I - DEFINITION AND GENERAL :

 This is a method of exchange between two solutions , blood and a liquid called dialysate through a semipermeable membrane synthetic .
Hemodialysis is performed using a device called a generator that produces the dialysis fluid or dialysate and a filter called a dialyzer or artificial kidney
It aims to prevent and correct the manifestations of uremic syndrome and its complications and to maintain homeostasis ( maintenance of normal value for different physiological constants , eliminate excess water , to overcome kidney failure and purify the blood of toxic waste, some toxic drugs.

II - MATERIAL:
- For the dialysis equipment :
* Capillary dialyzer fibers disposable.
* Bottles of saline .
* CC syringe 20 to increase the level of the expansion rooms.
* Heparin according to medical prescription.
* Extracorporeal circuit : arterial line and venous line .
* Bicarbonate.
Acetic acid * .
* Sterile compresses .
* Antiseptic.
- For connection :
* Needle arteriovenous fistula.
* Four clamp.
* Tray containing sterile hemodialysis : - two masks.
                                                                     - A waterproof field.
                                                                     - Sterile disposable gloves.
                                                                     - Boulle sponge for the patient's hand .
                                                                     - Sterile gauze .
                                                                     - Hypoallergenic tape .
                                                                     - Withers decontaminated and cleaned.
                                                                     - Antiseptic.
                                                                     - Tube for examination.
- To disconnect :
* Disposable gloves sterile and non- sterile.
* Mask .
* Sterile gauze .
* Antiseptic.
* 2 syringes of 5 CC .
* 2 10 CC syringes .
* 0.9% saline .
* 5 CC syringe containing heparin e .

III - PREPARATION OF THE PATIENT :

- Ensure cleanliness arm fistulized or support arm of the shunt.
- Take the weight before to assess weight relative to the weight lost on the checklist .
- BP and pulse after a rest.
- Take the patient's temperature .
- Place the patient supine elevated bars.
IV - TECHNICAL :

- Select the puncture which must be no closer than 6 inches to avoid recirculation.
- Sanitize the area of puncture on the arm and place the sterile field.
- Insert the needle into the blood arterial shunt but in the direction of blood flow and venous needle
  above the venous shunt.
- Fix 2 needles with hypoallergenic tape.
- The needles used must first be rinsed with saline.
- Turn on the blood pump .
- After stabilization , check: * 200A blood flow 300 ml / min
                                                   * Venous pressure
                                                   * Depression, and the conductivity of the dialysate flow
- Turn on the pump heparin.
- Check the TA and FC.
- Stop the heparin pump 1-15 minutes before the end of the dialysis session and measure the remaining content and
   note on the control sheet .
- Stop the blood pump and clamp the tubing and the arterial needle
- To empty the blood circuit by remaining saline.
- Keep the arm elevated patient.
- Ranger, clean and sterilize equipment .

V - SURVEILLANCE:

1 / BEFORE :

- Weigh the patient and check for digestive disorders.
- Take the patient's temperature .
- Examine the fistula pain inflammation or edema.
- Rinse all the dialyzer with saline to avoid serious namely shock accident.
  Anaphylactic , back pain .....
- To monitor the performance of the generator.
- Check pump heparin.
- Check the pressure at the bubble trap .

2 / DURING:

- Monitor BP and HR at least 3 times to detect in time the beginning of voltage drop.
- Monitor the facies of the patient.

3 / AFTER :

- Monitor the appearance of the dialyzer and verify the absence of clotted blood.
- Weigh the patient and take his TA .
- Take his temperature.
- Establish a long-term monitoring for vascular aging was found mainly in
   chronic patients.
- Pre joint pain were noted in the wrist of the vertebrae.