What to read after Dialysis Study :EXPERT NOTES for DHA, Bonent, CHT, B.Sc in Dialysis, Diploma in Dialysis?

KIDNEYS. 17

Structure of the kidneys. 17

The renal cortex. 18

The renal medulla. 18

The renal pelvis. 18

Structure of nephrons- 18

The nephron consists of two main parts: 18

Urine formation. 19

Filtration. 19

Reabsorption. 19

Secretion. 19

FUNCTIONS OF THE KIDNEYS. 20

Regulation of electrolyte composition. 20

Regulation of PH of blood. 20

Regulation of blood volume. 20

Maintenance of Blood osmolarity. 20

Regulation of blood pressure. 20

Production of hormones. 20

WHAT HAPPEN WHEN KIDNEYS DO NOT FUNCTION PROPERLY. 21

ACUTE RENAL FAILURE. 22

ETIOLOGY- 22

PRE-RENAL. 22

Intrinsic renal 23

Post renal cause. 23

SIGN AND SYMPTOMS OF ARF OR AKI- 23

RIFLE CRITERIA FOR THE DIAGNOSIS OF ARF. 24

INVESTIGATIONS –. 24

CHRONIC RENAL FAILURE. 26

Classification of the CKD- 26

ETIOLOGY- 26

Infection –. 26

Immune- 26

Metabolic- 27

Malignant- 27

Toxic- 27

Vascular- 27

Obstructive uropathy –. 27

Congenital- 27

SYMPTOMS OF CKD/ESRD.. 27

Initial symptoms. 27

Later symptoms- 28

COMPLICATIONS OF THE RENAL FAILURE- 28

Fluid overload- 28

Hypertension- 28

Anaemia- 28

Hyperkalaemia: - 28

Renal osteodystrophy- 29

Uremic nephropathy- 29

Itching- 29

Impotence and infertility in male. 29

Amenorrhea and infertility in female. 29

Metabolic acidosis. 29

Clinical manifestation of uremia. 29

Cardiopulrnonary system.. 29

Neurologic system.. 29

Dermatologic system.. 30

Metabolic system- 30

Reproductive system.. 30

Hematologic system.. 30

Skeletal system.. 31

Uremic toxins. 31

small water soluble, non-protein bound compound. 31

small lipid soluble and protein bound compounds such as. 31

larger or middle molecules such as- 31

INSTIGATIONS- 31

ASSESSMENT OF RENAL FUNCTION.. 32

1.Serum creatinine. 32

2.Blood urea nitrogen (BUN)- 32

3.Potassium –. 32

4.Creatinine clearance- 32

TREATMENT OPTION FOR RENAL FAILURE. 33

Kidney transplant- 33

Hemodialysis –. 33

Advantages of Hemodialysis- 34

Disadvantages of Hemodialysis- 34

Peritoneal dialysis –. 34

Types of peritoneal dialysis- 34

Role of a dialysis technician. 35

BIOMEDICAL WASTE. 36

Types of waste. 36

Steps in waste management. 36

Segregation. 36

Collection. 37

Storage. 37

Transportation. 37

treatment. 37

Disposal 37

Hospital waste- 38

Colour coding. 38

KIDNEY TRANSPLANT. 39

WHY KIDNEY TRANSPLANT- 39

ADVANTAGES OF KIDNEY TRANSPLANTATION- 39

CONTRAINDICATIONS FOR A KIDNEY TRANSPLANT- 39

PRE-TRANSPLANT. 40

Donor is of two types- 40

Deceased (cadaver) donors –. 40

A person cannot donate kidney if he or she has- 40

Blood group- 40

HLA Typing- 41

Assessment of patient –. 41

Evaluation of donor- 42

TRANSPLANT. 42

POST TRANSPLANT CARE. 42

DISADVANTAGES OF KIDNEY TRANSPLANTATION.. 42

Complications of the renal transplant- 43

1.Rejection- 43

2.Infection- 43

3.Acute tubular necrosis (ATN)- 43

4.Hematuria- 43

5.Arterial thrombosis- 43

6.Venous thrombosis –. 44

7.Steroids induced diabetes. 44

8.Hypertension. 44

9.cardio-vascular disease. 44

10.Malignancy. 44

Medication used in kidney transplant- 44

Prednisone,Prednisolone (steroids) 44

Tacrolimus      (Dialysis study) 44

Cyclosporine. 45

Mycophenolate Mofetil 45

TRANSPORT MECHANISMS: -Principles of Hemodialysis. 45

Osmosis. 46

Osmotic pressure. 46

Types of solution. 46

factors affecting the rate of Osmosis? (Dialysis study) 47

DIFFUSION.. 47

Factors affecting the rate of diffusion    (Dialysis study) 48

ULTRA-FILTRATION.. 49

Ultrafiltration coefficient (kuf) 50

ADSORPTION: - 50

CONVECTION: -          (dialysis study) 50

FILTRATION: - 51

FILTRATION FRACTION: - 52

SIEVING COEFFICIENT (SC) 52

Factors that determining the sieving coefficient. 52

DIALYSATE. 53

The purpose of dialysate. 53

Acid concentrate- 54

Bicarbonate concentrate- 54

Range of substances in dialysate (mEq/l) 54

Sodium (Na+) 55

Potassium (K+) 55

Calcium (Ca++) 55

Magnesium (Mg++) 56

Chloride (Cl–) 56

Glucose (C6H12O6) 56

Acetate (CH3 COO–) 56

Bicarbonate (HCO3 –) 56

Sodium profiling-- 56

Aim of sodium profiling. 57

Types of Sodium Modelling or Profiles. 57

Why concentrate A and B are separated?. 57

HOW HEMODIALYSIS WORKS? Mechanism of Dialysis. 58

What is Hemodialysis?. 58

Diffusion in Hemodialysis- 58

Flow of blood and dialysate- (counter current flow) 59

Convection and ultrafiltration in Hemodialysis- 60

Osmosis in hemodialysis. 60

HEMODIALYSIS EQUIPMENT OR DEVICE. 62

Blood circuit. 62

Dialyzer –. 62

Blood tubing –. 63

Blood pump- 63

Heparin Pump- 63

Blood tubing clamp- 63

The dialysate circuits. 64

Heating of the dialysate: - 64

Dialysate deaeration: - 64

Dialysate proportioning: - 64

Monitors and detectors: - 65

Air detectors. 65

Pressure monitors- 66

Temperature monitor. 66

Blood leak Monitoring. 67

Conductivity monitor. 67

ANTICOAGULATION DURING DIALYSIS. 68

HEPARIN.. 68

TYPES OF HEPARINS. 69

Heparin Induced thrombocytopenia. 70

ANTICOAGULATION MONITORING.. 70

HEPARIN ADMINISTRATION TECHNIQUE. 70

HEPARIN TERMINATION- 71

HEPARIN ANTAGONIST- 72

HEPARIN FREE DIALYSIS. 72

Indications for heparin free dialysis- 72

PROCEDURE of heparin free dialysis: - 72

Disadvantages of heparin free dialysis. 73

ALTERNATIVES TO HEPARIN OR CITRATE dialysis. 73

THE ADVANTAGE OF REGIONAL CITRATE OVER HEPARIN-FREE DIALYSIS ARE- 73

DISADVANTAGES. 74

Dialyzer or Hemodialyzer. 74

Dialyzer design types: - 75

COIL DIALYZER- 75

PARALLEL PLATE DIALYZER- 75

HOLLOW FIBER DIALYZER. 76

Parts of the dialyzer- 76

hemodialyzer MEMBRANE MATERIAL. 76

Cellulose membrane: - 76

Modified cellulose membrane -or semi synthetic- 77

Synthetic membrane –. 77

How dialyzer works- 77

Remove waste from blood. 77

Remove extra fluid- 77

Balance electrolytes- 78

CATEGORIES OF DIALYZER- 78

Conventional dialyzer- 78

High efficiency dialyzer- 78

High flux dialyzer- 78

FACTORS DETERMINING THE PERFORMANCE OF THE MEMBRANE. 78

OTHER TERMS THAT ARE USED FOR DIALYZER. 79

Biocompatibility- 79

Surface area- 79

Mass transfer coefficient (KoA)- 79

Molecular weight cut-off- 79

Ultrafiltration coefficient (Kuf) –. 79

Clearance- 79

Measuring dialyzer effectiveness- 79

Conditions for an effective dialyzer- 80

Dialyzer sterilization- 80

DIALYZER REACTIONS. 80

Type A reaction. 80

Type B eaction. 81

Treatment- 81

Vascular access. 81

Types of vascular access. 82

AVF ARTERIO-VENOUS FISTULA.. 82

The fistula is considered the “gold standard” access. 83

WHY ANASTOMOSIS IS NEEDED? arterialization?. 83

Types of anastomosis Or methods of AVF creation. 83

HOW IS AN AVF CREATED?. 84

PRE-OPERATIVE evaluation of AVF- 84

COMMON LOCATIONS OF THE AVF ARE: 84

advantages of Av fistula. 84

Disadvantages. 85

ASSESSING MATURITY OF FISTULA.. 85

(RULE OF 6S.) 85

Assessment of av fistula normal or abnormal 85

CANNULATION OF NEW AV FISTULA.. 86

HAND WASHING.. 86

ASSESSMENT OF AVF. 86

SKIN PREPARATION.. 86

Needle. 87

NEEDLE PLACEMENT. 87

Needle- 87

AV fistula needle has. 88

Needle size is measured in gauge. 88

CANNULATION TECHNIQUE. 88

Rope-ladder technique: 88

Buttonhole technique: 88

Area puncture technique: 89

needle removal/ de-cannulation- 89

FISTULA CARE POST DIALYSIS. 89

FISTULA COMPLICATIONS- 89

Failure of fistula. 89

Edema. 90

Hematoma. 90

Thrombosis. 90

Stenosis. 91

Aneurysm formation- 92

Steal syndrome- 93

Infection- 93

Needle infiltration. 94

Neuropathy. 95

Bleeding. 95

ARTERIO-VENOUS GRAFT. 96

Graft material- 96

name of graft materials. 97

TYPES OF GRAFT. 97

Advantages and disadvantages of AV Graft. 97

Complications of AV Graft. 98

Infection. 98

Thrombosis. 98

Stenosis. 98

Aneurysm.. 98

Steal syndrome. 99

HEMODIALYSIS CATHETERS. 99

Types of Hemodialysis catheter. 100

Chronic Dialysis Catheters. 100

Acute Dialysis Catheters. 100

Why are Chronic Dialysis Catheters Used?. 100

Why are Acute Dialysis Catheters Used?. 100

FEMORAL CATHETER- 101

INTERNAL JUGULAR CATHETER OR DOUBLE LUMEN CATHETER. 101

Access recirculation- 101

CATHETER PLACEMENT. 102

IJV catheter placement. 102

Seldinger (catheter-over-guidewire) technique. 102

Needs. 102

TECHNIQUE. 103

Contraindications. 104

COMPLICATIONS OF THE IJV CATHETERS- 104

Care of catheter. 105

Catheter locks. 106

Femoral Vein Cannulation. 106

Need. 106

Procedure. 106

Contraindications. 108

Complications of Femoral Vein Cannulation. 108

DIALYSIS PRESCRIPTION AND INDICATION OF DIALYSIS. 108

INDICATIONS FOR RRT. 108

Renal 108

Nonrenal 109

Chronic outpatient dialysis session. 109

Time: 109

Dialyzer: 109

Blood Flow (Qb): 109

Dialysate Flow (Qd): 109

Dialysate Concentrate: 109

Heparin anticoagulation: 109

Dry weight goal or ultrafiltration goal: 110

Access- 110

First dialysis or acute dialysis prescription. 110

Time: 110

Dialyzer: 110

Blood flow: 110

Dialysate flow: 110

Ultrafiltration: 110

DIALYSATE: 110

HEPARIN: 110

ACCESS: 110

DIALYSIS PROCEDURES. 111

Pre-dialysis safety checks- 111

Integrity of extracorporeal circuit. 111

Dialysis machine safety. 111

water system.. 111

Prescription. 111

Pre-dialysis patient evaluation. 111

Rinsing & priming of dialyzer. 112

How to do priming. 112

Patient assessment. 113

Vascular access. 113

catheter. 113

AV fistula. 114

Arteriovenous graft: 114

Initiating dialysis: 114

Monitoring of patient: 115

Complications monitoring- 115

Hemodialysis Termination of dialysis: 115

Closure of vascular access: 116

Post dialysis monitoring. 116

Documentation or charting. 116

MEASURING DIALYSIS TREATMENT EFFICACY. 117

Urea Reduction Ratio (URR) 117

Example: 117

Post dialysis blood sampling method or technique- 118

2. Kt / V.. 118

Example: 119

What if a patient’s URR and Kt/V are below the standards?. 119

OCM- online Clarence monitoring. 119

MONITORING DURING DIALYSIS- 120

Patient monitoring- 120

Weight- 120

Blood pressure. 120

Temperature. 121

Access site. 121

During dialysis. 121

Laboratory test. 121

Serum urea (BUN) 121

Serum albumin. 121

Serum creatinine. 121

Serum total cholesterol 122

Serum potassium.. 122

Serum calcium.. 122

Serum alkaline phosphates. 122

Serum bicarbonate- 122

Haemoglobin. 122

Hepatitis B. 122

Technical monitoring. 123

low Arterial pressure. 123

high Venous pressure. 123

Low venous pressure. 124

TMP (TRANSMEMBRANE pressure) 124

Monitoring during dialysis. 125

Blood related complications. 125

Patient related complications. 125

Dialysate related. 125

COMPLICATIONS OF DIALYSIS- 125

Intradialytic hypotension- 125

Etiology- 126

Treatment and prevention. 126

Intradialytic Hypertension. 126

Etiology. 127

Treatment and prevention. 127

Dialyzer Reactions. 128

Type A – anaphylactoid reaction. 128

Type B reaction. 129

Treatment. 129

Dialysis Disequilibrium Syndrome (DDS) 129

Etiology. 129

Pathophysiology. 130

Diagnosis. 130

Management and prevention. 130

muscles Cramping. 130

Etiology. 131

Treatment and Prevention. 131

Air Embolism.. 132

Etiology. 132

Symptoms. 132

Treatment. 132

Prevention. 133

Acute Hemolysis. 133

Etiology. 133

Signs & Symptoms. 134

Treatment. 134

Prevention. 134

Cardiac Arrhythmias. 135

Risk Factors. 135

Diagnosis and Treatment. 135

Prevention. 136

Haemorrhage. 136

Risk Factors. 136

Diagnosis and Treatment. 136

Prevention. 137

Pruritus. 137

Etiology. 137

Treatment. 138

Prevention. 138

Dry weight        (dialysis study) 138

DIALYZER REUSE. 139

DIALYSER REUSE (MANUAL) 139

Water. 139

CLEANING AND DISINFECTING AGENTS: 140

PROCEDURE OF REPROCESSING (MANUAL RINSE SEQUENCE) 141

BENEFITS OF DIALYZER REUSE- 142

DRAWBACKS OF DIALYZER REUSE- 142

CLEANING & DISINFECTING HEMODIALYSIS MACHINES. 143

Rinse: 143

Descalent: 143

Heat Disinfection. 143

Chemical Disinfection: 144

Descalent with Heat Disinfection: 144

WATER TREATMENT. 144

WHY WE NEED WATER TREATMENT- 144

HOW WATER BECOME IMPURE- 144

Types of impurities present in the tap water- 145

TOXIC EFFECTS OF SOME IMPURITIES. 145

METHODS USED TO TREAT WATER FOR HEMODIALYSIS: - 146

COMPONENTS OF WATER TREATMENT. 146

SEDIMENT FILTER. 147

Layer of multimedia filter. 147

What to monitor: 148

Multimedia filter has three options- 149

CARBON FILTER- 149

CARBON FILTER WORKING METHOD: 149

Carbon filter has three options. 150

Empty bed contact time (EBCT) 151

WATER SOFTENER. 151

Regeneration and brine tank- 152

Water softener filter have three options- 152

reverse osmosis- 152

Pre-filter: 153

RO pump and motor: 153

RO membrane. 153

Rejection percentage- 154

Distribution system- 154

Direct feed- 155

Indirect feed- 155

Ultra violet light (UV)- 155

Submicron filter- 155

What Is Deionization     (dialysis study) 155

types of DI 156

INFECTION CONTROL IN HEMODIALYSIS. 157

Hand hygiene: 157

Personal protective equipment (PPE): 157

Environmental cleaning. 158

Patient isolation. 158

Screening and testing. 158

CANNULATION PROCEDURE. 159

DE-CANNULATION PROCEDURE. 159

CATHETER CONNECTION PROCEDURe. 159

CATHETER EXIT SITE CARE. 159

PATIENT CARE EQUIPMENT. 160

SAFE HANDLING OF DIALYZERS AND BLOOD TUBING.. 160

EXTERNAL CLEANING & DISINFECTION OF HEMODIALYSIS MACHINES. 160

PRACTICE IN HEMODIALYSIS UNIT. 160

IMMUNIZATION.. 161

HBV and dialysis. 161

Infection control practices. 162

Vaccination. 162

Dedicated equipment. 162

Screening and testing. 162

Cohorting or separating. 162

Education. 162

HCV and dialysis         (dialysis study) 162

Infection control practices: 163

Dedicated equipment. 163

Screening and testing: 163

Cohorting or separating. 163

Education. 163

Treatment. 163

HIV.. 163

Infection control practices. 164

Dedicated equipment. 164

Screening and testing. 164

Cohorting: 164

Education. 164

Treatment. 164

Factors increases the risk of transmission of blood borne disease. 164

PERITONEAL DIALYSIS. 165

PERITONEAL MEMBRANE. 166

The peritoneum has two layers. 166

Three pore model of solute transport- 166

GOAL OF PD.. 167

Indications of peritoneal dialysis. 167

Non-Renal Indications. 167

PRINCIPLES OR KINETICS OF PERITONEAL DIALYSIS. 167

Three pore model. 168

Diffusion. 168

Factors affecting the rate of diffusion. 168

Osmosis: (ultrafiltration) 168

Types of solution. 169

factors affecting the rate of Osmosis. 169

Convection: 170

Net ultrafiltration. 170

PERITONEAL DIALYSATE: composition of solutions. 170

Ideal pd solution. 170

Biocompatibility. 170

Osmolarity. 170

pH.. 171

Sterility. 171

Nutrient content 171

Stability. 171

Pd fluid consist of. 171

Osmotic agent. 171

Buffer. 171

Electrolytes. 171

HOW DOES PERITONEAL DIALYSIS HAPPEN?. 172

Catheter placement. 172

Filling the abdominal cavity. 172

Dwell time. 172

Drainage. 172

Repeat. 173

How peritoneal dialysis works-     (dialysis study) 173

TYPES OF PERITONEAL DIALYSIS. 173

CAPD- Continuous ambulatory peritoneal dialysis. 174

Peritoneal dialysis (PD) has a Y shaped configuration. 175

AUTOMATED PERITONEAL DIALYSIS (APD) 175

Types of APD- 176

Peritoneal equilibration test-     (dialysis study) 177

FACTORS AFFECTING EFFICIENCY OF PERITONEAL DIALYSIS: - 178

Adequacy of peritoneal dialysis. 178

Indications of adequate peritoneal dialysis. 178

Target KT/V.. 178

Contraindication of peritoneal dialysis- 178

Advantages and disadvantages of peritoneal dialysis. 179

Advantages of peritoneal dialysis are- 179

Disadvantage. 179

PERITONEAL DIALYSIS CATHETER. 179

Segment of peritoneal catheter. 180

Commonly used peritoneal dialysis catheters are: 180

Coiled Tenckhoff catheters. 180

Tenckhoff catheters straight. 181

Swan necked catheter- 181

TORONTO western catheter. 182

CATHETER MATERIAL - 182

catheter insertion technique- 182

Percutaneous seldinger technique –. 183

Laparoscopic technique and surgical 184

Caring for PD Catheter. 184

Follow these rules to reduce risk for peritonitis: (dialysis study) 184

COMPLICATIONS OF PD     (dialysis study) 185

Peritonitis. 185

Catheter dysfunction. 186

Hernias: 186

Exit site infection- 186

Protein loss. 187

Fluid overload. 187

Electrolyte imbalances. 187

Back pain. 187

Others complication. 187

MEDICATIONS FOR DIALYSIS PATIENTS. 187

IRON.. 188

Oral iron supplements. 188

Intravenous iron supplements. 188

Erythropoietin-stimulating agents (ESAs) 189

Erythropoietin alfa. 189

Darbepoetin alfa. 189

Methoxy polyethylene glycol 189

PHOSPHATE BINDERS. 189

Calcium-based phosphate binders: 189

Aluminium-based phosphate binders. 190

Magnesium-based phosphate binders. 190

Non-calcium, non-aluminium phosphate binders. 190

Antihypertensive medication. 190

Diuretics. 190

Beta-blockers. 191

ACE inhibitors. 191

Calcium channel blockers. 191

Angiotensin receptor blockers (ARBs) 191

Vitamin D analogues. 191

Statins. 191

RENAL DIET. 192

GOALS OF DIETARY THERAPY IN CKD PATIENTS. 192

CALORIE INTAKE. 192

What are carbohydrates. 192

Fat. 193

PROTEIN- 193

Albumin      (dialysis study) 194

FLUID INTAKE- 194

SODIUM... 195

POTASSIUM... 196

High potassium- 197

Medium potassium.. 197

Low potassium.. 197

PHOSPHORUS      (dialysis study) 197

The body uses phosphorus to: 198

Some common phosphorus additives found in foods include: 198

Calcium.. 198

The body uses calcium to: 198

Some common sources of calcium additives include: 199

CRRT Continuous renal replacement therapy. 199

INDICATIONS FOR CRRT. 199

PRINCIPLE OR MECHANISM OF SOLUTE & WATER REMOVAL. 200

GOAL OF CRRT. 200

CRRT MODALITIES. 200

SLOW CONTINUOUS ULTRAFILTRATION (SCUF) 200

CONTINUOUS VENO-VENOUS HEMOFILTRATION (CVVHF) 201

CVVHD -CONTINUOUS VENO-VENOUS HEMODIALYSIS. 202

CVVHDF- Continuous Veno Venous Hemodiafiltration. [CVVH+CVVHD] 204

PRE AND POST DILUTION- 205

Vascular access- 205

Anticoagulation. 206

Complications Of CRRT- 206

SUMMARY OF CRRT. 206

Hemodiafiltration OR HDF. 206

Principle of the hemodiafiltration. 207

Online Hemodiafiltration (online HDF) 207

PRE AND POST DILUTION- 207

Prescription. 208

Qb. 208

Qd. 208

dialyzer. 208

Needle size. 208

Filtration fraction. 208

Substitution fluid. 208

Advantages of the HDF. 208

Disadvantage. 208

Complication of HDF. 209

SLED (Sustained Low-Efficiency Dialysis) 209

Reduced risk of hypotension: 209

Better fluid removal: 209

Improved hemodynamic stability: 210

Lower cost: 210

RENAL REPLACEMENT IN INTENSIVE CARE SETTING. 210

initiation of RRT in AKI in ICU.. 210

Type of initial modality of RRT in ICU: 210

frequency of dialysis is determined. 211

vascular access for dialysis in ICU: 211

Dialysate & Replacement Fluids. 211

Dialyzers & Haemofilters for RRT in ICU.. 211

Anticoagulation for ICU RRT. 211

Adequacy of RRT in AKI 212

Hemoperfusion, Cytosorb, Extracorporeal therapy in sepsis. 212

Cartridge. 213

Indications of hemoperfusion- 213

Choice of therapy- 213

Peritoneal dialysis. 213

Hemodialysis. 213

Hemoperfusion. 213

Principle of hemoperfusion. 214

Vascular access- 215

Anticoagulation- 215

Complications of hemoperfusion. 215

Bleeding. 215

Infection. 215

Electrolyte imbalances. 216

Hypothermia. 216

Thrombocytopenia. 216

Malnutrition. 216

Hypotension. 216

Sorbent dialysis. 216

SORBENT. 216

Principle- 216

Adsorption. 216

How does a sorbent regenerative system work?. 216

Three actions are involved in a sorbent system- 217

Sorbent cartridge and work- (dialysis study) 217

Advantages and disadvantages. 218

Advantages. 218

Disadvantages. 218

PLASMAPHERESIS. 219

therapeutic plasmapheresis. 220

Indications. 221

Autoimmune and Inflammatory Diseases: 221

Neurological Disorders: 221

Other Conditions: 221

Technique of plasmapheresis- 221

Centrifugal technique-   (dialysis study) 221

Membrane based- 222

Plasma volume estimation- 223

One plasma volume exchange drops immunoglobulins- 223

Replacement fluid solution- 223

Albumin. 223

fresh frozen plasma (FFP) 223

Saline. 224

Vascular access- 224

Anticoagulation- 224

Complications of the plasmapheresis- 224

Bleeding: 224

Infection: 224

Hypotension: 224

Electrolyte imbalances: 225

Allergic reactions: 225

Death. 225

Blood clots: 225

Hypocalcaemia. 225

Hypokalemia. 225

Contraindications of Plasmapheresis:    (dialysis study) 225

Double Filtration Plasmapheresis (DFPP)   (dialysis study. 226

Liver dialysis          (dialysis study) 227

Procedure. 227

Two circuit. 228

Types of liver diseases in which liver dialysis can be useful: 228

MEDICINES TO BE AVAILABLE FOR EMERGENCY USE. 229