All the equipment in direct and permanent contact with your blood during the session is single-use.
This prepares the dialysate and circulates it through the dialyser against the current of the blood. Control and monitoring devices ensure that the session runs smoothly and safely.
This is a filter comprising hollow synthetic fibres through which the blood circulates, while the dialysate circulates in counter-current outside these fibres. This repeated flow throughout the dialysis session rids the blood of toxic waste, corrects biological abnormalities and eliminates excess water accumulated in the body.
This is a liquid solution prepared by the haemodialysis machine from purified water, with a mineral salt composition similar to that of blood.
This allows blood to be drawn through the arteriovenous fistula using an arterial needle. The blood passes through the dialyser and returns to the body "cleaned" by the venous needle. The basic principle of haemodialysis is to bring your blood into contact with a liquid of a specific composition ("dialysate") through a membrane that ensures the exchanges required for purification.
Your blood travels through a closed circuit including a filter (dialyser) that purifies it. The waste products are collected by the dialysate and then evacuated down the drain.
Your blood leaves and returns via your blood supply route: arteriovenous fistula, prosthesis or catheter. Haemodialysis usually involves three sessions of four to five hours each per week. Whichever method you choose (in-centre dialysis, self-dialysis or home dialysis), the technique remains the same.
At the start of the session, 2 sterile single-use needles are inserted into the vascular access port to gain access to the blood. They are connected to the tubes that make up the extracorporeal circuit.
The principle of haemofiltration (HF) differs from that of haemodialysis (HD) in that no dialysis fluid is transported in the dialyser and a haemofiltration solution is infused directly into the blood, then eliminated again by ultrafiltration through the haemofilter. In ultrafiltration, the substances to be removed from the blood are transported - entrained with the water - through the filter. The advantage of this convective transport of substances is that molecules of a certain size can also be eliminated (medium-sized molecules such as ß2 microglobulin), whereas their elimination by conventional haemodialysis would be less effective.
Haemodiafiltration (HDF) is a combination of haemodialysis (HD) and haemofiltration (HF), combining the advantages of both processes. Low-molecular-weight substances are eliminated mainly by diffusion, while medium-molecular-weight substances are eliminated by convection. The combined use of haemodialysis and haemofiltration achieves a higher rate of elimination of low- and medium-molecular-weight substances than using either process alone.
This is a hollow, flexible, 2-way tube inserted into a large vein (internal jugular, subclavian or common femoral), providing direct access to blood for dialysis. It has one or two outlets for direct connection to the dialyser lines.
A catheter is generally used temporarily when dialysis has to be started urgently, before a definitive approach is created, if it is not yet usable or in the event of complications. In certain situations (where it is impossible to create another permanent approach), a tunnelled catheter (of the Canaud or Quinton type) can be inserted for long-term use.
The catheter is inserted under local or general anaesthetic by a nephrologist, anaesthetist or vascular surgeon in the operating theatre or in the patient's bed, under strict aseptic conditions. An X-ray must be taken to check the patient's position.
Communication with the outside and inside is a source of infection. It must be handled with great care and asepsis, and protected outside dialysis sessions by a sterile, watertight dressing.
This is a hollow, flexible tube inserted into the abdominal cavity between the two layers of peritoneum. It has a single channel which alternates the flow and return of the exchange fluid. Access to the blood is provided by the vascularisation of the peritoneum. It is inserted under local or general anaesthetic by a digestive surgeon or nephrologist in the operating theatre, in compliance with strict aseptic conditions.
The risk of infection is controlled by the presence of a non-return valve at the external orifice of the catheter and under the skin by a containment system (CUFF). It must be handled with great care and asepsis. It is advisable to protect it with a sterile, watertight dressing outside dialysis periods.
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