The Renal Unit

290 Pages·1975·25.483 MB·English

by  A. J. Wing MA, DM, MRCP, Mary Magowan SRN (auth.)

THE RENAL UNIT
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THE RENAL UNIT
A. J. Wing, MA, DM, MRCP,
Physician, St. Thomas's Hospital
Mary Magowan, SRN,
Nursing Officer, St. Thomas's Hospital
M
ISBN 978-1-349-02529-9 ISBN 978-1-349-02527-5 (eBook)
DOI 10.1007/978-1-349-02527-5
©A. J. Wing and Mary Magowan 1975
@Appendix B: M. Vennegoor 1975
Softcover reprint of the hardcover 1st edition 1975 978-0-333-18014-3
All rights reserved. No part of this publication
may be reproduced or transmitted, in any form or
by any means, without permission
First published in 1975 by
THE MACMILLAN PRESS LTD
London and Basingstoke
Associated companies in New York Dublin
Melbourne Johannesburg and Madras
SBN 333 18014 3
Preface
'Watch me-one day you'll be doing this for yourself'-so the
nurse initiates a patient to his first haemodialysis. The specialist
nurse in a renal unit must be competent, knowledgeable and
understanding. This book is an introductioo to what she will
need to know and what she will be teaching her -patients.
There is a brief summary of normal renal structure and function
and brief allusion to the investigation and treatment of renal
disease, but the book really begins when the patient's renal
function requires replacement. We describe the history and prin
ciples of dialysis, which have determined why techniques and ap
paratus are the way they are, and which will determine future de
velopments. The technology of peritoneal dialysis, vascular access
and haemodialysis makes up the central section of the book.
Nurses will want to know something of the medical problems and
complications of home dialysis and transplantation, for on all these
things their patients are always likely to ask penetrating questions.
Throughout the book an attitude to the patient emerges making a
contrast with nursing in other fields. The degree to which patients
are involved in their own care is extraordinary and at first the nurse
will find it surprising. Doctors and nurses in this new field have
learned that self-dialysis makes sense. Home dialysis has been
particularly developed in the UK. We hope that the nurse who reads
this book will be better able to participate in the brave experiment
in long-term treatment which this specialist work represents.
Miss Yvonne Banks has made a fine job of converting our
sketches into pleasing drawings.
We are grateful to the following colleagues for reading and
commenting on various parts of the manuscript: J. V. Banatvala,
Miss G. Boase, N. F. Jones, W. Lloyd-Davies and A. E.
Thompson.
Mary Magowan St. Thomas's Hospital
A. J. Wing January, 1975.
Contents
PREFACE
1 RENAL FUNCTION AND ITS REPLACEMENT 1
The kidneys 1
Renal function 3
Renal failure 10
2 HISTORY OF DIALYSIS AND
TRANSPLANTATION 18
Development of the artificial kidney 18
Development of peritoneal dialysis 23
Other techniques 25
Dialysis in terminal renal failure 25
Home dialysis 28
Transplantation 29
Hepatitis in renal units 32
3 PRINCIPLES OF DIALYSIS 33
The purpose of dialysis 33
Diffusion 34
Osmosis and ultrafiltration 39
The membranes 41
Dialysis fluid 41
4 PERITONEAL DIALYSIS 51
The role of peritoneal dialysis: when and where 51
Technique for insertion of the peritoneal dialysis catheter 52
Complications associated with the peritoneal catheter 56
Carrying out a peritoneal dialysis 57
Problems encountered in running a peritoneal dialysis 62
Care of the patient 63
Biochemical complications 64
Contents Vll
Medical complications 66
Nutritional disturbances 69
Automatic cycling machines 70
5 SHUNTS AND FISTULAE 71
The external shunt (Quinton-Scribner) 71
Nursing care of the shunt 76
General shunt care 78
Declotting a shunt 80
Prevention of infection in the shunt 85
The internal fistula 92
The surgery of fistulae 94
Catheters for ~enovenous dialysis (Shaldon) 101
6 HAEMODIALYSIS PRINCIPLES AND
EQUIPMENT 103
Illustrated principles of haemodialysis 103
Anticoagulation 105
The dialyser: factors influencing choice 108
The production and delivery of dialysis fluid 113
Monitoring the dialysis 122
7 HAEMODIALY SIS TECHNIQUE 135
Preparing the equipment 135
Preparing the patient 143
The dialysis 143
Major complications during dialysis 151
8 MEDICAL ASPECTS OF REGULAR DIALYSIS
TREATMENT 161
Dietary restriction and supplements 161
Blood pressure control 168
Anaemia 173
Bone disease 177
Neurological complications 182
Growth and development of children on RDT 184
9 HEPATITIS IN DIALYSIS UNITS 185
Epidemiology 185
Hepatitis prevention 189
Vlll Contents
10 DIALYSIS IN THE HOME 195
The advantages 195
Training the patient 196
Preparing the home 198
Supporting the home patient 206
The cost of home dialysis 208
11 DIALYSIS AND TRANSPLANTATION 211
Selection 212
Inter-relationship of hospital and home dialysis and
transplantation 215
Survivals compared 217
Transplantation-pre-operative care 219
Grafting 224
Nursing the transplant patient 227
Diagnosing and treating rejection 230
Abandoning the graft 236
12 WORKING IN A DIALYSIS UNIT 238
Understanding the patient's problems 238
Understanding the family's problems 243
Understanding our own problems 247
Conclusion 248
APPENDIX A: NURSING RESPONSIBILITIES IN
SETTING UP A NEW UNIT FOR REGULAR
DIALYSIS TREATMENT 252
Treatment to be carried out in the unit 252
The situation of the unit in relation to the rest of the
hospital and other facilities 252
The construction of the unit 254
Allocation of responsibilities 256
APPENDIX B: DIALYSIS, DIET AND
DISCRETION: INSTRUCTIONS FOR PATIENTS 258
by Miss M. Vennegoor, SRD, Dietician, St. Thomas's
Hospital
Contents IX
GLOSSARY 262
BIBLIOGRAPHY 268
NOTE ON UNITS OF MEASUREMENT 269
INDEX 271