Page 512 - ACCCN's Critical Care Nursing

Support of Renal Function 489

TABLE 18.1 Historical events in the development of dialysis

Time period and developer Description
1854: Thomas Graham, Scottish First used the term ‘dialysis’ to describe the transport of solutes through an ox bladder, which drew
chemist attention to the concept of a membrane for solute removal from fluid.
1920s: George Haas, German physician First human dialysis was carried out, performing six treatments on six patients. Haas failed to make
further progress with the treatment but is recognised as an early pioneer of dialysis.
1920–30s Synthetic polymer chemistry allowed development of cellulose acetate, a membrane integral to the
further development of dialysis treatments.
1940s: Willem Kolff, Dutch physician The discovery of heparin, an anticoagulant, enabled further development of dialysis during World
War II, the Kolff rotating drum kidney.
1940–50s: Kolff and Allis-Chalmers, USA Further modification of Kolff dialyser and the development of improved machines.
1950s: Fredrik Kiil, Norway Developed the parallel plate dialyser made of a new cellulose, Cuprophane. This required a pump to
push the blood through the membrane and return the blood to the patient.
1950–60s Dialysis began to be widely used to treat kidney failure.
1960s: Richard Stewart and Dow The hollow-fibre membrane dialyser used a membrane design of a cellulose acetate bundle, with
Chemical, USA 11,000 fibres providing a surface area of 1 m . 2
1970s Use of first CAVH circuits for diuretic resistant oedema by Kramer
1980s First continuous therapies using blood pump and IV pumps to control fluids removal and
substitution: Australia and New Zealand led the way
1990s New purpose built machines used; Gambro Prisma, Baxter BM 11 + 14 to provide pump controlled
therapies with integrated automated fluid balance using scales to measure fluids. Cassette circuits,
automated priming; new membranes
2000 Further purpose built machines using direct measurement for waste and substitution fluids via
Hygieia–Kimal machine. Introduction of high fluid exchange rates for sepsis treatment.
introduction of dialysis based machines in ICU for daily ‘hybrid’ treatments: SLEDD and SLEDDf
2010 Multiple CRRT machines; more advanced graphics interface and smart alarms. Waste disposal
systems. High flux, porous membranes

dialysis is today with modern machines and dialysis millions of people who suffer acute and chronic kidney
membranes. A major impediment to the safe use of this failure. 39,40
system was, however, the large amount of patient blood
required in the tubing and membrane. Historical Perspectives of Dialysis Nursing
This large extracorporeal blood volume became a focus Key to the application of these technical and scientific
for further development of the therapy. The goal was to developments has been the role of nurses, who have
develop a membrane for solute exchange with a greater made a substantial contribution to the safety and effi-
surface area than the cellulose membrane used by Kolff ciency of dialysis. Barbara Coleman is recognised as the
but needing less blood volume. This led to the develop- first dialysis nurse to publish a treatment protocol for
ment of the hollow-fibre filter membrane structure in the dialysis using the rotating drum machine in 1952. 39,41
1960s, the same design concept that is used today. Since Nursing of dialysis patients has developed into a special-
then significant developments have occurred, with new ist field of knowledge and skill, with nurses combining
fibres using the polymer polysulfone or other artificial their holistic view of patient management with the spe-
synthetic chemical structures that better imitate the cialist needs of patients with renal failure, from the out-
42
nephron glomerulus and the ability to transfer wastes patient setting to the ICU, including a collaborative
and plasma water for an effective ‘artificial kidney’. approach to further adaptations of dialysis best suited to
38
the critically ill. 43,44
This combination of extracorporeal circuit (EC), blood
pump and filter membrane (or artificial kidney or dialy-
ser), and the associated nursing management is now Development of Renal Replacement
commonly known as haemodialysis. The major treat- Therapy in Critical Care
ment components are essentially the same as those first Improvements in many fields of health care, including
developed in the 1960s, with the key component being resuscitation and treatment for shock, and the growing
the device membrane. Over the past 50 years, industrial number of patients undergoing and surviving extensive
and scientific developments such as plastics moulding surgery and trauma, have led to developments and chal-
and electronics have made current dialysis techniques lenges in critical care practice. Many patients who would
safe, effective and a life-sustaining treatment for the previously have died from an acute illness now survive,