What Is Involved in Hemodialysis Training?

The hemodialysis machine is divided into a blood monitoring alarm system and a dialysate supply system. Blood monitoring alarm system includes blood pump, heparin pump, arteriovenous pressure monitoring and air monitoring; dialysate supply system includes temperature control system, liquid distribution system, degassing system, conductivity monitoring system, ultrafiltration monitoring and blood leakage monitoring, etc. Partial composition. Its working principle is: the concentrate for dialysis and the water for dialysis are formulated into a qualified dialysate through the dialysate supply system, and through the hemodialyzer, the solute disperses, permeates, and ultrafilters with the patient's blood from the blood monitoring alarm system; The patient's blood is returned to the patient's body through the blood monitoring alarm system, while the dialysis liquid is discharged as waste liquid from the dialysis solution supply system; it is continuously circulated to complete the entire dialysis process.

The hemodialysis machine is divided into a blood monitoring alarm system and a dialysate supply system. Blood monitoring alarm system includes blood pump, heparin pump, arteriovenous pressure monitoring and air monitoring; dialysate supply system includes temperature control system, liquid distribution system, degassing system, conductivity monitoring system, ultrafiltration monitoring and blood leakage monitoring, etc. Partial composition. Its working principle is: the concentrate for dialysis and the water for dialysis are formulated into a qualified dialysate through the dialysate supply system, and through the hemodialyzer, the solute disperses, permeates, and ultrafilters with the patient's blood from the blood monitoring alarm system; The patient's blood is returned to the patient's body through the blood monitoring alarm system, while the dialysis liquid is discharged as waste liquid from the dialysis solution supply system; it is continuously circulated to complete the entire dialysis process.

Chinese name

Hemodialysis

Foreign name

Hemodialysis

Nature

Waste in the blood is removed through a semi-permeable membrane

Features

Safer, easier, and widely used

Hemodialysis machine overview

Introduction of hemodialysis machine

Hemodialysis, clinically means that some waste in the blood is removed through a semi-permeable membrane. Hemodialysis is one of the safer, easier and more widely used blood purification methods. Dialysis refers to the movement of a solute through a semi-permeable membrane from a high-concentration solution to a low-concentration direction. Hemodialysis includes the movement of solutes and water, that is, the exchange of blood and dialysate in the dialyzer (artificial kidney) through semi-permeable membrane contact and concentration gradients to make the metabolic waste in the blood and excessive electrolytes to the dialysate When it moves, calcium ions and bases in the dialysate move to the blood. If the mixed solution of albumin and urea is placed in a dialyzer and the outside of the tube is soaked with water, then the urea in the dialyzer tube will move to the water outside the tube through the artificial kidney membrane hole. The albumin molecules are large and cannot pass through the membrane. hole. This phenomenon of material movement where small molecules can pass but large molecules cannot pass through the semi-permeable membrane is called dispersion. The basic principle of hemodialysis is to use the diffusion phenomenon to clinically separate and purify blood for purification purposes.

The thickness of the semi-permeable membrane used for hemodialysis is 10-20 microns, and the average pore size on the membrane is 3 nanometers, so only small molecules with a molecular weight of less than 15,000 and some of the molecular substances are allowed to pass, while large molecules with a molecular weight greater than 35,000 Matter cannot pass. Therefore, proteins, pyrogens, viruses, bacteria, and blood cells are all impermeable; most of the components of urine are water. If you want to replace the kidney with an artificial kidney, you must expel a lot of water from the blood. The artificial kidney only Can use osmotic pressure and ultrafiltration pressure to achieve the purpose of removing excessive moisture. The artificial kidneys used, that is, the hemodialysis devices, all have the functions described above, so that the quality and quantity of blood can be adjusted to bring it closer to a physiological state.

Hemodialysis machine classification

The dialysis used in medicine is roughly divided into two categories: hemodialysis, peritoneal dialysis

Hemodialysis

Hemodialysis, called hemodialysis for short, is also commonly referred to as artificial kidney and dialysis, which is a type of blood purification technology. It uses the principle of semi-permeable membrane, through diffusion, harmful to the human body and excess metabolic waste and excessive electrolytes removed from the body, to achieve the purpose of purifying the blood, and to achieve the purpose of correcting the water electrolyte and acid-base balance.

Peritoneal dialysis

Peritoneal dialysis uses the peritoneum as a semi-permeable membrane. The prepared dialysate is poured into the peritoneal cavity of the patient through a silicone catheter using gravity. In this way, there is a difference in the concentration of solutes on both sides of the peritoneum, and the solutes on the high concentration side are low. The concentration side moves (dispersion); the water moves from the hypotonic side to the hypertonic side (osmosis). The dialysis fluid is continuously changed. In order to achieve the purpose of removing metabolites, toxic substances in the body, and correcting disorders of water and electrolyte balance.

Disadvantages of peritoneal dialysis

Induced infection: Because the catheter for peritoneal dialysis must be connected to the dialysis bag during fluid exchange, there is a possibility of infection in the abdominal cavity. Therefore, before performing any steps related to peritoneal dialysis treatment, wash your hands thoroughly before peritonitis. The incidence has been significantly reduced.

Increase in weight and triglycerides in blood: Because the dialysate uses glucose to eliminate excess water, it may absorb part of the glucose during dialysis, which may increase the patient's weight, blood triglycerides and other lipids. Therefore, proper exercise and reduced sugar intake are needed.

Excessive protein loss: A small amount of protein and vitamins will be lost during dialysis, so it needs to be supplemented from food. In addition to maintaining the original normal eating habits, you can consume more high-quality protein such as fish, meat, eggs, and milk, and the best source of vitamins is fruits and vegetables to supply the body's needs.

Development status of hemodialysis machine

Hemodialysis equipment

The number of dialysis patients in developing countries is relatively small, but it is growing rapidly. In the past ten years, the growth rate of dialysis in China, India, Brazil and other countries has reached more than 15%, which is much higher than the level of 3% -5% in Europe and the United States. Moreover, the proportion of patients with advanced kidney disease in developing countries receiving dialysis is only about 10%, which is far lower than the level of about 80% in Europe and the United States. With the expansion of medical insurance coverage and the increase in national income in developing countries, the number of dialysis patients is expected to be longer. The period will continue to grow rapidly. The hemodialysis industry includes two parts: hemodialysis services and hemodialysis equipment. From 2010 to 2011, the market scale ratio of the two has remained at 5.2: 1. In 2011, the global hemodialysis service market size was approximately USD 58.8 billion, mainly concentrated in North America, Europe, Japan and other developed regions. Among them, European hemodialysis services are mainly public institutions, while the United States and Japan are mainly private operating institutions. The global companies providing hemodialysis services include Fresenius Medical Services, DaVita, Kuratorium, etc. In 2011, the total number of dialysis services provided by the three services was about 350,000.

Hemodialysis machine home dialysis

Home hemodialysis is one such treatment. It is not a new thing. Family hemodialysis has a history of more than 40 years in foreign countries, and once accounted for about 40% of the entire dialysis population in the 1970s. Many research results show that patients with hemodialysis at home have a longer survival time, fewer complications, and a better quality of life than patients with other dialysis methods.

Like In-center hemodialysis, patients with home hemodialysis need to establish vascular access, such as arteriovenous fistulas; they also need to install a hemodialysis machine and related equipment suitable for home hemodialysis at home. In addition, patients and their families may need several weeks to receive training and master the knowledge and operation skills of family hemodialysis, such as how to operate a dialysis machine, how to puncture and place a tube, how to monitor dialysis parameters and vital signs. Many people have difficulty understanding how patients can perform self-piercing on their own, which is difficult to do with traditional puncture methods. But the application of "buttonhole" technology allows patients to puncture themselves with special puncture needles with minimal pain. After the patient has mastered these techniques, he will gradually do his own operation under the guidance of the nurse. When a patient has problems with hemodialysis at home, they can call the medical staff for help at any time.

Hemodialysis machine advantages

Compared with hemodialysis in a dialysis center, home hemodialysis has many advantages. It can make your dialysis treatment more free and more flexible in timing. You can arrange dialysis time according to your work and life schedule. It will have less impact on your work and life. You will feel that you are the disease Master of dialysis treatment. Patients with home hemodialysis also do not need to visit the hospital frequently, and monthly or longer clinic visits are sufficient. Of course, due to the complexity of home hemodialysis operations, not everyone is suitable for home hemodialysis. However, if you have sufficient confidence in the self-management of the disease, you are willing to assume more tasks and responsibilities during the treatment of the disease. If you want to minimize the impact of dialysis treatment on work and life, Thorough may be a good choice.

Indications for hemodialysis machine

Indications for hemodialysis machine

Uremic syndrome.

Cerebral edema, pulmonary edema and hypertension caused by excessive volume load.

uremia and neurological and mental symptoms.

Uremic pericarditis.

Blood urea nitrogen 28mmo1 / L, blood creatinine 530 840mo1 / L.

Ccr <l0ml / min.

blood potassium 6.5mmol / L.

HCO3-<6.8 mmol / L (15% voI).

Uremic anemia, Hb <60g / L, HCT <15%.

Reversible chronic renal failure, preparation before renal transplantation, acute renal failure caused by acute rejection after renal transplantation, or chronic rejection when the transplanted kidney fails

Others: such as some drug poisoning, hypercalcemia, metabolic alkalosis, free hemoglobin> 80mg / L during hemolysis.

Indications for hemodialysis machine

Hyperkalemia.

pulmonary edema.

uremia encephalopathy.

Uremia pericarditis.

Contraindications for hemodialysis machine

Hemodialysis has no absolute contraindications, only relative contraindications.

Malignant tumors are advanced.

Non-volume-dependent hypertension.

severe myocardial disease and intolerance of hemodialysis.

People with mental illness and those who refuse to receive dialysis treatment.

Intracranial hemorrhage and increased intracranial pressure.

Intractable heart failure and hypotension caused by severe shock and cardiomyopathy.

Hemodialysis machine implementation

Anticoagulation in hemodialysis

In order to prevent coagulation from blocking the empty fiber duct during hemodialysis, affecting the progress of dialysis and reducing the effect of dialysis treatment, anticoagulation measures need to be taken. The usual method is to give heparin for treatment. However, heparin has anticoagulant effects, and patients should be prevented from bleeding. Then the blood doesn't clot.

General dialysis: The first dose of heparin is 40-50 mg (or 0.8-1.2 mg / kg) during venipuncture, and 5 mg / h will be added afterwards. The additional heparin will be stopped 0.5 to 1 hour before dialysis. It is appropriate to monitor PTT or KPTT to keep it at 180% of the base value when conditions permit.

Heparin-free dialysis:

1) Dialysis (or bloody) pericarditis.

2) (within 1 week) surgery, such as heart and blood vessel surgery, eye surgery and kidney transplantation.

3) Intracranial hemorrhage, gastrointestinal bleeding, and other active bleeding.

4) Coagulation dysfunction.

(3) Low-molecular-weight heparin: Nadroparin calcium (Faming, low-molecular-weight heparin, fast-avoiding coagulation) is used clinically. It can replace heparin, and its effect is similar to heparin, but the price is more expensive.

Acute hemodialysis

Vascular access: the internal jugular vein, femoral vein or subclavian vein cannula to ensure blood flow.

Anticoagulation: Heparin, low-molecular-weight heparin, or no heparin can be selected according to the tendency of bleeding.

(3) Frequency of dialysis: Flexible control according to the patient's primary disease and the situation of daily medication.

Ultrafiltration volume: When the main manifestation of acute renal failure is water retention, the amount of dehydration is determined according to different situations. Generally, the initial dehydration should not exceed 4.0L.

dialysis method: choose ordinary dialysis, diafiltration or continuous renal replacement therapy.

Dialyzer: Select membrane materials that are not easy to activate complement, such as polyacrylonitrile membrane, polysulfone membrane, and cellulose acetate membrane.

Chronic hemodialysis

That is maintenance hemodialysis.

Vascular access: arteriovenous fistula, permanent deep vein catheter or artificial blood vessel.

Dialysis time: 4.0 to 4.5 hours each time.

(3) Frequency of dialysis: It can be twice or three times a week, or five times every two weeks. It should be determined according to the urine output of the patient. If the urine output is less than 800ml every 24 hours, the dialysis time should be 15 hours per week, that is, 3 times a week, if the 24-hour urine volume is more than 800ml, the dialysis time should be 9.0 hours, that is, twice a week.

Dialysis blood flow: 4 times of body weight, generally 250 ~ 300ml / min.

The dialysate flow rate is 500ml / min.

Induced dialysis

To avoid dialysis encephalopathy (imbalance syndrome) during the first dialysis. Depending on the condition, dialysis can be performed 1 to 3 times.

Dialyzer area: select area <15m.

Blood flow: 150ml / min.

Ultrafiltration volume: less than 1.5L (if the capacity is too heavy, it can be appropriately relaxed).

Time: less than 3.0 hours.

Scr or BUN decline: it should be limited to 30%.

Application of prion protein preparation: Fresh blood or 20% albumin is given during dialysis to increase plasma osmotic pressure.

Dialysis before kidney transplant

As with chronic hemodialysis, dialysis should be performed once before transplantation to reduce the patient's volume load, create conditions for intraoperative blood transfusion and increase the tolerance of the operation.

Hemodialysis machine complications

Immediate complications of hemodialysis machine

Complications related to dialysis itself that occur during each hemodialysis or within hours after the end of hemodialysis.

(A) imbalance syndrome

It is common in patients with high levels of urea nitrogen and creatinine and obvious symptoms of uremia, especially in the first dialysis and induction periods. The main reason is that the urea-based substances are unevenly distributed between blood and brain tissues after being penetrated, and the imbalance of PH value causes cerebral edema and cerebral hypoxia, which are manifested as headache, fatigue, and burnout during and after penetration , Nausea, vomiting, increased blood pressure, sleep disturbance, severe cases may have mental disorders, epileptic seizures, coma and even death.

(Two) hypotension

The most common complication of hemodialysis. Causes include reduced effective blood volume, excessive and excessive ultrafiltration, autonomic neuropathy, decreased vasoconstriction, excessive atrial natriuretic peptide levels, and the effects of antihypertensive drugs. It manifests as dizziness, chest tightness, pale, sweating, dark, nausea and vomiting, muscle spasm and even loss of consciousness. Treatment is mainly to quickly replenish blood volume while slowing blood flow and reducing or suspending ultrafiltration. Preventive measures include prefilling the dialyzer, increasing blood flow from small to large, using sequential dialysis or high-sodium dialysis, and instructing patients to control weight gain during dialysis to reduce ultrafiltration.

(Three) hypoxemia

More common in acetate dialysis, the reason is related to the metabolism of acetate in the body and the reduction of CO2 and HCO3- concentration in the blood. Poor dialysis membrane biocompatibility can cause white blood cell aggregation in pulmonary capillaries to affect ventilation, and it is also an important cause of hypoxemia. The clinical manifestations are not obvious. Patients with old cardiopulmonary disease or the elderly may show symptoms of hypoxia and even induce angina pectoris and myocardial infarction. Nasal cannula can be used for oxygen therapy. Preventive measures include the use of bicarbonate dialysate and a biocompatible dialyzer.

(D) arrhythmia

Often caused by hypokalemia, the cause of hypokalemia is mostly repeated use of hypokalemia or potassium-free dialysate. Hemolysis can produce hyperkalemia and induce arrhythmia, but it is quite rare. Digitalis poisoning-induced arrhythmia may occur in patients who use digitalis before dialysis due to decreased blood potassium concentration and changes in pH during dialysis. Prevention and control measures include: dietary control of potassium-containing foods to prevent pre-dialysis hyperkalemia, strict restrictions on the use of digitalis drugs in dialysis patients, and the use of dialysate containing potassium> 3.0mmol / L. Antiarrhythmic drugs can be used when arrhythmia occurs, but the dose needs to be adjusted according to the metabolism of the drug.

(E) Pericardial tamponade

Pericardial tamponade during hemodialysis and short time after hemodialysis is mostly hemorrhagic, often based on the original uremic pericarditis due to the application of heparin to cause pericardial bleeding. The clinical manifestations are: Progressive decrease in blood pressure with signs of shock; Jugular venous distension, liver enlargement, odd pulses, and central venous pressure; enlarged heart and distant heart sounds; B-ultrasound sees a large amount of pericardial fluid. Treatment measures: Those who occur during dialysis should immediately stop dialysis, neutralize heparin with protamine, and closely observe changes in the condition. Patients with severe tamponade symptoms can be decompressed with pericardial puncture or direct surgical decompression. Preventive measures are mainly for patients with suspected uremia and pericarditis, especially those with pericardial friction sounds in the precardiac area, using low molecular weight heparin or no heparin for dialysis.

(6) Hemolysis

It is mostly caused by dialysate abnormality and dialysis machine failure. If the dialysate is hypotonic, the temperature is too high, and the content of chlorine, chloramine or nitrate is too high, etc., others are also found in abnormal blood transfusions, disinfectant residues, etc. Patients with acute hemolysis have venous pain, chest tightness, palpitations, shortness of breath, and irritability, which can be accompanied by severe back pain and abdominal cramps. In severe cases, they have chills, chills, decreased blood pressure, arrhythmia, hemoglobinuria, and even coma. The hypotonicity of dialysate can also cause water poisoning or cerebral edema at the same time. Little and slow hemolysis is manifested only by anemia.

(7) Air embolism

Because the dialysis machine has perfect monitoring measures, air embolisms rarely occur, mostly caused by operating errors or pipeline damage.

Entering more than 5ml of air at a time can cause obvious embolism symptoms, which mainly cause cerebral embolism when sitting, mainly pulmonary hypertension and acute right heart failure when lying, coronary embolism or cerebral embolism, physical examination and heart agitation.

(8) Cerebral hemorrhage

One of the leading causes of death in maintenance hemodialysis patients. Mainly caused by hypertension and anticoagulation, the clinical manifestations are similar to cerebral hemorrhage in non-dialysis patients, and the treatment is the same.

(9) Subdural hematoma

Common causes include: head trauma, anticoagulation, excessive ultrafiltration, and hypertension. Clinical manifestations are similar to imbalance syndrome, but more persistent. CT of the head is clear. Treatment is mainly based on conservative medical treatment. Those who need to continue dialysis within 7 to 10 days should undergo heparin-free dialysis or change to peritoneal dialysis.

Long-term complications of hemodialysis machine

Hemodialysis technology significantly prolongs the survival of patients with chronic renal failure. However, hemodialysis is not a complete renal replacement therapy. It cannot completely remove urea toxins from the body, cannot completely correct metabolic disorders caused by uremia, and cannot replace renal endocrine function. With the prolonged dialysis time, the problems caused by the accumulation of toxins, metabolic disorders and endocrine disorders gradually increase, which can cause a series of complications and seriously affect the quality of life and survival time of patients.

1.Hypertension

Mainly caused by water and sodium retention, increased activity of the renin angiotensin system, and increased excitability of the sympathetic nervous system.

Treatment should first limit water and sodium intake, pay attention to maintain dry weight, 75% of patients can control blood pressure. Ineffective patients can be added antihypertensive drugs, ACEIs and calcium channel blockers are preferred. 3% to 5% of patients are refractory hypertension, and it may be effective to switch to dialysis or hemofiltration.

The etiology is related to anemia, acidosis, internal fistula, electrolyte disturbance, and malnutrition in addition to hypertension and sodium retention. Adequate dialysis and dehydration, and maintaining dry weight are the main treatment methods. Others also need to correct anemia, control blood pressure and perform nutritional treatment.

Mostly caused by coronary ischemia due to excessive ultrafiltration based on the original coronary atherosclerosis. Control of hypertension, hyperlipidemia, correction of anemia, and maintenance of body weight during dialysis to avoid excessive dehydration can effectively prevent its occurrence. Treatment is the same as for nondialysis patients. Patients with angina during dialysis should slow blood flow, stop ultrafiltration, and receive oxygen and nitroglycerin, and those with hypotension should be expanded. Those who fail to treat should stop hemodialysis before treatment. Anti-relapse authors may switch to dialysis or hemofiltration.

The pericarditis that appears within 2 weeks after the start of dialysis is called early pericarditis, and the pericarditis that appears after 2 weeks is called delayed pericarditis. The pathogenesis is not clear. Early pericarditis often has symptoms of chest tightness and chest pain and pericardial friction sounds. Strengthening dialysis can be effectively treated. Delayed pericarditis is mostly asymptomatic, with repeated episodes of hypotension only during dialysis, some of which are effective for enhanced dialysis, and some require peritoneal dialysis.

Mostly caused by excessive water load, other causes include congestive heart failure, hypoproteinemia, and increased pulmonary capillary permeability. Sufficient ultrafiltration of water can quickly improve symptoms. Strict restrictions on water intake, adequate dialysis and correction of hypoproteinemia can be effectively prevented.

Exudative. It is mostly caused by heart failure, retention of water and sodium, kidney syndrome, infection, etc., partly due to idiopathic uremic pleural effusion of unknown cause. Treatment should strengthen dialysis and ultrafiltration, correct hypoalbuminemia, improve the state of the body, and if necessary, perform chest drainage.

Including esophagitis, gastritis, gastric ulcers, delayed gastric emptying and gastrointestinal bleeding. Most of them are caused by gastrointestinal disorders caused by urinary toxins and urinary damage to autonomic nerves; abnormal gastrin metabolism leads to increased gastric acid secretion; anemia, malnutrition and other weakened mucosal protective factors. It is more effective to strengthen dialysis in treatment, and drugs for promoting gastrointestinal activity, gastrointestinal mucosal protective agents without aluminum and magnesium, and antacids can also be used. When there is gastrointestinal bleeding, attention should be paid to the choice of anticoagulation methods.

Common diseases such as hypertension, hyperlipidemia, heart failure, diabetes and other hemodialysis patients and commonly used drugs such as Betaloc and vasodilators can reduce intestinal blood flow. Once too much ultrafiltration can induce intestinal ischemia and bowel Infarct. It manifests as severe abdominal pain, nausea and vomiting, diarrhea, bloating, and shock. Early rapid blood volume replenishment can relieve intestinal ischemia. If intestinal infarction is suspected without effect, surgery should be performed once the diagnosis is confirmed.

Repeated blood transfusions in hemodialysis patients due to renal anemia increase the infection rate of hepatitis B and C, which can cause iron deposition in the viscera and cause liver cirrhosis; aluminum and silicone in dialysis circuits can also be deposited in the liver and cause damage. Hepatic hemodialysis patients rarely have jaundice during liver damage, and digestive symptoms are masked by uremia, which is difficult to detect early. Treatment focuses on prevention, such as the use of erythropoietin to reduce blood transfusion and avoid the use of aluminum preparations.

Most of the cases occurred in patients who had undergone peritoneal dialysis. The reasons include water and sodium retention, increased peritoneal permeability, infection, hypoalbuminemia, heart failure, pericardial disease, and liver cirrhosis. Tuberculosis, tumors and liver ascites should be excluded before treatment. Treatment includes limiting sodium and water intake, adequate dialysis and ultrafiltration, ascites concentration and infusion, and peritoneal drainage, local glucocorticoid treatment. Kidney transplantation is the answer to the problem of refractory ascites.

Inadequate production of renal erythropoietin (EPO) is the main cause. Other factors include: lack of hematopoietic materials, hemodialysis, increased red blood cell destruction, bone marrow fibrosis, and aluminum poisoning. EPO is the main method for the treatment of renal anemia. Generally, 3000u is administered subcutaneously 2 to 3 times per week. When the HCT reaches 30 to 33%, the dose can be reduced and the HCT can be maintained at this value. Other treatments include strengthening dialysis, supplementing hematopoietic materials, and reducing dialysis Blood loss, etc., severe anemia can be a small amount of blood transfusion.

12. Secondary hyperparathyroidism and renal osteopathy

It is generally believed that patients with hemodialysis can cause secondary hyperparathyroidism (2-HPT) due to calcium and phosphorus metabolism disorders, lack of active vitamin D3, and acidosis, while 2-HPT results in increased osteoclasts, decreased collagen fiber synthesis, and bone Mineralization disorders and so on cause renal bone disease. The clinical manifestations are bone pain, fractures, bone deformation, joint swelling, pain and deformation, decreased muscle strength and muscle tension, metastatic calcification, and tendon rupture. Diagnosis depends on clinical symptoms, blood calcium, blood phosphorus, I-PTH concentration and bone X-ray performance. Bone biopsy is a golden indicator for the diagnosis of renal bone disease. Treatment is mainly supplemented with active vitamin D3, others can also undergo hemoperfusion and surgical removal of parathyroid glands.

13. Genitourinary system

The incidence of urinary stones, infections, malignant tumors, impotence and hyposexuality in hemodialysis patients increased significantly. In addition, acquired renal cysts are more common. They are caused by kidney lesions and are not related to dialysis. They can also cause blood, infections and malignant changes. Treatment was symptomatic, and nephrectomy was performed in severe cases.

14. nervous system

Mainly caused by aluminum poisoning, uremic toxins, parathyroid hormone retention, lack of vitamins, trace elements, water and electrolyte disorders and other factors. Central lesions are manifested as attention disorders, pale membranes, delusions, mental decline, severe cases of speech and movement disorders, or even cramps, dementia. Peripheral neuropathy is mainly manifested as deep and shallow sensory disturbances. A small number of patients in the later stage have dyskinesia or even flaccid paralysis. Autonomic neuropathy manifests as hypotension, sexual dysfunction, sweat gland secretion disorders, and gastrointestinal dysfunction. Treatment includes avoiding aluminum exposure, strengthening dialysis, improving nutritional status, correcting anemia, etc., and switching to hemofiltration or dialysis if necessary. Kidney transplantation is the most effective method.

15. skin

The main manifestations are changes in skin color, itching, dryness, changes in hair and nails, and oral lesions. Some of them are effective in strengthening dialysis, and most of them can only be treated symptomatically without special treatment.

Hemodialysis machine blood pressure relationship

Hemodialyzer is commonly known as artificial kidney. It just replaces the non-functional kidney to ensure the metabolism of the human body. It does not have the effect of healing the kidney.

It is a treatment method for the treatment of end-stage renal disease. Long-term hemodialysis can cause some complications. Hypotension is one of them, and it occurs more during dialysis. Almost all patients have regular long-term blood Occurred at least once during dialysis treatment, with an incidence of 25% -40%.

The most common causes of hypotension during dialysis are the excessive weight gain between dialysis sessions and the rapid dehydration rate during dialysis. The use of antihypertensive drugs before dialysis, diabetic autonomic neuropathy, abnormal heart function, and allergies to dialysis equipment are all causes of hypotension. To avoid this complication, you need to control your diet and take in the right amount of water.

Dialysis therapy needs to be performed for a long time and cannot be interrupted. Failure to do so may result in a loss of efficacy and even threaten life.

What range of blood pressure is safe for patients with nephritis who need dialysis? Do you want to stay within the normal range?

The target range of control for different patients and different ages is different.

For maintenance dialysis patients, there is no one standard.

For patients without cardio-cerebral complications, it is recommended that blood pressure not exceed 140/90 mmHg.

For elderly patients with atherosclerosis, cerebrovascular disease, and inadequate coronary blood supply, the blood pressure cannot be too low, often not exceeding 160 / 90mmHg.

Hemodialysis machine principle

Dialysis refers to the solution on both sides of the semi-permeable membrane through dispersion, osmosis, and ultrafiltration, that is, the solute flows from the side with a higher concentration to the side with a lower concentration, and the water molecules from the side with a lower osmotic pressure to the side with a higher osmotic pressure. The process of side flow finally reaches dynamic equilibrium. Hemodialysis achieves therapeutic purposes by dispersing and ultrafiltration of the solution between blood and dialysate. Therefore, the dialysis process is the process of dispersing and filtering the solute.

Structural principle of hemodialysis machine

The hemodialysis machine can be roughly divided into two parts: a blood monitoring alarm system and a dialysate supply system. Blood monitoring alarm system includes blood pump, heparin pump, arteriovenous pressure monitoring and air monitoring; dialysate supply system includes temperature control system, liquid distribution system, degassing system, conductivity monitoring system, ultrafiltration monitoring and blood leakage monitoring, etc. Partial composition. Its working principle is: the concentrate for dialysis and the water for dialysis are formulated into a qualified dialysate through the dialysate supply system, and through the hemodialyzer, the solute disperses, permeates, and ultrafilters with the patient's blood from the blood monitoring alarm system; The patient's blood is returned to the patient's body through the blood monitoring alarm system. At the same time, the dialysis liquid is discharged as waste liquid from the dialysis solution supply system; it is continuously circulated to achieve the purpose of treatment and complete the entire dialysis process. As shown in Figure 1: 1-2 represents the blood circuit; 3-5-7 indicates that when the dialysate is prepared for dialysis or the dialysate is incorrect, the dialysate is bypassed and does not pass through the dialyzer; 3-6 -7 indicates the route of dialysate flowing through the dialyzer during normal dialysis; 6 indicates a single timeout.

Some functions of hemodialysis machine

The blood monitoring alarm system uses Gambro AK 95 as an example shown in Figure 2, and briefly introduces the functions of each part.

Used to promote blood circulation to maintain the smooth progress of hemodialysis treatment. Generally speaking, the blood pump part often has a speed detection function to monitor the blood flow of the patient, and the blood flow is related to the removal of various toxins (as shown in Figure 3), so the distance between the blood pump rotor and the groove The setting must be accurate and need to be adjusted frequently. According to the condition of the blood circuit pump tube, the distance is generally set to 3.2 ~ 3.3mm, not too loose, otherwise it will cause inaccurate blood flow detection; it should not be too tight, if too tight It may cause pipeline rupture and accident.

The heparin pump is equivalent to a clinically used microinjection pump to continuously inject heparin into a patient's blood. Because the patient's blood is in contact with air during extracorporeal circulation, clotting is prone to occur, and heparin pumps are used to prevent clotting.

Arterial pressure monitoring is used to monitor changes in thrombus, coagulation, and pressure in the dialyzer. When the blood flow is insufficient, the arterial pressure will decrease; when there is coagulation and thrombosis in the dialyzer, the arterial pressure will increase; the venous pressure monitoring is used to monitor the pressure of blood return in the circuit. Venous pressure will decrease when the dialyzer is clotted or clotted, blood flow is insufficient, and the venous return needle is shed. If the blood return tube is twisted or blocked or the return needle is blocked, the venous pressure will increase. When the above situation occurs, the machine will automatically alarm.

It is used to monitor the air flow in the blood flow path and intravenous drip pot. Generally, the principle of ultrasonic detection is used to prevent air embolism in patients. When air bubbles are detected, the detection system will drive arterial and venous blood clips to block blood flow and prevent danger.

a. Temperature control system

Including heating and temperature detection, during normal dialysis, the reverse osmosis water that meets the treatment standard is generally heated to 36 ~ 40 ° C. After mixing with the concentrated solution, the temperature is detected by the temperature sensor, and then the heating is controlled to make the dialysate temperature The temperature is consistent. Generally, the temperature of the dialysate is controlled at about 37 ° C, which can be adjusted appropriately according to the patient's condition. With heat sterilization machine, the heating temperature can reach 100 during heat sterilization.

Preparation of qualified dialysate, taking carbonate dialysis as an example, the mixing ratio is: A solution: B solution: pure water = 1: 1.83: 34. Many machines use ceramic pumps for proportioning, and adjust the speed to achieve the accuracy of dialysate preparation.

There is a certain amount of air in the water and concentrated solution. During the process of preparing the dialysate, gas will also be generated due to the presence of carbonate. These bubbles in the dialysate may cause blood air embolism, reduce the removal rate of waste, and affect dialysis. The flow rate and pressure of the liquid, and then the conductivity concentration, etc. occur, so the air in the dialysate needs to be removed. The principle of negative pressure is used when degassing. Generally, the degassing pressure is set to about -600mmHg, but in the plateau area, the negative pressure should be appropriately reduced, such as -500mmHg in Lanzhou and Kunming.

Generally, hemodialysis machines with a carbonate dialysis function are often equipped with 2 to 3 conductivity monitoring modules. First, the concentration of liquid A is detected. If the concentration of liquid A reaches the requirement, then liquid B is sucked, and then the detected conductivity is that of the dialysate. Actual conductivity. The conductivity value monitored by the conductivity monitoring module is transmitted to the CPU circuit, and compared with the set conductivity, the concentrated solution preparation system is controlled to make a dialysate that meets the requirements. The cation concentration in the dialysate is usually measured in the range of 13.0 ~ 15.0ms / cm, and the dialysate concentration is maintained between 13.8 ~ 14.2.

Trans-membranous Press (TMP) pressure control or volume control is used to achieve the purpose of ultrafiltration and removal of water from the blood. When the transmembrane pressure increases, the corresponding ultrafiltration volume will increase under the certain time (as shown in Figure 4). Due to the failure or complete loss of kidney function in most hemodialysis patients, it is impossible to exclude water from the body, so ultrafiltration systems are very important in hemodialysis machines. The ultrafiltration control system of hemodialysis machines on the market can be divided into two types: flow sensor system and balance chamber. Gambro company uses the former, while most other uses are the latter. Each has its advantages and disadvantages. It is passed through the dialyzer through comparison. The difference in flow rate before and after to calculate the ultrafiltration volume is more accurate. There is also an ultrafiltration detection method, and that is weighing control! Only Dota is in use.

In the process of hemodialysis, the membrane rupture of the dialyzer sometimes occurs. At this time, blood leakage occurs. In order to detect the occurrence of blood leakage, the general hemodialysis machine uses optical principles to detect the hemoglobin in the dialysate. The detection sensitivity is 0.25 ~ 0.35. ml hemoglobin / 1 liter dialysate, if there is precipitation or dirty during the dialysis process, false alarms are prone to occur, which requires the operator to promptly remove the stolen goods at the blood leakage detection site.

Development of hemodialysis machine

Development of hemodialysis machine equipment

The development of hemodialysis machines is becoming more and more mature, and the user-friendly design of the operation is also popular. As a therapeutic device, the personalized, safety performance and modular design of the treatment are the first issues considered by each manufacturer. According to the actual electrolyte situation of each patient, being able to easily provide different dialysates is an important direction for the development of hemodialysis machines; in order to improve the safety of hemodialysis, some companies have proposed the concept of a health chain; in terms of engineering, The design of the hemodialysis machine tends to be a modular design, which improves the maintenance performance of the machine.

Hemodialysis machine research report

"2012 Global and China Hemodialysis Machine Industry Development Forecast Research Report" is a professional and comprehensive in-depth research report in the field of hemodialysis machines. The report first introduces the definition, classification, application and application of hemodialysis machines (next to hemodialysis filter beds). Industry chain structure, then introduced the production process and production cost structure of hemodialysis machine, and then introduced the global and Chinese hemodialysis machine 2009-2016 production capacity, output, enterprise market share, and then introduced the supply and demand of hemodialysis machine And the gap, and introduced detailed information on the price, cost, profit, output value and profit rate of hemodialysis machine. After that, the production capacity, output, cost, price, profit and profit margin of 11 international hemodialysis machine manufacturers and 3 domestic hemodialysis machine companies are introduced, and the technical sources of these manufacturers, their production and expansion and the basic situation of the company are introduced. Then introduced the types and prices of related products used by hemodialysis machines. Finally, the feasibility analysis of a project with an annual output of 2000 hemodialysis machines is introduced in the form of a case. At the same time, the past of the entire hemodialysis machine industry is summarized in depth.

Maintenance of hemodialysis machine

Hemodialysis machine is different from other commonly used electronic instruments. During the dialysis process, a slight problem in each unit will cause downtime and affect the normal progress of treatment. Therefore, to ensure the normal operation of the machine, strict and meticulous maintenance and regular inspection and maintenance management are very important. The daily maintenance and maintenance of the dialysis machine should be operated in conjunction with the instructions of the machine and should be performed in the off state. The surface of the machine should be kept clean and free of dust, liquid marks, and blood. Use clean water and wet cloth, if necessary, clean the case with a flexible detergent, disinfect the vein clips and optical sensors, and keep the blood monitoring, bubble monitoring, and air monitoring clean and bright to avoid false alarms. If there is contamination, use a semi-moist cotton swab to repeatedly scrub the probe, and then wipe it with a dry cotton swab to keep it clean and dry. Do not drip dialysate on the red and blue connector sockets of the instrument to prevent crystals from forming and blocking the switch from popping up. If this happens, use a syringe to drip glacial acetic acid in the gap of the switch and press repeatedly until it is lubricated; once the effect is not good, you can repeat the above operation times.

Hemodialysis machine important events

On June 13, 2014, the Ministry of Commerce issued 2014 Announcement No. 42 and decided to conduct an anti-dumping investigation on imported hemodialysis machines originating from the European Union and Japan. ^[1]

The English name of the product involved in this anti-dumping investigation is Hemodialysis Equipment, which is under the "Import and Export Tariff of the People's Republic of China": 90189040. Products other than hemodialysis machines under this tariff code are not within the scope of this survey. ^[1]

Upon application from domestic industries, according to the "Anti-dumping Regulations of the People's Republic of China", the Ministry of Commerce will immediately dump and dump the above-mentioned imported products originating in the European Union and Japan, as well as the degree of damage and damage to similar Chinese products industries Investigate and make a ruling in accordance with the law. ^[1]