menyiapkan mesin HD :

v Mesin diperiksa harus dalam keadaan siap pakai.

v Hubungkan mesin dengan aliran listrik.

v Hubungkan mesin dengan saluran air.

v Drain line ditempatkan di saluran pembuangan tidak dalam keadaan tersumbat.

v Jerigen tempat cairan dialisat terisi sesuai jumlah yang dibutuhkan untuk satu kali dialisa.

B. Menyiapkan dialisat

Dialisat adalah cairan yang digunakan pada proses HD, terdiri dari camuran air dan elektrolit yang mempunyai konsentrasi hampir sama dengan serum normal dan mempunyai tekanan osmotic yang sama dengan darah.

Fungsi Dialisat :

v Mengeluarkan dan menampung cairan serta sisa-sisa metabolisme dari tubuh.

v Mencegah kehilangan zat-zat vital dari tubuh selama dialisa

Dialisat :

v Dialisat konsentrat

Berisi larutan pekat, sebelum dipakai harus dicampur kontinyu dalam perbandingan tertentu oleh mesin.

· Mudah pemakaiannya.

· Kesalahan pengenceran sangat kecil.

· Sulit transport dan penyimpanan.

v Bentuk kering atau puyer.

· Mudah menyimpan.

· Sulit mendapatkan komposisi yang benar.

Kandung Cairan Dialist :

Dialisat mengandung macam-macam garam / elektrolit / zat antara lain :

1. NaCl / Sodium Chloride.

2. CaCl2 / Calium Chloride.

3. Mgcl2 / Magnesium Chloride.

4. NaC2H3O2 3H2O / acetat atau NaHCO3 / Bilkarbonat.

5. KCl / potassium chloride, tidak selalu terdapat pada dialisat.

6. Dextrose.

Menyiapkan / mencampur Dialisat

1. Batch Sistem

Sebelum HD dimulai, dialisat disiapkan dulu dalam suatu tempat dengan jumlah tertentu sesuai kebutuhan.

2. Proportioning system.

Adalah system penyediaan dialisat dimana dialisat dibuat / dicampur secara otomatis oleh mesin selama HD berlangsung.

- DBC / Dialysate Batch Concentrate dan air dicampur dengan perbandingan tertentu.

- Biasanya perbandingan air : DBC adalah 34 : 1.

C. Menyiapkan Air

Air untuk dialisat seharusnya tidak mengandung zat / elektrolit / mikroorganisme dan benda asing lainnya karena itu untuk mendapatkan air yang ideal untuk dialysis maka dilakukan tindakan pengolahan air / water treatment.

Pengolahan air / water treatment :

1. Saringan / filter

a. Penyaring sedimen, untuk menyaring partikel.

- Pre filter (100 U)

- Sebelum masuk ke mesin HD (5 U)

- Sebelum masuk selang dialyzer (1 U)

b. Penyaring penyerap / adsorption filter

- Arang / carbon : untuk menyerap zat-zat chlorine bebas, chloraming, bahan organic atau pyrogen.

- Besi : untuk menyerap besi dan mangan.

Alat ini harus sering dibersihkan atau diganti secara berkala.

2. Sistem Reverse Osmosis

Air dengan tekanan cukup tinggi dialirkan melalui alat yang mempunyai membran semi permeable sehingga dihasilkan air yang murni bebas (kesadahan / CaCO kurang dari 1,8 mg/L).

Sistem pengolahan air ini cukup mahal, sehingga tidak semua unit HD dapat memilikinya.

D. Menyiapkan Alat-alat dan Obat-obatan

1. Peralatan kedokteran

· Tensimeter dan stetoscope

· Timbangan berat badan

· Tabung oksigen lengkap

· Alat KG

· Slym Zuiger

· Tromol (duk, kassa, klem)

· Bak spuit, kom kecil

· Korentang dan tempatnya

· Klem-klem (besar dan kecil)

· Gunting

· Bengkok

· Gelas ukuran

· Zeil / karet untuk alas tangan

· Sarung tangan

· Kassa

· Plester / band aid

· Verband

2. Alat-alat khusus

Dyalizer

· Blood line

· AV fistula

· Dialisat pekat

· Infus set

· Spuit 1 cc, 3 cc, 20 cc.

· Conducturty meter

3. Obat-obatan

· Lidocain, novocain

· Alcohol, betadin

· Heparin, protamin

· Sodium bikarbonat

· Obat-obatan penyelamat hidup

4. Lain-lain

· Surat izin dialysis

· Formulir hemodialisa

· Treveling hemodialisa

· Traveling dialysis

· Formulir-formulir : laboratorium, radiology dan lain-lain

E. Menjalankan Mesin HD

1. Periksa saluran listrik dan saluran air

2. Hubungkan slang water inlet ke kran air dan slang water outlet ke lubang pembuangan

3. hubungkan kabel power dengan stop kontak

4. siapkan cairan dialisat dalam jerigen sebanyak yang dibutuhkan, perhatikan cairan yang diperlukan apakah standar atau free potassium

5. Hidupkan mesin dengan posisi rinse selama 15 menit, bila mesin mengandung formalin, maka posisi rinse lebih lama (30 menit)

6. Setelah rinse selesai, masukan slang untuk concentrate ke dalam jerigen dialisat.

7. Lampu temperatur, lampu conductivity dan lampu concentrate di mesin akan warna merah, tunggu lampu 2 tersebut sampai warna hijau.

8. Pindahkan tombol ke posisi dialisa bila lampu sudah berwana hijau.

9. Mesin HD siap digunakan.

F. Menyiapkan Sirkulasi Darah

Yaitu menyiapkan dialyzer dan blood lines pada mesin HD

Hal-hal yang harus dilakukan :

1. Soaking yaitu melembabkan dialyzer (hubungkan dialyzer dengan sirkulasi dialisat).

2. Rinsing yaitu membilas dialyzer dan blood lines

3. Priming yaitu dialyzer dan blood lines.

G. Menyiapkan pasien

1. Persiapan mental

· Memberitahu pada pasien bahwa akan dilakukan HD

· Memberi penjelasan dan motivasi mengenai proses HD dan komplikasi yang mungkin terjadi selama HD.

2. Persiapan fisik

· Menimbang berat badan

· Observasi keadaan umum

· Observasi tanda-tanda vital

· Mengatur posisi

3. Mengisi izin hemodialisa

· Izin / persetujuan HD

· Harus tertulis

· Pasien dan keluarga harus mendapatkan infomasi yang jelas tentang HD

· Izin HD merupakan dasar pertanggung jawaban yang sah bagi dokter kepada pasien dan keluarga.

· Surat izin HD disimpan pada rekam medis

II. PROSES PELAKSANAAN HEMODIALISA

1) Menyiapkan sarana hubungan sirkulasi

Untuk menghubungkan sirkulasi darah dari mesin dengan sirkulasi sistemik dilakukan dengan :

a. Cara Sementara

Yaitu punksi V femoralis untuk inlet dan untuk outlet dapat dipilih salah satu vena di tangan.

b. Cara permanent

Yaitu dengan membuat shunt antara lain

· c mino shunt

· seribner shunt

2) Antikoagulansia

Yaitu obat yang diperlukan untuk mencega pembekuan darah selama HD. Obat yang digunakan adalah heparin.

Pemakaian heparin :

§ Intermiten : diberikan selama 1 jam

§ Continous : terus-terusan selama HD berjalan

§ Minimal : diberikan pada waktu menyiapkan sirkulasi darah

§ Regional : pada ABL diberikan heparin pada BL diberikan protamin

Dosis heparin : 1000 unit / jam

Dosis awal : diberikan pada waktu punksi ke sirkulasi sisemik dan pada waktu darah mulai ditarik.

Dosis selanjutnya diberikan ke sirkulasi ekstra corporeal

III. POST HEMODIALISA

A. Persiapan Untuk mengakhiri HD

o Alat/obat yang disiapkan

o Deppers

o Bethadin

o Plester

o Alat penekan

o Sarung tangan

o Ember

B. Hal-hal yang dilakukan setelah HD selesai

Setelah HD selesai maka mesin harus dibersihkan baik bagian diluar maupun dalam. Cara membersihkan :

1. Bagian luar mesin

Seluruh permukaan dan slang dialisat bagian luar dilap dengan larutan chlorine 0,5 % lalu dilap basah dan dikeringkan.

2. Bagian dalam mesin

Disesuaikan dengan protocol pembersihan masing-masing tipe mesin

DAFTAR PUSTAKA

Beti Budiwangsih, Persiapan Tindakan Hemodialisis, RSUP Dr. Hasan Sadikin

Eddy Harjadi S. Hemodialisis, RS. Dustira

Enday Sukendar, Gagal Ginjal Kronik dalam Nefrologi Klinik Bandung Penerbit ITB. Edisi II, 1997

Hendro Sujono Y., “Vascular access” untuk Hemodialisa

http://3rr0rists.net/medical/hemodialisis.html

Hemodialisis adalah sebuah terapi medis. Kata ini berasal dari kata haemo yang berarti darah dan dilisis yang berarti dipisahkan. Hemodialisis merupakan salah satu dari Terapi Pengganti Ginjal, yang digunakan pada penderita dengan penurunan fungsi ginjal, baik akut maupun kronik. Hemodialisis dapat dikerjakan untuk sementara waktu (misalnya pada Gagal Ginjal Akut) atau dapat pula untuk seumur hidup (misalnya pada Gagal Ginjal Kronik).

Hemodialisis berfungsi membuang produk-produk sisa metabolisme seperti potassium dan urea dari darah dengan menggunakan mesin dialiser. Mesin ini mampu berfungsi sebagai ginjal menggantikan ginjal penderita yang sudah rusak kerena penyakitnya, dengan menggunakan mesin itu selama 24 jam perminggu, penderita dapat memperpanjang hidupnya sampai batas waktu yang tidak tertentu.

Prinsip dari Hemodialisis adalah dengan menerapkan proses osmotis dan ultrafiltrasi pada ginjal buatan, dalam membuang sisa-sisa metabolisme tubuh. Pada hemodialisis, darah dipompa keluar dari tubuh lalu masuk kedalam mesin dialiser ( yang berfungsi sebagai ginjal buatan ) untuk dibersihkan dari zat-zat racun melalui proses difusi dan ultrafiltrasi oleh cairan khusus untuk dialisis (dialisat). Tekanan di dalam ruang dialisat lebih rendah dibandingkan dengan tekanan di dalam darah, sehingga cairan, limbah metabolik dan zat-zat racun di dalam darah disaring melalui selaput dan masuk ke dalam dialisat. Proses hemodialisis melibatkan difusi solute (zat terlarut) melalui suatu membrane semipermeable. Molekul zat terlarut (sisa metabolisme) dari kompartemen darah akan berpindah kedalam kompartemen dialisat setiap saat bila molekul zat terlarut dapat melewati membran semipermiabel demikian juga sebaliknya. Setelah dibersihkan, darah dialirkan kembali ke dalam tubuh.

Mesin hemodialisis (HD) terdiri dari pompa darah, sistem pengaturan larutan dialisat, dan sistem monitor. Pompa darah berfungsi untuk mengalirkan darah dari tempat tusukan vaskuler ke alat dializer. Dializer adalah tempat dimana proses HD berlangsung sehingga terjadi pertukaran zat-zat dan cairan dalam darah dan dialisat. Sedangkan tusukan vaskuler merupakan tempat keluarnya darah dari tubuh penderita menuju dializer dan selanjutnya kembali lagi ketubuh penderita. Kecepatan dapat di atur biasanya diantara 300-400 ml/menit. Lokasi pompa darah biasanya terletak antara monitor tekanan arteri dan monitor larutan dialisat. Larutan dialisat harus dipanaskan antara 34-39 C sebelum dialirkan kepada dializer. Suhu larutan dialisat yang terlalu rendah ataupun melebihi suhu tubuh dapat menimbulkan komplikasi. Sistem monitoring setiap mesin HD sangat penting untuk menjamin efektifitas proses dialisis dan keselamatan.

Dialisator tersedia dalam berbagai jenis ukuran. Dialisator yang ukurannya lebih besar mengalami peningkatan dalam membran area, dan biasanya akan memindahkan lebih banyak padatan daripada dialisator yang ukurannya lebih kecil, khususnya dalam tingkat aliran darah yang tinggi. Kebanyakan jenis dialisator memiliki permukaan membran area sekitar 0,8 sampai 2,2 meter persegi dan nilai KoA

memiliki urutan dari mulai 500-1500 ml/min. KoA yang dinyatakan dalam satuan ml/min dapat diperkirakan melalui pembersihan maksimum dari dialisator dalm tekanan darah yang sangat tinggi dari grafik tingkat alirannya. Secara singkat konsep fisika yang digunakan dalam hemodialisis adalah konsep fluida bergerak. Syarat fluida yang ideal yaitu cairan tidak viskous (tidak ada geseran dalam), keadaan tunak (steady state) atau melalui lintasan tertentu, mengalir secara stasioner, dan tidak termampatkan (incompressible) serta mengalir dalam jumlah cairan yang sama besarnya (kontinuitas).

Hemodialisis mempunyai beberapa keuntungan,diantaranya sebagai berikut :

1. Tidak ada nyeri/sakit selama prosedur. 2. Dilaksanakan secara santai, pasien bisa sambil makan/nonton TV, baca buku dll.3. Hemodialisis sebagai terapi dapat meningkatkan kualitas hidup pasien dan memperpanjang

usia.Namun, tindakan itu tak bebas risiko. Selain kesiapan tenaga kesehatan di unit dialisis untuk mengatasi komplikasi, kesiapan pasien secara psikologis dan dukungan keluarga berperan penting dalam keberhasilan hemodialisis.

4. Hemodialisis dapat sedini mungkin menghambat progresivitas penyakit. Yaitu, jika pengeluaran kreatinin 9-14 ml/menit/1,73 m2, baik pada penderita diabetes maupun nondiabetes. Hemodialisis bisa dimulai lebih awal pada pasien malnutrisi, pasien mengalami kelebihan cairan tubuh, penurunan kesadaran, kejang, radang kandung jantung, hiperkalemia (meningginya kadar kalium darah), serta asidosis metabolik berulang. Kreatinin adalah zat racun dalam darah, terdapat pada seseorang yang ginjalnya sudah tidak berfungsi dengan normal.

5. Hemodialisis dapat dilakukan pada pasien gagal ginjal akut dan gagal ginjal kronik6. Hemodialisis dapat dilakukan pada pasien gagal ginjal karena sumbatan batu yang akan

menjalani operasi dan pasien yang menunggu cangkok ginjal.

Banyak beberapa merk dialysis machine yang sudah dipakai di beberapa Rumah Sakit antara lain :

B Braun Fresenius Nipro Baxter Nikkiso

http://elektromedik.blogspot.com/2010/06/hemodialisis-cuci-darah.html

http://medical-dictionary.thefreedictionary.com/Hemodialisis

hemodialysis

Nephrology A therapeutic procedure for removing low-molecular-weight toxins by allowing the blood to flow past a semipermeable membrane where the toxins diffuse away from the blood

down a concentration gradient, either via an external AV shunt, or a surgically-placed AV fistula; hemodialysis is used in renal failure to ↓ BUN, creatinine, hyperkalemia and correct metabolic acidosis; prolonged dialysis results in a poor quality of life–anemia, infections, myalgia, peripheral neuropathy, cerebral edema, acute MI, aluminum toxicity, ergo renal transplants are always preferred to long-term hemodialysis Complications Pyogenic reactions due to gram-negative endotoxemia, with chills, fever, hypotension, nausea and myalgia, ↓ NK cell activity, ↓ serum calcitriol. See Dialysis dementia. Cf Hemapheresis.

removal of certain elements from the blood by virtue of difference in rates of their diffusion through a semipermeable membrane while the blood is being circulated outside the body. The procedure is used to remove toxic wastes from the blood of a patient with acute or chronic renal failure. See also kidney.

n a procedure in which impurities or wastes are removed from the blood. The patient's blood is shunted from the body through a machine for diffusion and ultrafiltration and returned to the patient's circulation. This procedure is used in treating renal failure and various toxic conditions. Without this, toxic wastes build up in the blood and tissues and cannot be filtered out by the ailing kidneys. This condition is known as uremia, which means “urine in the blood.” Eventually, this waste buildup leads to death. Dental treatment should occur within 24 hours of hemodialysis. See also kidney failure.

n mechanical process for removing waste products and impurities from the blood. Blood is drawn out and filtered through a dialysis machine and then reinfused. Often used in patients suffering from renal failure as well as other toxic blood conditions.

the use of principles of DIALYSIS for removal of certain elements from the blood while it is being circulated outside the body in a HEMODIALYZER or through the peritoneal cavity (see PERITONEAL DIALYSIS ). The procedure is used to remove toxic wastes from the blood of a patient with acute or chronic RENAL FAILURE . Called also dialysis, kidney dialysis, and renal dialysis. adj., adj  hemodialyt´ic.

Either the membrane lining the peritoneal cavity (in peritoneal dialysis) or a synthetic membrane (in extracorporeal hemodialysis) may be used as the dialyzing membrane. In the latter, the patient's blood is pumped from the arterial circulation through the hemodialyzer to the venous circulation. In the dialyzer, it flows past a cellulosic or synthetic semipermeable membrane while DIALYSATE fluid flows past the other side of the membrane. Small molecules and ions diffuse through the membrane, passing from the side on which the concentration is higher to the side on which it is lower. The dialysate fluid contains no UREA or CREATININE , so that these constituents are removed at maximum rates. The concentrations of electrolytes are adjusted according to the needs of the patient. If the patient has HYPERKALEMIA or HYPERNATREMIA , the excess ions of potassium or sodium are also removed. Other electrolytes are adjusted so that serum pH and electrolyte levels are not changed by the dialysis. Large molecules and blood cells cannot pass through the membrane and, therefore, stay in the blood.

Two commonly used accesses to the patient's vascular system are the external shunt and the internal arteriovenous (AV) fistula. An external shunt is usually indicated when dialysis must

begin immediately. It requires two lengths of specially prepared tubing; one for insertion in a vein and the other in an artery, usually in the forearm. Between dialysis treatments, the tubes are joined by a connector. Although the external shunt has the advantage of being immediately available for use in an emergency, it has the potential of becoming infected or obstructed with clots, and, if the integrity of the system is disrupted, rapid and copious blood loss may occur.

The internal AV fistula is surgically created by anastomosing an artery to a vein; that is, the vein is arterialized or made into a large superficial vessel that is easily accessible by venipuncture. The fistula must heal gradually and become mature before a cannula can be inserted. When END- STAGE RENAL DISEASE is inevitable, the fistula can be prepared months in advance for use when symptoms of UREMIA appear.PATIENT CARE. Hemodialysis treatments for chronic renal failure are usually done two to three times a week. The problems that a patient on hemodialysis may experience are fluid overload (HYPERVOLEMIA ), electrolyte imbalance, and alterations in blood components, leading to anemia or platelet abnormalities resulting in a tendency to bleed excessively. Another problem is infection, either of the access site and the blood or in the urinary or respiratory tract because of urinary or pulmonary stasis. Infection with human immunodeficiency VIRUS is also a possibility since blood has not always been routinely screened for this virus and clients may have been infected. Precautions must be taken when handling any blood products or the dialysis equipment.

Patients who depend on hemodialysis to prolong their lives require extensive instruction in the care of their cannulae and access sites. Some individuals receive intensive training and are able to undergo hemodialysis at home. A partner must be trained in order to safely administer home hemodialysis. Follow up care, instruction, and evaluation by health care professionals are imperative to ensure patient safety.

Patients also must know about special precautions for avoiding the complications that accompany long-term hemodialysis. The purposes for prescribed medications should be explained, as well as side effects that should be reported. These drugs may include multivitamins, antacids, iron supplements, antihypertensives, digitalis, vasodilators, and antibiotics. Rigid dietary and fluid intake restrictions are particularly difficult for some patients and their families. Patient compliance can be a major challenge to caregivers who also must work with family members to help them deal with changes in sexual activities, role reversal, financial burdens, and encouragement of self-care and independence for the patient, balanced with as much support as necessary.

Additionally, caregivers should take time to examine their personal feelings and clarify their values in regard to patients' rights to treatment or refusal of it, and allowing patients to die with dignity.

Heparin is given before treatment is begun to patients who are to be treated by extracorporeal hemodialysis in order to prevent clotting of the blood during the procedure.

Etymology: Gk, haima + dia, apart, lysis, looseninga procedure in which impurities or wastes are removed from the blood, used in treating patients with renal failure and various toxic conditions. The patient's blood is shunted from the body through a machine for diffusion and ultrafiltration and then returned to the patient's circulation. Hemodialysis requires access to the patient's bloodstream, a mechanism for the transport of the blood to and from the dialyzer, and a dialyzer. Also spelled haemodialysis. See arteriovenous fistula, external shunt. method Access may be achieved by an external shunt or an arteriovenous fistula. The external shunt is constructed by inserting two cannulas through the skin into a large vein and a large artery. When hemodialysis is not being performed, the cannulas are joined, allowing the blood to flow from artery to vein. When hemodialysis is being performed, the cannulas are separated, allowing the arterial blood to flow to the dialyzer and the dialyzed blood to return from the dialyzer to the circulation through the cannula in the vein. An arteriovenous fistula is created by the anastomosis of a large vein to an artery. Large-bore needles are threaded into superficial vessels enlarged by the increased flow caused by the fistula. Various dialyzers may be used. Hemodialysis takes from 3 to 8 hours depending on the patient's condition, weight, and laboratory values and may be necessary daily in acute conditions or two to three times a week in chronic renal failure. interventions A decrease in blood flow through the shunt may cause clotting. Therefore any factor that may result in a slowing of the flow should be avoided. Some of these factors are systemic hypotension, infection of the shunt or fistula, compression of the shunt or fistula, thrombophlebitis, and prolonged inflation of a blood pressure cuff. Infection is prevented in the area around an external shunt by placing a sterile dressing over the shunt and changing the dressing daily. Before the procedure is begun, the patient is told how long it will take, what pain or discomfort may be expected, what will be felt afterward, what food or activity will be allowed during the procedure, and whether family or friends may be present during treatment. Headache, nausea, and muscle cramps are common, especially during the procedure and for a few hours afterward. The patient usually feels best on the day after hemodialysis. Rest, an antiemetic, and a mild analgesic may make the procedure more comfortable. Most patients need emotional support and some physical assistance during hemodialysis. The physical status of the patient is monitored frequently throughout. Blood pressure, pulse, and blood tests for electrolyte and acid-base balance are performed. Normal saline solution may be administered to counteract hypotension that results from rapid removal of fluid from the intravascular compartment. The patient is weighed before and after the treatment to determine the amount of fluid lost during the procedure. An anticoagulant is usually given to prevent coagulation of the blood in the dialyzer, cannulas, or catheters. To prevent hemorrhage, protamine sulfate may be administered after the procedure to reverse the effect of the anticoagulant. Any treatment that

causes tissue trauma, such as dental extraction, venipuncture, or intramuscular injection, is not recommended during or immediately after dialysis. outcome criteria Infection and clotting of the shunt and erosion of the skin around the shunt are frequent complications with an external shunt; therefore the method that uses an arteriovenous fistula is more common. The discomfort before, during, and just after dialysis; the prolonged time of relative immobility during the procedure; and the dietary restrictions necessary in renal insufficiency all cause considerable stress in the patient. Adjustments in the patterns of daily life are necessary and require the assistance of professionals with experience and training.

A method of mechanically cleansing the blood outside of the body, in order to remove various substances that would normally be cleared by the kidneys. Hemodialysis is used when an individual is in relative, or complete, kidney failure.

A procedure for removing metabolic waste products or toxic substances from the bloodstream by dialysis

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http://ls1959.com/health/prinsip-dialysis-dan-hemodialisis

PRINSIP DIALISIS DAN HEMODIALISIS

Bila dua macam cairan dengan kepekatan yang berbeda dibatasi oleh membrane semipermeabel, maka oleh karena proses konveksi dan difusi kepekatan cairan akan berubah. Cairan yang kurang pekat akan menjadi lebih pekat dan yang pekat menjadi kurang pekat.

Pada peritoneal dialysis, sebagai membrane semipermeabel adalah peritoneum (selaput perut). Cairan dialisat adalah cairan yang mempunyai komposit zat terlarut yang mirip dengan plasma darah.

Caranya adalah: cairan dialisat dialirkan ke dalam rongga perut, dibiarkan selama 30 menit di dalam rongga perut. Disini terjadi proses konveksi dan difusi, sehingga sampah metabolism dan racun tubuh akan berpindah ke cairan dialisat. Kemudian cairan dialisat dikeluarkan. Hal ini dilakukan berulang ulang sampai sampah metabolism dan racun tubuh berkurang.

Hemodialisis adalah suatu cara untuk memisahkan darah dari sampah metabolism dan racun tumbuh bila ginjal sudah tak berfungsi. Disini digunakan ginjal buatan yang berbentuk mesinhemodialisis.

Cara kerjanya adalah: darah dikeluarkan dari tubuh melalui pipa pipa plastic menuju mesin ginjal buatan (mesin hemodialisis). Setelah darah bersih dari sisa metabolism dan racun tubuh, darah akan kembali ke tubuh. Pada GGA dilakukan hemodialisis sampai fungsi ginjal membaik. Pada GGK berat, dilakukan hemodialisis 2 – 3 kali seminggu, diulang seumur hidup atau sampai dilakukan cangkok ginjal

Pdpersi, Jakarta - Hemodialisis merupakan salah satu alternatif pilihan bagi penderita gagal ginjal kronis untuk bertahan hidup. Manfaat hemodialisis sendiri yaitu untuk menjaga keseimbangan cairan dan elektrolit. Sebab, tanpa adanya keseimbangan tersebut, maka tubuh akan menimbun banyak cairan.

Imbasnya, akan terjadi sesak nafas, terganggu serta melambatnya denyut jantung.

Seperti diutarakan Dr HMS Markum SpPD-KGH, beberapa waktu lalu, manfaat lain hemodialisis adalah upaya menunggu cangkok/transplantasi ginjal, atau apabila transplantasi gagal ginjal ditolak. Meski demikian, imbuhnya, ada beberapa masalah yang mungkin timbul saat hemodialisis.

Masalah yang kemungkinan timbul, ungkapnya, yaitu;

Penyakit dasar seperti tekanan darah tinggi dan kencing manis masih harus mendapatkan pengobatan sebaik mungkin. Penyakit-penyakit ini dapat menimbulkan komplikasi kardiovaskular seperti gangguan jantung dan stroke.

Cimino Shunt. Pemeliharaan cimino shunt harus diperhatikan oleh pelaksana dialisis dan juga oleh pasien. Misalnya menghindari benturan, tekanan, dan infeksi. Cimino Shunt ini dapat tersumbat sehingga perlu diperbaiki.

Munculnya anemia, gatal, penyakit tulang, dan masalah psikologis. Soal diet dan pembatasan minuman.

http://www.pdpersi.co.id/?show=detailnews&kode=1309&tbl=cakrawala

Hemodialysis (HD) is a treatment / procedure act to separate the blood from residual substances / toxins carried by flowing blood through the membrane semi permeable where waste or toxic substances are diverted from the blood into the dialysate fluid is then discarded, while the blood back into the body accordance with the meaning of Hemo which means blood and dialysis, which means moving.

Indications HD

Immediately

Encephalopathy, pericarditis, peripheral neouropati, hyperkalemia and metabolic acidosis, malignant hypertension, pulmonary edema, severe or anuri oligouri.

Early or prophylactic

1. Uremia syndrome, bone disease, impaired growth.

2. Abnormal laboratory: metabolic acidosis, azotemia (creatinine 8-12 mg%, BUN 100-120 mg%, CCT is less than 50-10 ml/ minutes)

Complications of HD

Some complications during dialysis (intra-dialysis) is not rare to find and disrupt the comfort of hemodialysis patients

1. Hypotension

2. Muscle Cramps

3. Nausea and vomiting

4. Headache

5. Chest Pain

6. Lumbago

7. Itching

8. Febrile

Long-term follow-up

Long-term supervision every patients regular HD is very important because regular HD can affect quality of life is optimal. Supervision relates to medical aspects, social and professional, psychological.

1. Medical Aspects

Endocrine disorders, malnutrition, immune deficiency, anemia, cardiovascular system and metabolic disorders.

2. Aspects of social and professional

Losing hours of work 10-12 hours per week, loss of income, high medical expenses, etc..

3. Psychological Aspects

Frequent change in personality, tend to be depressed, and so on.

PROCESS hemodialysis

Pre-hemodialysis

A. Things to consider before preparing HD engine:

machine must be examined in a state ready for use. Connect the machine to the mains. Connect the machine with water channels.

Drain was placed in the sewer line is not in a state of congestion.jerry cans filled with dialysate fluid where appropriate the amount needed for one-time dialysis.

B. Prepare dialysate

Dialysate is a liquid used in the process of HD, consisting of water and electrolytes mix containing concentrations similar to normal serum and have the same osmotic pressure of blood.

Function dialysate:

Remove and hold liquids as well as the remains of the body’s metabolism. To prevent loss of vital substances from the body during dialysis

Dialysate:

dialysate concentrates

Contains a concentrated solution, before being used must be mixed continuously in a certain ratio by the engine.

Easy to use.

Error dilution is very small.

Difficult to transport and storage.

dry or powder form.

Easy to store.

It’s hard to get the right composition.

Biological Fluids Dialist:

Dialysate containing a variety of salt / electrolyte / substances include:

1. NaCl / Sodium Chloride.

2. CaCl2 / Calium Chloride.

3. MgCl2 / Magnesium Chloride.

4. NaC2H3O2 3H2O / acetat or NaHCO3 / Bilkarbonat.

5. KCl / potassium chloride, are not always present in the dialysate.

6. Dextrose.

Prepare / mix dialysate

1. Batch System

Before starting HD, the dialysate was prepared in a place with a certain amount as needed.

2. Proportioning system.

Is the dialysate supply systems which the dialysate is made / mixed automatically by the machine during HD in progress. DBC / Batch Dialysate Concentrates and water mixed with a certain ratio. Normally the ratio of water: DBC is 34: 1.

C. Preparing Water

Water for dialysate should not contain substances / electrolyte / microorganisms and other foreign matter therefore to find the ideal water for dialysis is then carried out the action of water treatment / water treatment.

Water treatment / water treatment:

1. The filter / filter

a. Sediment filter, to filter out particles.

Pre filter (100 U) Before entering the HD machine (5 U) Before entering the dialyzer tube (1 U)

b. Absorbent filter / adsorption filter

Charcoal / carbon: to absorb the chlorine-free substances, chloraming, organic materials or pyrogen.

Iron: to absorb iron and manganese.

This tool should be frequently cleaned or replaced periodically.

2. Reverse Osmosis Systems

Water with a high pressure device that has flowed through semi-permeable membrane so that the resulting free pure water (hardness / CaCO less than 1.8 mg / L).Water treatment system is quite expensive, so not all HD units can have it.

D. Preparing tools and Drug Administration

1. Medical Equipment

tensimeter and Stethoscope weight Scales complete oxygen tube Equipment KG Slym Zuiger Tromol (duk, gauze, clamps) Tub syringes, small kom Korentang and place clamp-clamp (large and small) Scissors Bent Glass size Zeil / rubber for the base of the hand Gloves Kassa plaster / band aid Verband

2. Special tools

Dyalizer Blood line AV fistula concentrated dialysate infusion sets Spuit 1 cc, 3 cc, 20 cc. Conducturty meters

3. Drugs

Lidocain, Novocain Alcohol, betadin

Heparin, protamin Sodium bicarbonate life-saving drugs

4. Other

permit dialysis Form hemodialysis Treveling hemodialysis Traveling dialysis forms: laboratory, radiology and other

E. Running Machine HD

1. Check the power lines and aqueducts

2. Connect the water hose to the tap water inlet and outlet water hoses into the sinkhole

3. connect the power cable with socket

4. dialysate fluid in a jerry can prepare as much as needed, consider the necessary fluids whether standard or free potassium

5. Turn on the machine with rinse position for 15 minutes, when the machine containing formaldehyde, then rinse position longer (30 minutes)

6. After the rinse is finished, put the hose to concentrate into a jerry can dialysate.

7. Lamp temperature, conductivity and light lamps in the machine will concentrate red, wait until the second light green color.

8. Move the knob to the position of dialysis when the lights are colored green.

9. HD machines ready for use.

F. Preparing Blood Circulation

Namely prepare dialyzer and blood lines on the HD machine

Things to do:

1. Soaking the moisten dialyzer (connect the dialyzer with dialysate circulation.)

2. Rinsing the rinsing dialyzer and blood lines

3. Priming the dialyzer and blood lines.

G. Preparing the patient

1. Mental preparation

Inform the patient that will be HD Provide an explanation and motivation of the HD process and complications that may occur

during HD.

2. Physical Preparation

Considering weight Observation of general condition Observation of vital signs Set position

3. Filling hemodialysis permission

Permission / approval HD Must be written Patients and families should get clear information about HD Permission HD is a legitimate basis for accountability for the physician to the patient and family. HD license stored on medical records

IMPLEMENTATION PROCESS hemodialysis

1. Setting up the connection means circulation

To connect the blood circulation of the engine with the systemic circulation is done by:

a. How to While

Namely punksi V femoral to the inlet and outlet can be selected for one of the veins in the hand.

b. Permanent way

Namely by creating a shunt between the other

Mino shunt seribner shunt

2. AntikoagulansiaThe drugs necessary for blood clotting prevent during HD. The drugs used were heparin.The use of heparin:

Intermittent: granted for 1 hour Continuous: constant current during HD Minimum: given at the time of preparing the blood circulation Regional: ABL given heparin at the BL provided protamin dose heparin: 1000 units / hour Initial dose: given at the time punksi into circulation at the time siskemik and blood began to be

withdrawn. next dose is given to extra-corporeal circulation

POST hemodialysis

A. Preparation To end HD

Tools / drug prepared Deppers Betadin Plasters suppressor Tools Gloves Bucket

B. The things done after the HD finish

After the HD is complete then the machine must be cleaned both the outside and inside. How to clean:

1. The exterior of the machine

All surface and wipe the outside of the hose dialysate with 0.5% chlorine solution and then wipe the wet and dried.

2. The inside of the machine

Adjusted for the cleaning protocol of each type of machine

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Hemodialysis is one kind of dialysis. It uses a machine that holds a filter called a dialyzer. As blood flows through the dialyzer, waste is removed and fluid and chemicals are balanced. Hemodialysis treatments are usually done at a special dialysis center. In some cases, treatments may be done at home.

How Hemodialysis Is Done

Two needles are inserted into a blood vessel (called an access), usually in your arm. Each needle is attached to a tube. One tube carries your blood into the dialyzer, where it is cleaned. Clean blood returns to your body through a second tube and needle.

Experience

Hemodialysis usually takes about 3-5 hours. It is usually done 3 times a week. You’ll have a regular schedule for your hemodialysis. Many centers have evening and weekend

hours as well as weekday hours to help you continue working. A trained nurse or technician connects you to the dialysis machine. He or she watches for

problems and makes sure you are comfortable. During treatment, only a small amount of blood (about 1 cup) is out of your body at any one

time. During or after your first few treatments, you may have a headache, muscle cramps, or feel

nauseated. These should decrease as your body gets used to the treatments.

http://www.mountnittany.org/wellness-library/healthsheets/documents?ID=3890

hemodialysis device hemodialysis machine Product ID: TMS4000a

TMS-4000 A Hemodialysis System (Single Pump)

Forms of Therapy:Hemodialysis, isolated ultrafiltration, sequential ultrafiltration, hemoperfusionIndication:Acute and chronic renal failure, uremia, MODS(Multiple Organ Dysfunction Syndrome) and intoxication.Technical Features1. Multifunction, individual therapy 2. The advanced Volume Balance Control System enables accurate control of ultrafiltration.3. The combination of sodium profile and ultrafiltration profile effectively avoids complications: Low blood pressure and electrolyte unbalance.4. Reliability and safety are ensured by a dual-control-supervising system.Functional features1. Sodium and ultrafiltration profiles provide individual treatment for patients.2. Convenient program of sequential therapy and dialysis with variational sodium.3. KT∕V calculation function evaluates the sufficiency of dialysis.4. The special hemoperfusion mode reduces the time for self tests and the consumption of water and concentrates in normal dialysis machines.5. Can provide the isolated dialysate 6. The battery supplies for the entire blood section all monitoring devices and displays for 30 min

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