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BY HAJI HUSIN HARUN (MA) DIALYSIS MANAGER HEMODIALYSIS UNIT HOSPITAL SELAYANG
DIALYZER
A dialyzer is composed of a dialysis membrane and supporting structure. There are four components: Blood compartment Dialysate compartment Semi permeable membrane separating (1) and (2) Membrane support structure
Membrane
A membrane can be described as an imperfect barrier between two solution
TYPES OF DIALYZER
Kiil dialyzer Coil dialyzer Parallel Plate dialyzer (PPD) Hollow fibre dialyzer The hollow fibre dialyzer is the most popular of the above four types and is composed of a group of between 8000 to 12,000 fibre like structures (capillaries) with an internal diameter of 200 microns
Organ centered specialties including Nephrology was developed in Europe I t took more than a decade such development came to this country
TYPES OF DIALYZER
Kiil dialyzer Coil dialyzer Parallel Plate dialyzer (PPD) Hollow fibre dialyzer
The hollow fibre dialyzer is the most popular of the above four types and is composed of a group of between 8000 to 12,000 fibre like structures (capillaries) with an internal diameter of 200 microns
Kiil dialyzer
Used by HKL 1964 Assemble by dialysis staff before HD session Treatment time
8 hrs to 10 hrs
Haemodialysis
Coil dialyzer
Use by HKL from 1975 to 1978
Coil dialyzer
HKL used till 1978
Anatomy of a Hemofilter
Blood in Cross Section Dialysate in
Dialysate out
Dialysate Out
Blood out
Dialysate in
Characteristics of a dialyzer
Hollow fibre artificial kidney (dialyzer) Blood inlet Potting material Dialysate port & outlet Fibre Dialysate port & inlet End cap Blood outlet
diameter ( in microns)
Fibre : - diameter
- length - thickness
(measured in microns)
thickness
Design : individual fibre ,allows better membrane transport therefore allows efficient clearance Membrane structure:
1. symmetric pores on both sides of membrane are same in size 2. Asymmetric pores on dialysate side of membrane are larger in size.
Substitute Cellulose
Cellulose acetate Hemophane
Synthetics
Polyacrylonitrile (PAN) Polymethylmethacrylate (PMMA) Polysuphone (PS) Polycarbonate (PC) Polyamide (PA)
Notes
Cuphrophane has been used for more than 20 yrs, there is most experience with this membrane & it constitutes 45% of usage. Some of the hydroxyl group of cellulose polysaccharide has been substituted to e.g acetate, to make modified cellulosic membranes - about 30% of current total usage.
e.g: C-DAK
Substitute Cellulose
Cellulose acetate membrane e.g: CDAK 4000
Substitute Cellulose
Cellulose acetate
Synthetics Membrane
Polysulfone Polyamide
Synthetics membrane
Polyamide High flux S.A 2.1 m2, 1.7 m2 e.g Gambro
DIALYZER FLUX
Low (standard) flux dialyzer
Substances larger then 8000 daltons do not across the membrane Small marker molecules such as urea and creatinine pass through freely Pores are small and this is reflected by the low ultrafiltration coefficient (between 2 to 9 ml/mmHG/hour) Mainly cellulosic and some sinthetic membrane
Intermidiate Flux
UF coefficient 10 - 19 ml/mmHg/hour Sythetic membranes and altered cellulosic
Polyacrylonitrile (PAN) Polysulfone Polymethylmethacrylate (PMMA)
SIEVING COEFFICIENT
Defined as membrane permeability to solutes during ultrafiltration
Small solutes pass through without problems Permeability decreased with increasing molecular weight size Always expressed as a percentage
Molecule
A stable configuration of atomic nuclei and electron e.g.; water (H2O) consists of two hydrogen atoms and one oxygen atoms. Molecular Weight The weight of the sum of the atoms (dalton) e.g.: Sodium 23 Calcium 40 Urea60 Creatinine 113 Phosphates 120 Uric acid 168 Aluminium 700 Phosphorus 838
Molecular Weight (cont) Vit B12 Inulin Heparin Vit B2 Albumin Globulin RBC / WBC 1355 5000 8000 - 12000 11000 68000 180000 > above
Molecular Weights
100,000 ___ 50,000 ___ 10,000 ___ 5,000 ___ 1,000 ___ 500___
Glucose (180) Vitamin B12 (1,355) Aluminium/desfroxamine complex (700) Albumin (55,000 - 60,000) Beta, Microglobulin (11,800) Inulin (6,200)
Large
middle
100___
50___
small
Notes
All membranes are * hydrophillic except PA,PS,PMMA,PAN which are ** hydrophobic. The later are apolar, adsorb protein, are porous and have high coefficiency. Synthetic polymer (biocompatible membranes) account for 25% of usage and have been use for about 10 yrs. Most membrane are similar clearance for small molecules but synthetic one have increased clearance of middle molecules and higher UF coefficient.
Characteristic of a dialyzer
Membrane Type Wall Thickness (permeability) Surface area ( The area of the membrane exposed to the blood - effectiveness Performance UFR (the amt of fluid remove in a given period of time at a given pressure. Clearance (the vol of blood completely cleared of a substance in a certain time Stable Performance ( as well during the treatment as from batch to batch)
Characteristic of a dialyzer
Overall design
Flow geometry Internal resistance (the pressure drop in the blood and dialysis fluid during passage through the dialyzer Size & weight (important for handling and storage)
Volume
Priming volume (the vol of the blood compartment) Compliance (the volume increase of the blood compartment at increasing pressures (ml/mmHg) RBV (the amount of blood left in the dialyzer after rinseback.
Material
Sterile Biocompatible
Characteristic of a dialyzer
Components Material Membrane type Potting material Housing,cap Sterile Plug : :Polyurethane (PUR) ;Polycabonate (PC) :Polyprophylene (PP)
The holl
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