KIDNEY DIALYSIS EQUIPMENT

INTRODUCTION:

Peritoneal Dialysis:

Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your
blood inside your body. Doctors call this lining the peritoneum. A doctor will place a soft tube, called a catheter, in
your belly a few weeks before you start treatment.

When you start peritoneal dialysis, dialysis solution—water with salt and other additives—flows from a bag
through the catheter into your belly. When the bag is empty, you can disconnect your catheter from the bag and
cap it so you can move around and do your normal activities. While the dialysis solution is inside your belly, it
soaks up wastes and extra fluid from your body. After a few hours, you drain the used dialysis solution into a drain
bag. You can then dispose of the used dialysis solution, which is now full of wastes and extra fluid, in a toilet or
down the drain of a sink or bathtub. Then you start over with a fresh bag of dialysis solution.

The process of first draining the used dialysis solution and then replacing it with fresh solution is called an
exchange. Most people do four to six exchanges every day, or during the night using a machine that moves the
fluid in and out. The process goes on continuously, so you always have dialysis solution in your belly soaking up
wastes and extra fluid from your body. For the best results from peritoneal dialysis, it is important that you
perform all of your exchanges as your doctor instructs.

Peritoneal dialysis

Types of peritoneal dialysis:

The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysis—also called CAPD—and
automated peritoneal dialysis—which doctors sometimes call APD or continuous cycler-assisted peritoneal
dialysis. After learning about the types of peritoneal dialysis, you can choose the type that best fits your schedule
and lifestyle. If one schedule or type of peritoneal dialysis does not suit you, you can talk with your doctor about
trying another type.
  Continuous ambulatory peritoneal dialysis does not require a machine. You can do it in any clean, well-lit
place. The time period that the dialysis solution is in your belly is called the dwell time. With continuous
ambulatory peritoneal dialysis, the dialysis solution stays in your belly for a dwell time of 4 to 6 hours, or
more. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch
television, or sleep. Usually, you change the dialysis solution at least four times a day and sleep with
solution in your belly at night. You do not have to wake up and perform exchanges during the night.
 Automated peritoneal dialysis uses a machine called a cycler to fill and empty your belly three to five
times during the night while you sleep. In the morning, you begin one exchange with a daylong dwell time.
You may do an additional exchange around the middle of the afternoon without the cycler to increase the
amount of waste removed and reduce the amount of fluid left behind in your body.

If you weigh more than 175 pounds or if your peritoneum filters wastes slowly, you may need a combination of
continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. For example, some people use a
cycler at night and perform one exchange during the day. Your health care team will help you determine the best
schedule for you.

Equipment and Supplies:

The equipment and supplies you need will depend on the type of peritoneal dialysis you will use. You could need
the following equipment and supplies:

o catheter and transfer set

o dialysis solution
o cycler
o supplies to keep your exit site clean

The health care team will provide you with the equipment you need to begin peritoneal dialysis and help you
arrange to have supplies such as dialysis solution and surgical masks delivered to your home, usually on a monthly
basis.

 Catheter and Transfer Set:

Before your first treatment, a surgeon places a catheter into your belly. You may need to stay overnight in the
hospital; however, most people can go home after the procedure. You may receive general or local anesthesia. The
catheter stays in permanently and will transfer the dialysis solution to and from your belly. You will learn to care
for the skin around the catheter, called the exit site, as part of your dialysis training. The catheter tends to work
better when you give the insertion site adequate time to heal. Healing usually takes 10 to 20 days. Planning your
dialysis catheter insertion at least 3 weeks before your first exchange can improve treatment success.
The catheter for peritoneal dialysis is made of soft tubing for comfort. The catheter has one or two cuffs made of a
polyester material—called Dacron—that anchors the catheter in place. The end of the tubing inside your belly has
many holes to let solution flow freely in and out.

Abdominal catheter

A transfer set is tubing that connects the catheter to the bag of dialysis solution. When you first get your
catheter, the section of tube that sticks out from your skin will have a secure cap on the end to prevent infection.
A connector under the cap will attach to any type of transfer set.

When your dialysis training starts, your dialysis nurse will give you a transfer set and teach you how to

o keep bacteria from entering the catheter

o connect the transfer set to the disposable dialysis tubing at the beginning of an exchange and disconnect
the transfer set at the end

Follow instructions carefully to prevent infection.

Transfer set

Between exchanges, you can keep your catheter and transfer set
hidden inside your clothing. At the beginning of an exchange, you will remove the disposable cap from the
transfer set and connect the set to a tube that branches like the letter Y. One branch of the Y-tube connects to the
drain bag, while the other connects to the bag of fresh dialysis solution.

During an exchange, you can read, talk, watch

television, or sleep.

 Dialysis Solution:

Dialysis solution comes in 1.5-, 2-, 2.5-, or 3-liter bags. Solutions contain a sugar called dextrose or a compound
called icodextrin and minerals to pull the wastes and extra fluid from your blood into your abdominal cavity—the
space in the body that holds organs such as the stomach, intestines, and liver. Different solutions have different
concentrations of dextrose or icodextrin. Your doctor will prescribe a formula that fits your needs.

You will need a clean space to store your bags of solution and other supplies. You will also need to warm each bag
of solution to body temperature before use. You can use an electric blanket or let the bag sit in a tub of warm
water. Most solution bags come in a protective outer wrapper, and you can warm them in a microwave. Do not
microwave a bag of solution after you have removed it from its wrapper.

 Cycler:

In automated peritoneal dialysis, the cycler is the machine that automatically fills and drains your belly. You can
program the cycler to give you different amounts of dialysis solution at different times. Most cyclers include the
following:

Solution supply: At the beginning of the session, you connect bags of dialysis solution to tubing that feeds the
cycler. Most systems have a separate tube for the last bag because this solution may have a higher dextrose or
icodextrin content so that it can work for a daylong dwell time.

Pump: The pump sends the solution from the supply bags to a heater bag before it enters your body. The pump
also sends the solution to the disposal container or drain line after use. However, the pump does not move the
solution into and out of your belly; gravity performs that job.
Heater bag: Before the solution enters your belly, the cycler warms a measured dose to body temperature. Once
the solution is the right temperature and the previous exchange drains, the cycler releases a clamp to let the
warmed solution flow into your belly.

Fluid meter: The cycler’s timer releases a clamp to let the pump send the used dialysis solution into a disposal
container or drain line. A fluid meter in the cycler measures and records how much solution the cycler removes.
Some cyclers compare the amount that was put in with the amount that drains out. This comparison lets you and
your doctor know if the treatment is removing enough fluid from your body.

Disposal container or drain line: After measuring the used solution, the cycler pumps the used solution to a
disposal container that you can throw away. With some systems, you can just string a long drain line from the
cycler to a toilet or bathtub.

Alarms: Sensors will trigger an alarm and shut off the cycler if a problem occurs.

Automated peritoneal dialysis uses a machine called a cycler to fill and empty your belly three to five times during
the night while you sleep.

HEMODIALYSIS:

Hemodialysis is a treatment for kidney failure that uses a machine to filter your blood outside your body. At the
start of a hemodialysis treatment, a dialysis nurse or technician places two needles into your arm. Once trained by
the health care team, some people prefer to insert, or put in, their own needles. A pump on the hemodialysis
machine draws your blood through one of the needles into a tube, a few ounces at a time. Your blood travels
through the tube to the filter, called a dialyzer. Inside the dialyzer, your blood flows through thin fibers that filter
out

o wastes
o extra salt
o extra fluid

After the dialyzer filters your blood, a different tube carries your blood back to your body through the second
needle.
 Hemodialysis

Hemodialysis can replace part of your kidney function. Hemodialysis is not a cure for kidney failure; however, it
can help you feel better and live longer.

You also may need to make changes to your diet, medicines, and liquid intake. Changes to your diet and liquid
intake and the number of medicines you need will all depend on the amount of kidney function you have left and
whether you receive treatments three times a week or more often.

Equipment and Supplies:

Hemodialysis requires several pieces of equipment and many supplies for each treatment. The hemodialysis
machine, dialyzer, dialysis solution, and needles are four of the most important parts in hemodialysis treatments:

 Hemodialysis machine: The hemodialysis machine at a dialysis center is about the size of a microwave.
Machines for home hemodialysis are small enough to sit on an end table. The hemodialysis machine has
three main jobs:
o pump blood and regulate blood flow through the dialyzer
o monitor blood pressure
o control the rate of fluid removal from your body

Blood is removed from the body through one needle and propelled by a blood pump, which is, essentially like a
rolling pin on the outside of the tube. The blood passes through the dialyzer and then is returned to the body
through the other needle. Along the way, there are blood pressure monitors and detectors to ensure the
procedure is safe. The blood, while it does pass outside of the body, remains inside the tubes or in the dialyzer
and does not actually go into the hemodialysis machine.

 Dialyzer: The dialyzer is the “artificial kidney.” Blood enters at the top of the dialyzer, in this case, and is
forced into multiple, very thin, hollow fibers made of a semi-permeable membrane. Each fiber is about the
size of a human hair. As blood passes through the hollow fibers, dialysis solution passes in the opposite
direction on the outside of the fibers. In the less than one second it takes for the blood to pass from the
top of the dialyzer to the bottom, waste products diffuse out of the blood and into the dialysis solution.
 Inside the dialyzer, your blood flows through thin fibers that filter out wastes and extra salt and water.

 Dialysis Solution: Also known as dialysate, dialysis solution contains water and added substances that
allow the safe removal of wastes and extra salt and fluid from your blood during dialysis. Your doctor will
prescribe a specific dialysis solution for your treatments. If you have problems such as low blood pressure
or muscle cramps during your treatments, your doctor can prescribe a solution with a different balance of
chemicals. Your doctor might also adjust your solution if your blood tests show that your blood has too
much or too little of certain minerals, such as potassium or calcium.
 Needles: You, a nurse, or a technician will insert two needles into a vein, usually in the arm, at the start of
each hemodialysis treatment. One needle draws blood that goes to the dialyzer, and the other needle
returns the filtered blood to your body. When you first start hemodialysis treatments, the needle
insertions may be one of the most uncomfortable parts of the treatment. Most people get used to them
after a few treatments. If you find the needle insertions painful, you can put a numbing cream or spray on
your skin so you won’t feel the needles.

Many people who have their treatments at a dialysis center have their needles inserted by a nurse or technician;
however, you may prefer to insert your own needles. You’ll need training on inserting needles properly to prevent
infection and keep your vein healthy. With a little practice, you can become good at inserting needles. Whether
you insert your own needles or have it done by a nurse or technician, you should learn how to care for the area
where the needles are inserted to prevent infection