Flashcards in Alex: Dialysis Deck (98)
What are 4 options for end stage renal disease?
3. Peritoneal dialysis
4. No treatment
What stage of CKD should the patient be referred to a nephrologist?
Stage 4 (GFR under 30)
What plants must be made as part of pre-dialysis assessment for hemodialysis?
1. Dialysis access surgery
2. Type of renal replacement therapy (RRT)
*Advanced planning is essential
What the decision to initiate RRT based on?
A variety of factors:
What GFR do the majority of patients start dialysis at?
What are laboratory indicators for the initiation of renal replacement therapy?
-Severe Metabolic acidosis
-Uremic Symptoms / Encephalopathy: Nausea, vomiting, altered mental acuity, seizures, anorexia
-Pericardial friction rub
-Unmanageable volume overload
Is there a specific BUN, creatinine, or GFR level that mandates immediate dialysis?
What are the 3 options for RRT and associated %
1. Hemodialysis: 65%
2. Transplant: 25%
3. Peritoneal dialysis: 10%
What 5 things are needed for dialysis?
1. Vascular access to the circulation
2. Dialysis filter
3. Dialysis machine
4. Nursing staff to establish the vascular access and monitor the dialysis procedure
5. Dialysis facility
What are options for vascular access foe hemodialysis?
What is the angioacess of choice for dialysis?
A side-to-side arteriovenous fistula
What are the 2 sites where arteriovenous fistulas are usually placed?
1. The radial artery and cephalic vein in the non-dominant arm*
2. In the upper arm between the brachial artery and brachiocephalic vein (if necessary)
What can be placed in patients with poor vessels and in those whom previous AVF have failed?
An arteriovenous graft between the artery and vein
(Forearm, upperarm, thigh)
What are the 2 options for dialysis access?
1. Arteriovenous fistula
2. Arteriovenous graft (synthetic material)
What is an arteriovenous graft also called and what is it made of?
GORE-TEX graft...it's made of Teflon
In dialysis, what is the arterial line for?
Blood flow from the patient to the dialyzer
In dialysis, what is the venous line for?
Blood return from the dialyzer to the patient
What can inserted into the internal jugular vein and used for vascular access until proper access can be created?
A tunneled, cuffed double lumen catheter
Why is a tunneled catheter the least desirable alternative for dialysis access?
3. Inefficient dialysis
What should be avoided with a tunneled catheter?
Subclavian vein cannulation
What kind of lumen does a tunneled catheter have?
What does the separate inner lumen do in a double lumen tunneled catheter?
It return blood back to the patient after dialysis
What do small pores in the catheter do in a double lumen tunneled catheter?
They allow blood to be pulled out and circulated through the dialyzer
What are 2 methods of hemodialysis clearance?
2. Convection (ultrafiltration)
What is diffusion?
The rate of mass transfer between 2 compartment separated by a semi-permeable membrane
What is diffusion determined by?
1. Characteristics of the membrane
2. Solute concentration gradient between the 2 compartments: Plasma and dialysate compartments
What is fluid filtration through a porous membrane with the clearance directly related to the volume of fluid removed?
Ultrafiltration: Convective mass transfer
In convection or ultrafiltration, what does positive pressure lead to?
What must be established in dialysis?
2 compartments separated by a semi-permeable membrane