Dialysis Introduction Type And Principle Of Peritoneal Dialysis

Introduction:

Dialysis is the artificial process of getting rid of waste (diffusion) and unwanted water (ultrafiltration) from the blood. This process is naturally done by kidneys. Some people, however, may have failed or damaged kidneys which cannot carry out the function properly - they may need dialysis. In other words, dialysis is the artificial replacement for lost kidney function . Dialysis may be used for people who have become ill and have acute kidney failure (temporary loss of kidney function), or for fairly stable patients who have permanently lost kidney function (stage 5 chronic kidney disease). Dialysis  need  when people develop end stage kidney failure --usually by the time people lose about 85 to 90 percent of kidney function.

Types Of Dialysis:

There are two main types of dialysis.

1. Hemodialysis:

The blood circulates outside the body of the patient , it goes through a machine that has special filters. The blood comes out of the patient through a catheter (a flexible tube) that is inserted into the vein. The filters do what the kidney's do; they filter out the waste products from the blood. The filtered blood then returns to the patient via another catheter.

Patients need to be prepared for hemodialysis: A blood vessel, usually in the arm, needs to be enlarged. . The enlarged vein makes the insertion of the catheters possible. US researchers have developed a new way of growing blood vessels using patients' own skin cells to seed the growth of tissue and have tested it in dialysis patients with end stage kidney disease.

Hemodialysis usually lasts about 3 to 4 hours each week. The duration of each session depends on how well the patient's kidneys work, and how much fluid weight the patient has gained between treatments. Hemodialysis is either done in a special dialysis center in a hospital.

2. Peritoneal Dialysis :

A sterile (dialysate) solution rich in minerals and glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semi-permeable membrane.

The abdomen is the area between the chest and hips , it contains the stomach, small intestine, large intestine, liver, gall bladder, pancreas and spleen. Peritoneal dialysis uses the natural filtering ability of the peritoneum ,the internal lining of the abdomen. In other words, peritoneal dialysis uses the lining of the abdomen as a filter of waste products from the blood.

The dialysate is left there for some time so that it can absorb waste products. Then it is drained out through a tube and discarded. This exchange, or cycle, is generally repeated several times during the day - with an automated system it is often done overnight. The elimination of unwanted water (ultrafiltration) occurs through osmosis - as the dialysis solution has a high concentration of glucose, it results in osmotic pressure which causes the fluid to move from the blood into the dialysate. Consequently, a larger quantity of fluid is drained than introduced.

Although peritoneal dialysis is not as efficient as hemodialysis, it is carried out for longer periods. The net effect in terms of total waste product and salt and water removal is about the same as hemodialysis.

Peritoneal dialysis is done at home by the patient; by a willing and motivated patient. It gives the patient a greater amount of freedom and independence because he/she does not have to come in to the clinic at multiple times each week. It can also be done while traveling with a minimum of specialized equipment. Peritoneal dialysis is said to 'save lives and save money'.

Before having peritoneal dialysis, the patient needs to have a small surgical procedure to insert a catheter into the abdomen. This is kept closed off, except when fluid is being introduced or taken out of the abdomen.

There are two principal types of peritoneal dialysis:

1. Continuous ambulatory peritoneal dialysis (CAPD) :

This requires no machinery and can be done by the patient or a caregiver. The dialysate is left in the abdomen for up to eight hours. It is then replaced with a fresh solution straight away. This happens every day, about four to five times per day.

2. Continuous cyclic peritoneal dialysis (CCPD) :

A machine does the dialysis fluid exchanges. It is generally done during the night while the patient sleeps. This needs to be done every night. Each session lasts from ten to twelve hours. After spending the night attached to the machine, the majority of people keep fluid inside their abdomen during the day. Some patients may require another exchange during the day. A study found that a significant number of patients prefer "dialysis while patient sleep" treatment.

Latest Procedure Of Laparoscopic cholecystectomy

Procedure:

• To begin the operation, the patient is placed in the supine position on the operating table and anesthetized.

• Disinfect the skin of patient using antiseptic lotion like savlon,betadin,spirit.

• Maintain the sterile technique during procedure.

•  A scalpel is used to make a small incision at the umbilicus

•  Using either a Veress needle or Hasson technique the abdominal cavity is entered.

• The surgeon inflates the abdominal cavity with carbon dioxide to create a working space.

• The camera is placed through the umbilical port and the abdominal cavity is inspected.

• Additional ports are opened inferior to the ribs at the epigastric, midclavicular, and anterior axillary positions.

• The gallbladder fundus is identified, grasped, and retracted superiorly. 

• With a second grasper, the gallbladder infundibulum is retracted laterally to expose and open Calot's Triangle (the area bound by the cystic artery, cystic duct, and common hepatic duct). 

• The triangle is gently dissected to clear the peritoneal covering and obtain a view of the underlying structures.

• The cystic duct and the cystic artery are identified, clipped with tiny titanium clips and cut.

• Then the gallbladder is dissected away from the liver bed and removed through one of the ports

Recently, this procedure is performed through a single incision in the patient's umbilicus. This advanced technique is called Laparoendoscopic Single Site Surgery or "LESS".