Dialyzer ultrafiltration coefficient. Cardiac surgery in children

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

Patient S, 52 years old, was admitted to the Russian Academy of Medical Sciences on March 10, 1989 with a diagnosis of rheumatism, inactive phase. Rheumatic mitral heart disease: stenosis of the left atrioventricular orifice, insufficiency mitral valve. Relative insufficiency of the tricuspid valve. Cardiomegaly. Atrial fibrillation. Circulatory failure stage IB (classification by V.Kh. Vasilenko and N.D. Strashesko).

Rheumatic mitral heart disease identified in 1979. Since 1986, a permanent form of atrial fibrillation. In the summer of 1988, signs of circulatory failure appeared and gradually progressed in both circles. There has been a significant deterioration in his condition since the beginning of 1989. Shortness of breath at rest began to bother him, significant swelling of the legs and hepatomegaly appeared.

On admission general state heavy. The skin is pale, acrocyanosis. Swelling of the legs with trophic skin disorders. Respiratory rate at rest is 22 per minute. In the lungs, breathing is harsh, weakened in the posterior lower sections. Arterial pressure 140 and 80 mm Hg. Art., heart rate 86, rhythm is incorrect. The abdomen is increased in volume due to ascites. The liver has a dense elastic consistency, protrudes from under the edge of the costal arch by 12 cm. X-ray in the pulmonary circulation shows pronounced signs of arterial-capillary stagnation, fluid in the right pleural cavity with its flowing through the interlobar cracks; the heart is significantly increased in volume (397% of normal). The ECG shows atrial fibrillation, signs of hypertrophy of both ventricles of the heart, mainly the right one. According to echocardiography, the size of the cavitary ventricle is systolic 3.9 cm, diastolic - 5.3 cm; left atrium - 7.6 cm, right ventricle - 2.4 cm. During radioisotope study of the circulatory system - bcc 78.8 ml/kg, cardiac index - 2.32 lDminhm2), shock index - 20.3 ml/m2. Biochemical indicators blood, electrolytes, hemoglobin and hematocrit are within normal limits.

Considering inefficiency conservative therapy (cardiac glycosides, saluretics, peripheral vasodilators for 10 days, infusion of small doses of dopamine for 2 days) the patient underwent 2 sessions of isolated ultrafiltration. The right femoral and right internal jugular veins were catheterized. 2500 and 3000 ml of ultrafiltrate were removed per procedure. The patient's condition improved: shortness of breath, hepatomegaly (the liver protrudes from under the edge of the costal arch by 1.5 cm), ascites (free fluid in the abdominal cavity not determined), swelling in the legs disappeared, diuresis without the use of diuretics increased from 400-500 to 1200-1500 ml per day. When studying central hemodynamics, a decrease in central venous pressure was noted from 23 to 11 mm Hg. Art., increase in SI from 2.8 to 4.2 l/(min/hm2). Subsequently, the patient was hospitalized twice more in our department due to circulatory decompensation, mainly due to big circle. Repeated IUF sessions were carried out: in May 1989 - three, a total of 9500 ml of ultrafiltrate was removed; in October 1989 - one, 3200 ml of ultrafiltrate was removed. There was a significant improvement in the patient's condition, restoration of sensitivity to previously performed drug treatment. Significant side effects IUF was not noted from the sessions performed.

Thus, the data obtained indicate high efficiency IUF in the treatment of congestive heart failure, which is confirmed by other researchers.

The main positive effect of IUF along with a decrease in generalized edema, there is an increase in cardiac output in patients with decompensated heart failure.

As our research has shown, IUF It is not an effective and safe treatment method for all categories of patients with heart failure.

In cases of terminal stages of heart failure the use of IUV leads to an imbalance between significantly increasing oxygen consumption and the ability of the cardiorespiratory system to increase oxygen delivery to tissues and further deterioration of the patient’s condition.

We carried out impact studies the drug dobutamine in doses of 3 to 5 mcg/kg per minute on central hemodynamic parameters in patients with congestive heart failure during IUP.

Before appointment dobutamine The study patients had low cardiac output syndrome caused by myocardial insufficiency and high pre- and afterload of the ventricles of the heart. Infusion of the drug dobutamine in doses of 3 to 5 mcg/kg per minute led to a significant increase in cardiac performance both by increasing myocardial inotropism and by reducing (optimizing) the pre- and afterload pressures of the ventricles of the heart at their initially high values. In patients, central venous pressure and peripheral vascular resistance decreased by an average of 14-18% and CO, CI, CI, LVRI, and LVLV increased by 25-28%. Inotropic support of the myocardium with dobutamine allowed us to use IUP in patients with a critical decrease in stroke output, both due to impaired myocardial contractile function and volume overload of the heart cavities.

Uses of dobutamine made it possible to achieve a significant increase in PV while reducing ventricular filling pressures, which expanded the indications for IUF in the most severe patients and ensured the hemodynamic stability of the procedure and its clinical effectiveness.

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Ultrafiltration I Ultrafiltration

a method of correcting water homeostasis when there is excess water in the body by removing protein-free fluid from the blood through natural or artificial membranes that act as an ultrafilter. Most often, peritoneum, artificial dialysis and hemofiltration membranes are used as an ultrafilter. The source of ultrafiltrate formation is mainly extracellular fluid entering the bloodstream under the influence of oncotic pressure of plasma proteins. Unlike diuretics, ultrafiltration allows for dosed dehydration with little effect on the electrolyte composition and acid-base state of the blood. With the simultaneous removal of a large amount of fluid (several liters), a tendency to hyperkalemia, metabolic acidosis, increased hematocrit and blood viscosity, and an accelerated increase in azotemia develops.

Ultrafiltration of fluid in the blood is achieved by creating a pressure difference on both sides of the filtration membrane: osmotic or hydrostatic. Accordingly, osmotic and hydrostatic U are distinguished.

Osmotic U. is usually carried out during peritoneal dialysis. To obtain effects, it is necessary that the dialysate solution be higher than the osmotic pressure of the blood. Glucose is mainly used as an osmotically active substance, adding it to 1 l isotonic salt solution in an amount of 15, 25 or 42.5 g/l, which, when injecting the solution into the abdominal cavity, allows one to obtain, respectively, 200, 400 or 800 ml ultrafiltrate. After 4-6 h When the difference between the osmotic pressure of the blood and the solution disappears, all fluid is removed from the abdominal cavity. By selecting a certain concentration of glucose for dialysis, they regulate the water content in the patient’s body.

Hydrostatic ultrasonography is usually carried out using a dialyzer, on the membrane of which a positive difference is created between the blood pressure and the hydrostatic pressure of the dialysate solution. The magnitude of this difference, called transmembrane pressure, as well as the permeability coefficient of the membrane for ultrafiltrate, determines the ultrafiltration rate. The permeability coefficient is expressed by the amount of ultrafiltrate (in ml), passing through the membrane in 1 h for each mmHg st. transmembrane pressure. According to the value of this coefficient, all produced dialyzers are small (2-3 ml/mmHg st. in 1 h), medium (4-6 ml/mmHg st. in 1 h) and large (8-12 ml/mmHg st. in 1 h) permeability. The design of the devices allows you to set the required ultrasonic mode according to the selected transmembrane pressure. By subtracting from the latter the blood pressure measured by the direct method in the venous bubble chamber, the value of the solution pressure on the outside of the membrane necessary to obtain the required ultrafiltration rate is determined. The solution pressure in the apparatus is adjusted manually or automatically according to the specified transmembrane pressure. There are devices in which monitoring of fluid is carried out on the principle of volumetry or electromagnetic flowmetry. The limit value of the transmembrane pressure should not reach the value of the destruction pressure (approximately 600 mmHg st.).

Ultrafiltration at speeds from 5 to 35 ml/min eliminates quite significant fluid retention within a few hours. With some variants of the method, for example using constant spontaneous (due to blood pressure) arteriovenous U., for 1 day. can be removed from the body if necessary 15-20 l liquids, completely eliminating swelling.

In patients with heart failure, U. effectively reduces the central volume and central blood, restoring the heart and eliminating disorders of ventilation and gas exchange. In patients with uremia, the combination of hemodialysis with large volume, which is usually combined with fluid replacement infusion, improves the quality of blood purification (primarily from substances of medium molecular weight) and accelerates the reverse development of many dangerous symptoms of uremia.

Indications for emergency use of U. are pulmonary edema of any etiology, as well as cerebral edema that develops in connection with acute water stress. Along with other methods, U. is used in the complex treatment of patients with anasarca, with edema due to congestive heart failure (especially in the presence of resistance to diuretics and glycosides) or nephrotic syndrome without renal failure, with fluid retention in the body after surgery with artificial circulation and hemodilution. In addition, U. is an integral part of the hemodialysis treatment program for patients with renal failure in whom fluid is retained due to oliguria. Consecutive use of U. and hemodialysis in such patients is advisable only in cases where their joint implementation creates a threat of development of collapse and .

Ultrafiltration is carried out only in a hospital setting. The procedure is performed with the patient in a functional bed. Before starting the procedure, the patient is administered a dose of 15-30 per 1 kg body weight to prevent blood clotting when it fills the dialyzer; during the ultrafiltration process, a constant infusion of heparin is carried out at a rate of 10-15 units per 1 kg body weight per hour. The ultrafiltration mode is monitored throughout the entire procedure; if necessary, use special devices to regulate its speed and maintain the patient’s fluid balance. The effectiveness of the procedure is assessed by the amount of fluid removed, a decrease in the patient’s body weight, and the reverse development of symptoms of overhydration. Particular attention is paid to the dynamics of filling of the jugular veins, pulse and respiratory rates, peripheral edema, ascites, hydrothorax, hydropericardium, liver size, moist rales in the lungs, changes in blood color in the extracorporeal system. To objectively characterize the effectiveness of treatment, in some cases repeated x-rays of organs are performed chest, note the dynamics of central venous pressure, volumes of circulating plasma and extracellular fluid. After U. it is almost always observed.

Complications during exercise may include hypovolemia in the muscles of the legs and arms, spastic pain in the abdomen and chest, hoarseness, etc. In case of severe hypovolemia, it can develop with loss of consciousness, generalized convulsions and respiratory arrest. It should be borne in mind that severe collapse is rarely the result of an error in performing ultrasound; rather, it may be a manifestation of sudden onset internal bleeding, cardiac tamponade, myocardial infarction, bacterial shock, or adrenal insufficiency. The threat of collapse increases when U. is carried out in patients receiving β-blockers and. Complications that arise are treated immediately. Muscle cramps that occur before the required result is achieved are stopped without interrupting the procedure with infusions of 60-80 ml 40% glucose solution, 20 ml 10% calcium gluconate solution, 20-40 ml 10% sodium chloride solution. in case of arterial hypotension, it is to promptly lower the head end of the bed below the horizontal level, reduce the speed or stop ultrafiltration, and slow down arteriovenous blood perfusion. Then, based on the situation, an infusion of 500 ml 5% glucose solution prepared on a polyionic basis (this is easier to do through the arterial line of the dialysis system using a pump); if necessary, enter 200 ml 20% albumin solution, 30-60 mg prednisolone is returned from the device.

II Ultrafiltration (Ultra- + filtration ())

the process of filtration through biological or artificial semi-permeable membranes; for example, the formation of primary urine.

Ultrafiltration capillary- U. blood plasma or tissue fluid through the wall of the blood capillary, occurring under the influence of the difference in tissue osmotic pressure and the sum of osmotic and hydrostatic pressure in the lumen of the capillary; ensures the passage of water and other compounds of small molecular weight through the wall of the blood capillary.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

Synonyms:

See what “Ultrafiltration” is in other dictionaries:

Ultrafiltration… Spelling dictionary-reference book

Filtration, superfiltration Dictionary of Russian synonyms. ultrafiltration noun, number of synonyms: 2 superfiltration (1) ... Synonym dictionary

ULTRAFILTRATION- ULTRAFILTRATION, separation of the dispersion medium from the dispersed phase of the sol by filtering the latter under high blood pressure through a sealed filter. For the first time, U. used Malfitano (Malfrtano, 1904). Behhold, the term was introduced to Crimea... ... Great Medical Encyclopedia

Separation of solutions and colloidal systems using semi-permeable membranes in special apparatus under pressure of 0.1–0.8 MPa. Used for the purification of wastewater, blood, vaccines, fruit juices, etc... Big Encyclopedic Dictionary

ULTRAFILTRATION, a method of separating fine particles from suspensions or colloidal solutions using pressure filtration. Small molecules, ions and water are forced through the semi-permeable membrane in the opposite direction to the gradient... ... Scientific and technical encyclopedic dictionary

A method of concentration, purification and fractionation of highly dispersed multicomponent liquids by passing (pushing) them through membrane filters. In microbiology, they are used to sterilize culture media and other liquids that cannot be... ... Dictionary of microbiology

One of the main methods for reducing the volume of radioactive waste, based on the use of a tubular membrane for pre-treatment of liquid waste entering the evaporator. Nuclear energy terms. Rosenergoatom Concern, 2010 ... Nuclear energy terms

The high mass fraction of water in plasma (serum) limits the possibilities of its use in the production of certain types of meat products. Promising methods for reducing the mass fraction of moisture include ultrafiltration through semi-permeable membranes. Which allow water and low molecular weight substances to pass through, while macromolecules are retained. This leads to an increase in the concentration of high molecular weight components of the mixture. The driving force is the pressure gradient. The separation is carried out at room temperature, which helps preserve the native properties of the protein.

Using the ultrafiltration method, the mass fraction of proteins in blood plasma (serum) can be increased to 20%. The combination of ultrafiltration with drying reduces energy costs and produces a high-quality product.

Skin processing

Skin processing technology

Skin with hair is called skin. Skins differ in their structure and properties depending on the type of animal, their gender and age. The skin consists of three main layers: epidermis, dermis and subcutaneous tissue

Skins freshly removed from animal carcasses are called fresh skins. Under the influence of microorganisms and enzymes they quickly deteriorate. Microbes (spores, cocci, putrefactive ones) penetrate the subcutaneous tissue, the mucous layer of the epidermis, hair follicles and glands and multiply quickly there. At a deeper stage, the epidermis peels off, hair separates, and a strong smell of ammonia and hydrogen sulfide is felt. The dermis becomes flabby, dark, slimy and fragile. Under unfavorable conditions for keeping livestock, a pile (manure + dirt) forms on the skins. After shooting, cuts of muscle and fatty tissue remain on the skins, and blood clots are weighting agents. They create conditions for the development of microflora. Therefore they should be removed. This is also necessary to determine the so-called paired weight of hides, according to which the meat processing plant pays the leather industry. Skins are delivered to tanneries in a fresh or preserved state.

Processing or canning of hides must be carried out no later than three hours after the removal of the hides. At this time, they do not have time to transport them over long distances. Therefore, the bulk of the skins are preserved. Preparation of paired skins for delivery to the leather industry is carried out according to the following operations: removal of bulk, cuts of meat and subcutaneous tissue from the flesh side, washing, contouring, sorting, including determination of their mass and area.

Bulk removal: To facilitate the removal of the pile and avoid damage to the facial layer, the pile is pre-moistened by irrigating the woolen side of the skin with water from a hose or from a shower for 1 minute. The moistened skins are kept in a stack until the pile is completely softened, but not more than 1 hour. Then they are released from the pile using a pile-rolling machine or manually.

Flushing. Cattle skins without bulk are washed cold water to cool them, remove dirt and blood. Along with them, some microbes and some soluble proteins are removed. Washing is carried out under the shower or from a hose (can be in a drum). Excess water is removed by draining for no more than 1 hour. The skins of pigs and small animals are not washed.

Fleshment. Removal of muscle and fat tissue, as well as part of the subcutaneous tissue - mezdra. Fleshing allows you to preserve the cut and flesh for use for food and technical purposes, and also helps to accelerate the diffusion of salt into the skin during salting and reduce the mass of raw materials (up to 15%), which is important for its further use, transportation and storage. Large cuts are used for food purposes. The remaining cuts and flesh are used to produce technical fat and feed meal.

Contouring. The skins after shooting have a complex, sinuous contour. Their edge sections (heads, paws) are torn off during mechanical processing in meat processing plants and tanneries, forming low-value waste. At the same time, the adjacent useful materials for cutting also go into waste (16% of waste by weight of raw materials). To reduce waste during leather production, contour smoothing or contouring is performed. It increases the utilization rate of raw hides and finished leathers. When cutting them in shoe production. It also allows you to additionally obtain protein raw materials, which can be used for food and feed purposes. The removed areas of cattle skins make up 12% of their mass; the frontal part of the skin with eye holes, the ends of the front and hind legs are separated. When removing skins from pork carcasses using the croutonization method, crouton serves as a contoured raw material.

According to the new technology, when contouring, the skins are completely removed and fleshed, after which the larger-sized croup is cut out (65-70% of the total area, 34-38% larger than usual). The remaining part of the skin is used for food purposes, i.e. production of protein stabilizer, edible gelatin, crispy slices, etc. New technology, significantly improves the grade of hides.

Sorting. Natural features, the presence of defects (during life and production), weight, area, and condition of the skins determine the quality of the leather and fur made from them. The skins are examined from the flesh and wool sides, the mass is determined, and in the case of MRS, the area is determined. The fur of MRS skins is additionally determined. The area of the skin is determined in a straightened form using a decimeter board or planimeter.

Preservation of hides

Canning. It should not cause significant changes in collagen, since the quality of skin and fur depends on its properties and condition. The degree of hydration of a preserved hide after soaking is close to the degree of hydration of a fresh hide. Taking into account these requirements, various preservation methods are used: for short-term and long-term storage.

Canning for short-term storage carried out by physical and chemical methods. Behind last years There has been a tendency to reduce or completely eliminate table salt for preserving leather or hide and fur raw materials. Most often, canning is done using antiseptics. This guarantees the storage of skins from 2 days to several weeks without deterioration in quality. Antiseptics must be readily soluble in water and not have unpleasant odor, do not have a negative impact on the leather tanning process, be relatively harmless to operating personnel, not in short supply and inexpensive. To antiseptics. used for short-term preservation include ammonium salts, hypochloride, a mixture of it with boric acid, a solution containing 1% sodium sulfate and 1-3% acetic acid, fluorides, sulfates, zinc salts, reducing agents such as sodium bisulfite and sulfur dioxide formed from it, solution dimethyl sulfide + phenol, surfactant, HOUR, as well as antiseptics with the largest amount of table salt. For example, a mixture of 5% (relative to the weight of the skin) table salt and 0.5-1% antiseptic ensures the storage of skins for 21 days. The solution is sprayed onto the hide or it is immersed in it, or the hide is treated with the solution in a drum. To control the treatment of the entire surface, a non-toxic solvent, soluble in water, is introduced into the solution. The cost of short-term preservation with antiseptics is approximately 10 times less than usual. With this kind of preservation, the skins are practically not dehydrated and retain their native structure, but the bond between the hair and the leather tissue may be weakened.

Method of short-term preservation by brining leather raw materials without subsequent salting allows you to reduce the consumption of table salt by 10-15%. It is recommended to add sodium silicofluoride 0.75-1 g to brine, which guarantees storage of raw hides for 7 days

Preservation by cold occurs due to braking autolytic and bacterial processes. After shooting, the skins are cooled in a tunnel at a temperature of -1 ºС for 20 minutes. The temperature of the skins is reduced to 2 ºС. After this, they can be stored in stacks for up to 3 weeks.

Preservation of hides intended for long-term storage produced by spreading dry canning and brine (in a saturated solution): at sufficiently high concentrations it delays microbial spoilage. A 10-15% solution prevents the development of most putrefactive microbes. Some microbes can grow even on dry salt (halophilic). That. salt itself can be a source of contamination of brines with undesirable microflora and cause damage to the skins, especially if they are stored in unfavorable conditions. A skin is considered preserved if its salt content is at least 12% and moisture content is not more than 48%.

The duration of the process depends on the properties of the raw material: structure, permeability, and thickness. Even a slight decrease in the thickness of the skin leads to a significant reduction in the duration of salting. Therefore, removing subcutaneous tissue and fleshing the skins helps speed up canning.

Canning in rastil with table salt: A layer of salt, 20-50 mm thick, is poured onto the rack, the skins are laid with the flesh side up and, sprinkled with salt, they form a stack 1.5-2 m high. Salt consumption for salting is 35-50% of the weight of the raw material. Usol makes up 13% by weight of paired skins. The duration of salting for cattle and pig skins is 6-7 days, sheepskins - at least 4 days, rabbit skins - 2 days. Temperature = 18-20 ºС. Compositions based on table salt with the use of antiseptics enhance its preservative effect. Sodium fluoride silico, paradichlorobenzene, naphthalene are used as antiseptics, which are added to brine at the rate of 2.4 - 10 kg per 1 ton of leather or fur coat raw materials. Compositions with a reduced amount of table salt are obtained on the basis of dehydrating and inorganic salts and organic compounds. Sheepskins are treated with a mixture of table salt, potassium alum and ammonium chloride - This is an acidic method of canning.

In this case, rapid and significant dehydration of sheepskin occurs, a shift in pH to the acidic side, slight pickling (acid treatment under the influence of sulfuric and hydrochloric acids) resulting from the hydrolysis of alum and ammonium chloride, as well as partial tanning with aluminum ions. Sheepskins preserved in this way are more resistant to the action of microbes and enzymes, in conditions elevated temperatures and humidity. The processing time for sheepskins is 4-7 days; fur and fur sheepskins should contain 38-42% water, have a pH of 4-4.5 and a shrinkage of 4%.

Dry-salted canning:

Sheepskins and rabbit skins are first salted for 6 hours, and then dried for 16-18 hours at T = 20-30 ºС. Sheepskin shrinkage - 30%, area shrinkage - 6%, humidity 18-20%.

Fresh-dry canning:

Preserving sheepskin and calf skins using this method involves dehydrating the skins without treating them with preservatives or substances. Drying mode, as with the dry-salted method. Shrinkage -60%, shrinkage -10%.

Defects of leather raw materials

Skin defects are divided into lifetime and technological. Lifetime vices are caused by the peculiarities of the structure of the skin, arising as a result of skin diseases, technological - insufficient feeding, poor livestock management, damage during shooting, canning and storage. Intravital defects of skins include: wartiness (thickened rough folds on the collar of the skin of uncastrated bulls), fistula (damage to the skin by gadfly larvae), facelessness (absence of the front layer of the skin in certain areas as a result of mechanical damage), barbed skin (through punctures of the skins of sheep and goats by prickly grass). Defects that occur during the removal and processing of skins - incorrect cut of the skin, undercuts, holes, etc. Defects during canning and storage are associated with a delay in canning, uneven distribution of the preservative, etc.

Questions for self-control

1. What are the requirements for the blood processing process?

2. Tell us about preserving m.r.s. skins.

3. Explain about canning pig skins.

4. Tell us about preserving the skins of k.r.s.

5. Name the main operations of processing skins

6. What operations are carried out before preserving skins?

7. What canning methods do you know?

8. What preservatives and antiseptics are used when preserving hides?

9. Name the defects of skins. The reasons for their occurrence and ways to eliminate them.

10. What is the purpose of contouring skins?

BIBLIOGRAPHY

a) basic literature (SSAU library)

1. Pronin, V.V. Technology of primary processing of livestock products / V.V. Pronin, S.P. Fomenko, I.A. Mazilkin. – “Lan”, 2013. – 176 p. ISBN: 978-5-8114-1312-6

2. Rogov, I.A. Technology of meat and meat products [Text]: textbook. Book 1: General technology of meat / I. A. Rogov, A. G. Zabashta, G. P. Kazyulin. - M.: KolosS, 2009. - 565 p. - ISBN 978-5-9532-0538-2

2. Rogov, I.A. Technology of meat and meat products [Text]: textbook. Book 2: Technology of meat products / I. A. Rogov, A. G. Zabashta, G. P. Kazyulin. - M.: KolosS, 2009. - 711 p. - ISBN 978-5-9532-0538-2

Ultrafiltration is a method of correcting water balance when there is an excess amount of water in the body by eliminating protein-free fluid from the bloodstream through special membranes, artificial or natural, acting as an ultrafilter. The artificial membrane is the hemofiltration and dialysis membrane, the natural membrane is the peritoneum. Ultrafiltrate is extracellular fluid that is directed into the bloodstream under the influence of oncotic pressure of plasma proteins.

Why carry out the procedure?

Edema of the lungs, brain
Heart failure varying degrees severity that cannot be treated with diuretics or cardiac glycosides
General swelling of the body (anasarca)
Nephrotic syndrome without renal failure
Surgical interventions with artificial circulation or accompanied by hemodilution
In complex treatment in patients with renal failure undergoing hemodialysis.

Risks of the procedure

Hypovolemia
Convulsive contractions of the muscles of the arms and legs
Spasmodic pain in the abdomen and chest
Vomit
Hoarseness of voice
Reduced blood pressure.

How to prepare for the procedure

The procedure is performed only in a hospital setting. Before starting ultrafiltration, perform general analysis blood, urine, coagulogram, blood test for glucose content, for syphilis and HIV infection, as well as the electrolyte composition of the blood (potassium, calcium, sodium, chlorine content) in order to assess the stage of renal or heart failure, gas and acid-base composition is assessed blood.

How does the procedure work?

The procedure is performed with the patient lying on his back on a functional bed. Before the start of ultrafiltration, to prevent blood clotting when filling the dialyzer with it, heparin is administered, the dose of which is calculated per kilogram of body weight, and a constant infusion is carried out during the procedure. The patient is connected to a dialyzer machine by puncture of a vein, which collects blood and performs ultrafiltration. During the procedure, the regime is strictly monitored, the speed is regulated, and the fluid balance in the body is maintained. The effectiveness of the procedure is assessed by reducing the patient’s body weight, the amount of fluid removed, and eliminating the symptoms of overhydration.

After the procedure is completed, the patient experiences oliguria for some time.

The duration of the procedure is from 2 hours to 2 days. The volume of liquid removed is up to 1-20 liters.

Results of the procedure

Removing excess fluid from the bloodstream, eliminating cerebral and pulmonary edema, resolving heart and kidney failure.

The hemofiltration procedure is often used in the treatment of diseases of the urinary system. This type of therapy will help the patient reduce intoxication of the body, which occurs in a number of conditions and diseases.

Hemofiltration

Hemofiltration refers to a method of purifying blood by filtering it through synthetic highly permeable membranes, while the removed filtrate in the blood is replaced by a special solution. Treatment is carried out using a hemofilter connected to a large vessel, as well as parallel infusion of the necessary solutions.

Like hemofiltration, it is a method, but has significant differences with it.

Features of hemofiltration are as follows:

Blood purification is carried out due to the movement of toxic substances from plasma through membranes in the same way as it is carried out in the renal glomeruli - due to transmembrane pressure.
The procedure is effective for removing both large and small molecules of toxins from the blood, including inflammatory elements, microglobulins, enzymes, and bacterial endotoxins.
Due to the removal of a large volume of water and salts from the blood, they must be replaced with appropriate solutions.

Hemofiltration – modern look treatment, close in its effect to the natural activity of the kidneys. Now it is widely used in intensive care units, helping to save the lives of many patients. For the results of the procedure to be high, the volume of plasma filtration must be up to 80% of the person’s weight.

What is blood hemofiltration?

Indications

Hemofiltration is a common type of treatment for acute renal failure, especially after kidney surgery. The procedure is widely used for various types of multiple organ failure, and in this case it is prescribed in a continuous mode.

Other indications for performing blood filtration are:

Chronic renal failure.
Acute poisoning, other types of intoxication.
Pronounced phenomena of hyperhydration.
Acidosis.
Comatose states.
Hyperkalemia.
Pulmonary edema.
Toxic effects or overdose of medications, alcohol, drugs.
Heavy.
Brain damage.
Some acute heart diseases.

Despite the use of hemofiltration for various types and forms of diseases, in most cases this procedure is prescribed specifically for patients with nephrological pathologies.

Contraindications

This type of treatment cannot be carried out if:

Uncorrectable arterial hypotension;
Heavy bleeding.

Kinds

There are several types of procedures that are used in different circumstances:

Hemofiltration as an adjunct to hemodialysis. Used for chronic renal failure, especially in those patients who suffer from increased body weight due to fluid accumulation. The procedure helps remove more fluid than hemodialysis alone.
Continuous hemofiltration (slow continuous ultrafiltration). Recommended for patients with acute form renal failure. The process is regulated using a screw clamp, which is placed on the outflow tube. The filtered substances are collected in a urine bag. The method helps remove large volumes of liquid.
Maintenance hemofiltration. Just like the first method, it is combined with hemodialysis and is intended to remove nitrogenous waste from the blood. Intended for the treatment of acute renal failure.

For treatment, special devices are used - hemoprocessors. Some of them are quite simple to operate, others are equipped with a complex system for regulating the process. There are modern devices that independently prepare high-quality replacement solutions, and the entire process is regulated by a powerful computer. A number of portable models are now available that allow hemodialysis and hemofiltration to be carried out even at home.

Examples of the latest generation hemoprocessors are:

Nikkiso Aquarius. This is an automated device for renal replacement therapy, used in the treatment of adults and children. The device is equipped with an alarm signal that notifies medical staff of any violations that occur. The hemoprocessor displays the main indicators on the screen - the rate of solution administration, its volume, temperature, etc.
Infomed. Allows you to perform all types of hemofiltration, as well as hemodialysis in children and adults. All processes performed by this device are fully automated.

Replacement solutions for blood hemofiltration are close in composition to the protein-free part of plasma. In total, there are about 14 types of solutions, the difference between which is the amount of glucose and other substances, as well as osmotic pressure. Solutions are placed in sterile containers of 5 liters in volume.
Video review of the hemofiltration device:

Execution mechanism

Hemoprocessors are equipped with a pump for blood perfusion, a pump for removing filtrate, and devices for infusion of replacement solutions. The devices also have a thermostat for heating the solution and electronic scales for measuring its quantity. The process is controlled by a microprocessor - an automatic device that monitors the progress of blood filtration.

The design of the device must provide protection from:

Imbalance of fluids;
Blood leaks into the filtrate;
Air entering the blood;
Introduction of a superheated solution.

Hemofiltration apparatus

The mechanism of action of the devices is based on the removal of toxins and metabolites circulating in the blood using a filter. The resulting filtrate is similar to normal urine excreted by the kidneys healthy person. Blood flow through the filter is ensured by the difference in osmotic pressure of the blood and the replacement solution. The amount of solution administered is calculated based on individual indicators of the body’s condition.

A special bed is used for hemofiltration. The procedure is as follows. A large-diameter double-lumen catheter is inserted into the central vein, and the blood flow is set to approximately 120-150 milliliters per minute. Heparin preparations are injected into the blood, but this method is undesirable in patients at risk of bleeding. Also, blood purification and its replacement with special solutions can be carried out through an external arteriovenous shunt or arteriovenous fistula; otherwise, the procedure for hemofiltration is similar. The duration of the procedure can be from a day to several weeks.

Hemofiltration mechanism

Diet

Parenteral nutrition is indicated for many patients with acute renal failure. If the patient can eat on his own, a diet rich in amino acids is recommended. During hemofiltration, a person requires an increased amount of protein, because the nitrogen balance is greatly disturbed. The caloric content of the diet should be sufficient, but the amount of salt in the diet is strictly controlled and calculated individually.

The levels of calcium, phosphorus and vitamins must be strictly monitored and, if necessary, adjusted with medications.

Complications

Hemofiltration slightly disrupts the osmotic balance, so life-threatening complications from the heart, blood vessels, and brain are rare. Possible consequences due to blood perfusion and heparin administration are bleeding, failure of the hemostasis system, and occasionally thromboembolism is observed.

Other possible complications:

Overhydration, dehydration;
Decreased potassium in the blood;
Hypoglycemia;
Loss of amino acids.

If hemofiltration technology is violated, infection with HIV, hepatitis, and the occurrence of a febrile state are occasionally observed; in some patients, prolonged arterial hypertension. To prevent complications, the patient is given heart medications, Panangin, glucose and amino acids are administered, and the rules of asepsis and the actual hemofiltration technique are strictly observed.