Rutin Hemodiyaliz
Özet
Yoğun Bakım Ünitelerinde bulunan hasta sayısının giderek artması ve daha kompleks hale gelmesiyle birlikte Akut Böbrek Hasarı sık karşılaşılan sorunlardan birisi olmuştur. Renal Replasman Tedavileri, müdahalede kritik öneme sahip olup hemodiyaliz tedavisi de bu yöntemlerden biridir. Hemodiyaliz tedavisinde amaç; üremik toksinleri ve fazla sıvıyı kandan etkili bir biçimde uzaklaştırmaktır. Hemodiyaliz sistemi diyaliz makinesi, diyalizör, ekstrakorporeal kan seti ve su arıtma sisteminden meydana gelmektedir. Diyalizat elde edebilmek için konsantre diyaliz çözeltileri su ile seyreltilmekte ve dört saatlik standart bir Hemodiyaliz seansında ortalama 120 litre saf su kullanılmaktadır. Kullanılan suyun maksimum kontaminasyon düzeyi, mikrobiyal kontaminasyon için <100 CFU/ml. ve bakteriyel endotoksin için <0,25 IU/ml. olması kabul edilebilir değer olarak ifade edilmektedir. Standartları karşılamayan su kullanımı halinde sert su sendromu, bulantı, kusma, titreme, ateş, siyanoz, hipotansiyon veya hipertansiyon, kas güçsüzlüğü, osteoporoz gibi kemik rahatsızlıkları, hemolitik anemi, hemoliz gibi klinik tablolar görülebilmektedir. Tıbbi ve teknolojik gelişmelere paralel olarak Hemodiyaliz uygulamalarındaki iyileştirmelere rağmen birçok komplikasyon görülmeye devam etmektedir.
With the increasing number of patients in Intensive Care Units and the growing complexity of their conditions, Acute Kidney Injury has become one of the frequently encountered problems. Renal Replacement Therapies are critically important in intervention, and hemodialysis is one of these methods. The aim of hemodialysis treatment is to effectively remove uremic toxins and excess fluid from the blood. The hemodialysis system consists of a dialysis machine, dialyzer, extracorporeal blood set, and water purification system. To obtain dialysate, concentrated dialysis solutions are diluted with water, and approximately 120 liters of pure water are used in a standard four-hour Hemodialysis session. The maximum acceptable contamination level for the water used is <100 CFU/ml for microbial contamination and <0.25 IU/ml for bacterial endotoxin. If water that does not meet the standards is used, clinical conditions such as hard water syndrome, nausea, vomiting, chills, fever, cyanosis, hypotension or hypertension, muscle weakness, bone disorders like osteoporosis, hemolytic anemia, and hemolysis may occur. Despite improvements in Hemodialysis practices in parallel with medical and technological advancements, many complications continue to be observed.
Referanslar
Clapp, J.T., Diraviam, S.P., Lane-Fall, M.B., Szymczak, J.E., Muralidharan, M., Chung, J.J., Gutsche, J.T., Curley, M.A.Q., Berns, J.S., Fleisher, L.A. (2020). Nephrology in the academic intensive care unit: a qualitative study of interdisciplinary collaboration. Am J Kidney Dis. 75(1):61-71. doi: 10.1053/j.ajkd.2019.05.030.
Griffin, B.R., Liu, K.D., Teixeira, J.P. (2020). Critical care Nephrology: core curriculum 2020. Am J Kidney Dis. 75(3):435-452. doi: 10.1053/j.ajkd.2019.10.010.
Patterson, T., Hehir, D.A., Buelow, M., Simpson, P.M., Mitchell, M.E., Zhang, L., Eslami, M., Murkowski, K., Scott, J.P. (2017). Hemodynamic profile of acute kidney injury following the fontan procedure: impact of renal perfusion pressure. World J Pediatr Congenit Heart Surg. 8(3):367-375. doi: 10.1177/215013511770 1376.
Goode, P., Brown, T., Moore, A.S. (2020). Hemodialysis: Step by step. Nursing made Incredibly Easy!. January/February 18(1):21-24 https://www.nursingcenter.com/journalarticle?Article_ID= 521263 9&Journal_ID=417221&Issue_ID=5212595
Ye, H. et al. (2020). Hemodialysis. In: Yang, J., He, W. (eds) Chronic Kidney Disease. Springer, Singapore. https://doi.org/10.1007/978-981-32-9131-7_17
Su Arıtma Sistemi Yönergesi. ( 05.07.2024 tarihinde https://www.sa glik.gov.tr/TR-11248/su-aritma-sistemi-yonergesi.html adresinden ulaşılmıştır).
Kaze, F.F., Ashuntantang, G., Kengne, A.P., Hassan, A., Halle, M.P., Muna, W. (2012). Acute hemodialysis complications in end-stage renal disease patients: the burden and implications for the under-resourced Sub-Saharan African health systems. Hemodial Int. 16(4):526-31. doi: 10.1111/j.1542-4758.2012.00692.x.
Bhandari, B., Komanduri, S. (2024). Dialysis Disequilibrium Syndrome. StatPearls Publishing. Available from: https://www. ncbi. nlm.nih.gov/books/NBK559018/
Takahashi, A. (2021). The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment. Physiol Rep. 9(21):e15114. doi: 10.14814/phy2.15114.
Hamal, S.S., ve Khadka, P. (2022). Updates on hemodialysis. Rijeka: IntechOpen. Doi: 10.5772/intechopen.109529
Martin-Navarro, J., Esteras, R., Castillo, E., Carriazo, S., Fernández-Prado, R., Gracia-Iguacel, C., Mas, S., Ortiz, A., González-Parra, E. (2019). Reactions to synthetic membranes dialyzers: is there an increase in incidence?. Kidney and Blood Pressure Research. 44. 1-8. Doi: 10.1159/000501035.
Butani, L., Calogiuri, G. (2017). Hypersensitivity reactions in patients receiving hemodialysis. Ann Allergy Asthma Immunol. 118(6):680-684 https://doi.org/10.1016/j.anai.2017.04.006
Kanbay, M., Ertuglu, L.A., Afsar, B., Ozdogan, E., Siriopol, D., Covic, A., Basile, C., Alberto Ortiz, A. (2020). An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clinical Kidney Journal. 13(6):981-993, https:// doi.org/10.1093/ckj/sfaa078
Murdeshwar, H.N., Anjum, F. (2024). Hemodialysis. StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books / NBK563296/
Balikci, E., Yilmaz, B., Tahmasebifar, A., Baran, E.T., Kara, E. (2021). Surface modification strategies for hemodialysis catheters to prevent catheter-related infections: a review. J Biomed Mater Res B Appl Biomater. 109(3):314-327. doi: 10.1002/jbm.b.34701.
López-Briz, E., Ruiz, Garcia, V., Cabello, J.B., Bort-Martí, S., Carbonell Sanchis, R. (2022). Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database of Systematic Reviews. Issue 7. Art. No.: CD008462. DOI: 10.1002/14651858.CD008462.pub4.
Referanslar
Clapp, J.T., Diraviam, S.P., Lane-Fall, M.B., Szymczak, J.E., Muralidharan, M., Chung, J.J., Gutsche, J.T., Curley, M.A.Q., Berns, J.S., Fleisher, L.A. (2020). Nephrology in the academic intensive care unit: a qualitative study of interdisciplinary collaboration. Am J Kidney Dis. 75(1):61-71. doi: 10.1053/j.ajkd.2019.05.030.
Griffin, B.R., Liu, K.D., Teixeira, J.P. (2020). Critical care Nephrology: core curriculum 2020. Am J Kidney Dis. 75(3):435-452. doi: 10.1053/j.ajkd.2019.10.010.
Patterson, T., Hehir, D.A., Buelow, M., Simpson, P.M., Mitchell, M.E., Zhang, L., Eslami, M., Murkowski, K., Scott, J.P. (2017). Hemodynamic profile of acute kidney injury following the fontan procedure: impact of renal perfusion pressure. World J Pediatr Congenit Heart Surg. 8(3):367-375. doi: 10.1177/215013511770 1376.
Goode, P., Brown, T., Moore, A.S. (2020). Hemodialysis: Step by step. Nursing made Incredibly Easy!. January/February 18(1):21-24 https://www.nursingcenter.com/journalarticle?Article_ID= 521263 9&Journal_ID=417221&Issue_ID=5212595
Ye, H. et al. (2020). Hemodialysis. In: Yang, J., He, W. (eds) Chronic Kidney Disease. Springer, Singapore. https://doi.org/10.1007/978-981-32-9131-7_17
Su Arıtma Sistemi Yönergesi. ( 05.07.2024 tarihinde https://www.sa glik.gov.tr/TR-11248/su-aritma-sistemi-yonergesi.html adresinden ulaşılmıştır).
Kaze, F.F., Ashuntantang, G., Kengne, A.P., Hassan, A., Halle, M.P., Muna, W. (2012). Acute hemodialysis complications in end-stage renal disease patients: the burden and implications for the under-resourced Sub-Saharan African health systems. Hemodial Int. 16(4):526-31. doi: 10.1111/j.1542-4758.2012.00692.x.
Bhandari, B., Komanduri, S. (2024). Dialysis Disequilibrium Syndrome. StatPearls Publishing. Available from: https://www. ncbi. nlm.nih.gov/books/NBK559018/
Takahashi, A. (2021). The pathophysiology of leg cramping during dialysis and the use of carnitine in its treatment. Physiol Rep. 9(21):e15114. doi: 10.14814/phy2.15114.
Hamal, S.S., ve Khadka, P. (2022). Updates on hemodialysis. Rijeka: IntechOpen. Doi: 10.5772/intechopen.109529
Martin-Navarro, J., Esteras, R., Castillo, E., Carriazo, S., Fernández-Prado, R., Gracia-Iguacel, C., Mas, S., Ortiz, A., González-Parra, E. (2019). Reactions to synthetic membranes dialyzers: is there an increase in incidence?. Kidney and Blood Pressure Research. 44. 1-8. Doi: 10.1159/000501035.
Butani, L., Calogiuri, G. (2017). Hypersensitivity reactions in patients receiving hemodialysis. Ann Allergy Asthma Immunol. 118(6):680-684 https://doi.org/10.1016/j.anai.2017.04.006
Kanbay, M., Ertuglu, L.A., Afsar, B., Ozdogan, E., Siriopol, D., Covic, A., Basile, C., Alberto Ortiz, A. (2020). An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clinical Kidney Journal. 13(6):981-993, https:// doi.org/10.1093/ckj/sfaa078
Murdeshwar, H.N., Anjum, F. (2024). Hemodialysis. StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books / NBK563296/
Balikci, E., Yilmaz, B., Tahmasebifar, A., Baran, E.T., Kara, E. (2021). Surface modification strategies for hemodialysis catheters to prevent catheter-related infections: a review. J Biomed Mater Res B Appl Biomater. 109(3):314-327. doi: 10.1002/jbm.b.34701.
López-Briz, E., Ruiz, Garcia, V., Cabello, J.B., Bort-Martí, S., Carbonell Sanchis, R. (2022). Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Database of Systematic Reviews. Issue 7. Art. No.: CD008462. DOI: 10.1002/14651858.CD008462.pub4.
