All About Dialysis: Cost, Facilities, Risks, And Considerations

Setting up a dialysis machine and considering the necessary precautions

Questions:

1.What is the Costing Budget for set up and Installation of the Dialysis Machine?

2.Are there any Codes to follow? (anything that might relate to codes such as instruction, installation, Cleaning or etc.)

3.What kinds of Risks might be existed with the Operation of Dialysis Machine?

4.What risk or Potential Damage might occur to the patients during the Dialysis Procedures?

5.What should Patients do before going to Dialysis Treatment?

6.What are the general risk associated before Operation and after Operation?

7.What do Patients need to do after Dialysis Operation?

8.What do Renal Dialysis Technicians do?

9.What type of Training is required for a Dialysis Technician and Dialysis Nurse?

10.Which Materials are used and applied for Dialysis Performance?

11.What are the maximum and minimum number of patients who come for Dialysis Treatment in a month?

12.What types of Dialysis do you recommend for Patients?

13How Does a Dialysis Machine Work?

14.Demonstrate how Connection would be made to a patient and what would be desired outcome?

15.What Components are Special in it and why do they use?

16.What did you learn from this Research Project?

The research project on dialysis gives all the information regarding setting up a dialysis machine and considerations necessary for the operation of machine. The interview question from a hemodialysis manager helps to know all information regarding the training required by dialysis technicians, equipment needed for dialysis, risk associated with the process and patients and staffs role in care of patients.

1.The costing budget for installing dialysis machine depends on several factors such as buying new or used equipment, cost of hiring technician and additional cost related to dialysis medical supplies. A new dialysis machine may cost around $10,000 to $15,000, whereas as an used machine will cost around $7,000. In addition, dialysis medical supplies such as bandage, tubing and other products will cost $10-$35 (Deno, 2017).

2.A hemodialysis unit should have the following facilities:

• The machine requires 11*10 feet area to easily wheel on emergency equipment on all sides of the patient.
• Head end of patient’s bed should have stable electrical supply, drainage facility and oxygen outlet.
• Air conditioning is necessary to achieve 70- 72° F temperature and maintain humidity.
• The dialyzing area for patients with viral disease should be separate from those with other disease.
• The preparation area should be separate to store supplies such as IV fluids and dialyzers tubing (STANDARD TREATMENT GUIDELINES HAEMODIALYSIS, 2017).

3.The risk associated with operating dialysis machine may arise due to human factors at the machine interface and communication error among care giver. Some example of potential risk includes infections, medication errors and access-related errors (Kliger, 2014).

4.A patient undergoing the dialysis procedure is vulnerable to risk for infection around the catheter site. Other form of risk to patient includes high blood sugar due to use of dextrose in dialysate, abdominal muscle weakening, pericarditis, anemia, low blood pressure and depression. Some patients also have risk of developing amyloidosis when amyloid proteins build up in the kidney organs. Patient should always inform about this form of side-effect to health care provider (Sarnak et al., 2013).

5. Before going to dialysis treatment, the patient needs to prepare for dialysis treatment by creating a vascular access. Vascular access is needed to remove blood from the body and return the blood required by dialyzer. The purpose of vascular access is to allow high blood flow through the dialyzer and this is done mainly by creating an arteriovenous fistula in the arm of patients. Arteriovenous fistula is the best option to maintain blood flow and reduce complication rate in patient (Preparing for Kidney Failure Treatment, 2017).

Costing budget and factors for dialysis machines

6.As kidney disease patients require surgical intervention before undergoing dialysis treatment, they have high risk of peri-operative morbidity and mortality rates. The morbidity and mortality rate is high due to fluid and electrolyte issues and bleeding issues. Hyperkalemia is the most frequent complication seen in patients followed by infection, arrhythemias, bleeding and hemodynamic stability. Clotted vascular access ports also increased morbidity of patients and preoperative attention and assessment is needed to manage risk in patients with impaired renal function (Krishnan, 2002).

Patient after dialysis may develop risk of increased post-operative hypotension due use of general anesthesia. In some patients, dialysis may be required before anesthesia because post-operative complications occur is given before completion of hemodialysis. Hence time interval from end of dialysis to administration of general anesthesia is critical to avoid post-operative complication like hypotensive events (Deng, Lenart, & Applegate, 2014). 

7.After dialysis operation, patients need to take iron and folic acid medicines as prescribed by the doctor to make red blood cells. Furthermore, care of the arteriovenous fistula is also important after dialysis operation. Patient needs to clear the skin over the fistula and remove the bandage over it 4-6 hours after dialysis. Patient also needs to check the graft or fistula for signs of infection such as bleeding and swelling. Further precaution needed for care for fistula is to prevent damage to the fistula and avoid wearing tight clothes. After dialysis, patient will have limit potassium, phosphorus and sodium in diet. They also need to control consumption of fluid and consultation from physician is required fluid intake each day (Hemodialysis (Aftercare Instructions)-, 2017).  

8.The renal dialysis technicians are responsible for operating the machine and monitor the patient during treatment process. They follow strict operating guidelines and procedure to ensure that to ensure safety of patients. Their effort is to promote effective outcome by assessment of patient vital signs and adjusting fluid removal rate according to patient health status. They also need to be aware of emotional pressure experienced by patients during dialysis procedure to take care of patients.

9.Dialysis nurse needs training and expertise in kidney disease and treatment to make the dialysis process efficient and safe for patients. They have training in all types of dialysis- hemodialysis and peritoneal dialysis. They are trained in assessment of patient before and after the dialysis procedure to identify signs of infection. Apart from clinical skills, they also require excellent interpersonal skills to work well with inter-professional staff. Some dialysis nurse also specializes in care for elderly or pediatric patients.

A dialysis technician requires training in dialysis technology, setting up equipment, patient preparation and operating dialysis machine. They are also trained in monitoring patient and checking their health status before and after dialysis. They need to complete a dialysis technician training program to get knowledge about operation of dialysis equipment, patient care, medical terminology, dialysis principle, anatomy and diagnostic procedures.

10.The operation of the hemodialysis machine needs equipment such as blood pump for unidirectional flow, heparin pump, monitors for arterial and venous line pressure, air bubble detector, safety devices and dialysate temperature regulator. Dialysate helps to remove extra fluid from blood and needle is needed to carry blood to the dialyser and return clean blood back to the body.

Facilities required in hemodialysis units

11.The hospitals in US performs dialysis on 34 patients every month and 6,50, 000 patients per year are affected by end-stage renal disease in United States (Statistics | The Kidney Project | UCSF, 2017).

12. I would suggest hemodialysis to patients because they do not require participation in treatment and they just need to adhere to specific schedule and session for dialysis three times a week. It also means strict diet and fluid control, however still hemodialysis is advantageous than peritoneal dialysis because peritoneal dialysis has maximum chance of infection due to entry of the bacteria from the peritoneal cavity into the body.

Dialysis acts as an artificial kidney by which an arteriovenous access is made on patients arm, leg or neck and the blood is circulated out of the body and cleaned inside the machine to be returned back to the body. Dialysate fluid is required in dialysis machine to remove unwanted waste products from the blood and dialysis machine mixes the dialysate to balance the electrolyte and mineral level in the body. The blood tubing carries the blood from arteriovenous access to the dialyzer and heparin pump is used to release heparin into blood tubing to prevent blood clotting (Hemodialysis 2017).

14.Connection to the dialysis machine is made by creating a fistula or graft in the arms or leg of patient. A blood vessel created in arm called arteriovenous fistula that connects artery to vein. This helps in easier transfer of blood from the vascular access to the machine and then returning back filtered blood. The connection between the vascular access and dialysis machine is made by a needle and the fistula is created four weeks before dialysis to allow the skin to heal. Two needles are inserted into the fistula- one needle removes the blood and transfers to the dialysis machine and the second needle transfers back the filtered blood into the patient body (Dialysis - How it's performed - NHS Choices, 2017).

15.The important components of the dialysis machine are the peristaltic pump, valve and cleaning system. The pump helps in driving higher volume fluids like blood, dialysate and saline to the machine. For low volume fluids like heparin, syringe pump mechanism is useful to prevent blood clotting. Dialyzer and dialysate is also an important component that serves to filter waste from blood through a membrane in the dialyser and dialysate pulld impurities out from the blood through the membrane. Valve is needed to allow mixing proportion ratios and sensors are needed to monitor several parameters such as temperature, pressure, oxygen saturation and dialyzer membrane pressure (The Dialysis Machine — Dialysis Technician's Training, 2017).

16.This research project on dialysis machine gave me the idea about the setting up the dialysis machine such as the protocol, supply equipment and the facilities needed to carry out the procedure. The detail on the components and function of dialysis machine helped me gain knowledge regarding how the dialysis technology helps to filter blood of patient with renal disease.

Conclusion

The research project on dialysis highlighted the details needed to set up a dialysis machine and operate the machine on patients. The key trainings and skills needed by dialysis technician and nurses describes how they play a role in preparing the patient for dialysis, monitoring them during the procedure and teaching them to take care of the patient post dialysis. This information is useful for kidney disease patients as well as health care professionals to understand the rational for use and mechanism of the dialysis of the machine.

References

Deno, T. (2017). Pricing and Costs of Dialysis Equipment and Supplies. www.business.com. Retrieved 24 February 2017, from https://www.business.com/articles/pricing-and-costs-of-dialysis-equipment-and-supplies/

Kliger, A. S. (2014). Maintaining safety in the dialysis facility. Clinical Journal of the American Society of Nephrology, CJN-08960914.

Krishnan, M. (2002). Preoperative care of patients with kidney disease. American family physician, 66(8), 1471-6.

Hemodialysis. (2017). The National Kidney Foundation. Retrieved 25 February 2017, from https://www.kidney.org/atoz/content/hemodialysis

The Dialysis Machine — Dialysis Technician's Training. (2017). Dialysistechnicianstraining.com. Retrieved 25 February 2017, from https://dialysistechnicianstraining.com/the-dialysis-machine/

Hemodialysis (Aftercare Instructions) - What You Need to Know. (2017). Drugs.com. Retrieved 25 February 2017, from https://www.drugs.com/cg/hemodialysis-aftercare-instructions.html

Deng, J., Lenart, J., & Applegate, R. L. (2014). General anesthesia soon after dialysis may increase postoperative hypotension-A pilot study. Heart, lung and vessels, 6(1), 52.

Sarnak, M. J., Tighiouart, H., Scott, T. M., Lou, K. V., Sorensen, E. P., Giang, L. M., ... & Weiner, D. E. (2013). Frequency of and risk factors for poor cognitive performance in hemodialysis patients. Neurology, 80(5), 471-480.

Preparing for Kidney Failure Treatment. (2017). Niddk.nih.gov. Retrieved 24 February 2017, from https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/learn/living/kidney-failure/prepare-for-treatment/Pages/prepare-for-treatment.aspx

Statistics | The Kidney Project | UCSF. (2017). Pharm.ucsf.edu. Retrieved 25 February 2017, from https://pharm.ucsf.edu/kidney/need/statistics

Dialysis - How it's performed - NHS Choices. (2017). Nhs.uk. Retrieved 25 February 2017, from https://www.nhs.uk/Conditions/Dialysis/Pages/How-haemodialysis-is-performed.aspx

STANDARD TREATMENT GUIDELINES HAEMODIALYSIS. (2017) (pp. 10-15). Retrieved from https://clinicalestablishments.nic.in/WriteReadData/358.p