Hemodialysis units

The kidney removes waste materials from our blood. Because of partial or total kidney failure, many persons are on hematolysis. The first hemodialysis units were large and by today s standards were not very effective and the semipermeable tubes, made mainly of... 

Cyanobacteria - the Jekyll and Hyde of marine organisms - are a novel source of potential new pharmaceutical compounds (2618-2620, 2662). On the other hand, toxic cyanobacterial blooms in lakes, rivers, and water storage reservoirs have occurred worldwide (2621, 2663, 2664). For example, 60 patients in a Brazil hemodialysis unit died after drinking water from a lake contaminated with cyanobacterial microcystins (2622), not unlike the toxicity of red tides (2623). Cyanobacteria also produce the highly toxic neurotoxin, p-N-methylamino-L-alanine, which may be produced by all cyanobacteria (2624, 2665). 

Elevated aluminum levels have been implicated as the cause of dialysis encephalopathy or dementia in renal failure patients undergoing long-term hemodialysis [85]. Some patients used aluminum-containing medications. Moreover, patients with renal failure cannot remove aluminum from the blood. Dialysis dementia can arise after three to seven years of hemodialysis treatment. Speech disorders precede dementia and convulsions. Since many hemodialysis units rely on systems to purify fluoridated tap water, it is likely that many patients are being exposed inadvertently to increased concentrations of fluoride and aluminum. Increased serum fluoride concentration and fluoride intoxication have been also observed in chronic hemodialysis patients. Arnow et al. [96] reported that 12 of 15 patients receiving dialysis treatment in one room became acutely ill, with multiple non-specific symptoms and fatal ventricular fibrillation. Death was associated with longer hemodialysis time and increased age compared with other patients who became ill. 

Delarocque-Astagneau, E., Baffoy, N., Thiers, V., Simon, N., de Valk, H., Laperche, S., Courouce, A.M., Astagneau, R, Buisson, C., Desen-cios, J.C, Outbreak of hepatitis C virus infection in a hemodialysis unit Potential transmission by the hemodialysis machine Infect. Contr. Hosp. Epidem. 2002 23 328—334... 

In 2000 the FDA issued an urgent warning to aU hospital pharmacies and hemodialysis units that triCitrasol, an unapproved formulation of sodium citrate that has been used as an anticoagulant to keep intravascular lines open, can cause death after intravenous infusion. triCitrasol is marketed in individual sterile 30 ml glass vials, distributed both individually and in hemodialysis kits (4). A patient died of cardiac arrest shortly after the injection of triCitrasol 46.7% into a permanent hemodialysis blood access catheter that had just been implanted. Rapid or excessive infusion of citrate solutions can cause fatal cardiac dysrhjdhmias, seizures, or bleediug due to sequestra-tiou of blood calcium. 

The FDA urged hospital pharmacies and hemodialysis units across the USA to stop using the product. Alternative 4% solutions of citrate are available for use in these and most other medical settings. 

Nickel poisoning is well defined in occupational medicine and is occasionally experienced as a complication of exposure to nickel (or nickel-plated) medical devices. Use of nickel-plated dialysis equipment gave rise to nickel poisoning in 23 patients in one hemodialysis unit. They developed nausea, vomiting, weakness, headache, and palpitation, all of which remitted 3-13 hours after the end of dialysis (SEDA-6, 225). 

Human exposure to excessive copper intake from a variety of sources has been on the increase in recent years. Most of the sources are attributable to modem technology and lifestyle. Many examples could be cited in food and water contamination increased use of water pipes made of copper (15) in most municipal water systems (19) dispensing machines with copper check valves (20) acidic food or drink in metal containers (21) and semipermeable membranes containing copper or copper tubing used in hemodialysis units (22,23),... 

Arnow PM, Bland LA, and Garcia-Houchins S (1994) An outbreak of fatal fluoride intoxication in a long-term hemodialysis unit. Annals of Internal Medicine 121 339-344. 

The application of polymeric materials in medicine is a fairly specialized area with a wide range of specific applications and requirements. Although the total volume of polymers used in this application may be small compared to the annual production of polyethylene, for example, the total amount of money spent annually on prosthetic and biomedical devices exceeds 16 billion in the United States alone. These applications include over a million dentures, nearly a half billion dental fillings, about six million contact lenses, over a million replacement joints (hip, knee, finger, etc.), about a half million plastic surgery operations (breast prosthesis, facial reconstruction, etc.), over 25,000 heart valves, and 60,000 pacemaker implantations. In addition, over AO,000 patients are on hemodialysis units (artificial kidney) on a regular basis, and over 90,000 coronary bypass operations (often using synthetic polymers) are performed each year (]J. 

Kidney. The device called an artificial kidney is actually an external hemodialysis system, first developed in the early 1940s, that washes the blood and removes waste products from the body. Over 40,000 patients are maintained by this device each year in the United States, and there are over 100,000 people worldwide undergoing routine dialysis. In addition, many others are placed on the hemodialysis unit for short-term treatment. 

Hemodialysis units are usually hoUow-fibre devices with a membrane area of 0.5-1.5 m. The classical membrane material is regenerated cellulose, closest to the natural material. Other membranes include polyether sulphone (PES) and polysulphone (PS), which are made somewhat hydrophilic by blending with PVP, a necessary requirement to address the problems of biocompatibUity and fouhng by proteins [39]. The membranes are asymmetric (10—100 pm thick) with a narrow pore size distribution and the pore diameter less than 10 nm [17]. 

Thomas-Hawldns C, Flynn L (2015) Patient safety culture and nurse-reported adverse events in outpatient hemodialysis units. Res Theory Nurs Pract 29 53-65... 

Holley [21] conducted a study of adverse events and medical errors in four hemodialysis units. Incident data are based on reports by the units clinical directors. Among nearly 65,000 dialysis treatments, 88 errors occurred (1 event/ 733 treatments). Infiltration of the hemodialysis access, clotting of the dialysis circuit and omitted medications were common problems. In a surveillance study of dialysis patients in Gran Canaria (Spain), the incidence rate of adverse events was 8.6/100 patient-months [22]. The rate was higher among patients with arteriovenous fistula (9.1/100 patient-months) compared to patients with permanent catheter (2.9/100 patient-months). The preventability of the events is unknown. 

Axley B, Speranza-Reid J, Williams H Venous needle dislodgement in patients on hemodialysis. Nephrol Nurs J 2012 39 435-445. Holley JL A descriptive report of errors and adverse events in chronic hemodialysis units. Nephrol News Issues 2006 20 57-63. 

Department of Surgery and Hemodialysis Access Center and Hemodialysis Unit, Shaare Zedek Medical Center, Jerusalem, Israel... 

The Patient s Role in Patient Safety in the Hemodialysis Unit... 

Penneys, N. S., Edwards, L. S. and Katsi-kas, J. L. (1976) Allergic contact sensitivity to thiuram compounds in a hemodialysis unit. Arch. Derm., 112, 811. 

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