The Procedure For Catheter Patients.

                In the last post I explained the procedure of haemodialysis. But when it comes to the starting and closing of the catheter patients, it’s a bit different. It needs more care and patience as there is a higher risk of infection for catheter patients.  The procedure remains the same till priming. After that, remove the protective covering of the catheter with the gloves we primed the dialysis set. Then remove it and don a pair of new sterile gloves. Ask the assistant to open the outer flap of the autoclaved tray. Then open the tray and ask your assistant to open and transfer all the packaged articles to it. Wet a sterile cotton ball with spirit and povidone iodine and wipe the catheter and the portion of the skin to which the catheters come in contact with.  Uncap the catheter and wipe the catheter from the opening towards the other end. Place a sterilized towel under the catheter and withdraw 2-3 ml of blood from each tube using a 5ml syringe. This is to minimize the risk of infection and thromboembolism and to avoid the mixing of old flushed heparin with the blood.  The tubes of the catheter will be of two colours- red, arterial and the blue, venous.  Ensure the free flow of blood in the catheter by repeated aspirations followed by reinfusions.  In some patients, due to careless handling and bending, the catheters may get dislodged or kinked. In such cases, we have to carefully adjust the catheter position manually or try massaging the vicinal part of the catheter insertion.  After a free flow of blood is established, connect the blood lines accordingly and run the pump at a slow rate.

                                                                          After the blood is returned at the end of the dialysis, flush the catheter thoroughly until the transparent tubes become completely clear. Then we have to do hep-locking(1ml of 25000IU heparin diluted with 5ml saline. Some entertain choosing sodium bicarbonate injection instead of normal saline. According to me, it is more preferable. This is to prevent the formation of clots until next dialysis. For some people who frequently get infections, we close the catheter with antibiotics like gentamycin or amikacin. After the flushing is complete, clean the catheter tip with betadine and spirit. No blood or clot should be allowed to remain. Close it tightly with a cap, then repeat  wiping over the entire catheter 2 or 3 times with new swabs. Cover the catheter with a sterile gauze and then by a clean adhesive plaster. Remove the plaster over the catheter insertion site for cleaning. Remove the old gloves and don the new ones. Clean the insertion site thoroughly and most importantly carefully using gauze dipped in betadine and spirit. Repeat twice and move towards periphery. Remember, once you move towards periphery; don’t come back to the insertion site. After drying the site, cover it with sterile gauze then secure with a clean plaster. That’s all….

Know More About Dialysis.

WHAT IS DIALYSIS?

The incidence of renal patients has skyrocketed all over the world since the recent past. It is assumed that one’s lifestyle has the most significant role in his health and illness. People’s food preferences have changed. They like to consume palatable junk foods which destroy their health instead of fostering them. There is also a boom in the invention and modification of a number of medicines. Surely these inventions have helped mankind in many ways. But we ways fail to realize that no drug is available which doesn’t have any side effect.  Even the food or water we take will show adverse effects when taken unnecessarily. So how can we believe drugs? Most of the drugs are either nephrotoxic or hepatotoxic. For some, gene really matters. We cannot rule out the possibility of transmitting kidney disease from one generation to the next.  Other lifestyle associated conditions like diabetes and hypertension also play a remarkable role in the development of renal problems. Once an acute illness is left unnoticed or neglected, it will turn out to be a big mess. In chronic renal diseases, no pharmacological management is considered effective. So the only options left are either dialysis or kidney transplantation.

Dialysis is a treatment method of removing the waste products from blood, when one’s kidneys are not capable of performing this duty.   What waste? The wastes in the blood are urea, uric acid and creatinine. Kidneys also regulate the level of electrolytes like sodium, potassium, etc by two processes known as diffusion and osmosis. The water in excess is also removed by ultrafilteration. The kidneys are responsible for the regulation of electrolytes, BP and the buffer system. The production of erythropoietin (for RBC formation), calcitriol and renin is undertaken by these two beans.  Dialysis cannot do all these works. It’s helpful only in the waste clearance. Besides, the production works which are halted due to kidney failure should be rectified by supplementation or injections. That means dialysis can never substitute the normal kidney. Blessed are those whose organs are in good conditions.

WHO SHOULD UNDERGO DIALYSIS?

It may not be necessary to start dialysis as soon as one is diagnosed with a possible kidney failure. Acute cases may get cured by lifestyle modification and pharmacological interventions.  It is advised to start dialysis as soon as possible if the GFR is below 15ml/min. Up to 8-10ml/min is also ok, but who wants to take the risk? The blood studies also should be carried out to know the urea, creatinine and electrolyte levels. High concentrations of electrolytes are an indication for immediate dialysis. Some patients with poisoning and snake bite would benefit from haemodialysis. Those disease prone people with the baseline kidney functions and suffering from pulmonary edema will get relief from the dyspnoea associated with fluid accumulation in the lungs.  Profound edema will get a mild relief from a number of short, consecutive dialyses.