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Flashcards in Dialysis Deck (24):
1

When does a patient need to start dialysis?

When the risks of uremic complications exceed the risks of dialysis therapy.

2

What are possible indications for dialysis?

  • Volume overload refractory to diuretics
  • Hyperkalemia refractory to medical therapy
  • Uremic pericarditis
  • Uremic symptoms
    • Lethargy, difficulty concentrating (early)
    • Coma, seizures (late)
    • Nausea, decreased appetite
    • Uremic bleeding
  • Other metabolic derangements (metabolic acidosis, severe hyperphosphatemia, calcium abnormalities)

3

What form of dialysis is most common?

Hemodialysis (greater than 90% of patients)

4

Dialysis vascular access ideally has what characteristics? (6)

  1. Provides fast blood flow
  2. Allows repeated access
  3. Can be used immediately
  4. Has low infection rate
  5. Has long lifespan
  6. Doesn't cause morbidity

5

What is an AV fistula?

A surgically placed access which connects a native artery to a native vein. When this happens, the vein gets thicker so that it can withstand being stuck many times. Also, this provides a fast blood flow for the dialysis.

This is typically done on the non-dominant arm.

6

What are pros for using AV fistula for hemodialysis? (3)

  1. Lowest infection rate
  2. longest lifespan
  3. requires fewest procedures to maintain

7

What are the cons for using AV fistula for hemodialysis? (4)

  1. Can take months to mature
  2. some may never be usable for dialysis
  3. risk of steal syndrome
  4. needles

8

What are 3 typical locations for AV fistulas?

  1. Radiocephalic
  2. Brachiocephalic
  3. Brachiobasilic

9

What is an AV graft?

Synthetic conduit between artery and vein.

10

What are pros for AV grafts? (3)

  1. can be used quicker than AV fistula
  2. Good blood flows
  3. lower infection rate than catheters (but higher than AVFs)

11

What are cons for AV grafts (4)

  1. High rate of stenosis, requiring interventional procedures
  2. Shorter life span than AV fistula
  3. Risk of steal syndrome
  4. Needles

12

What is a dialysis catheter?

This is a double lumen catheter that is typically placed in the internal jugular vein and terminates in the SVC.

13

What are the pros for dialysis catheters? (3)

  1. Immediate use
  2. No needles
  3. Does not require surgery

14

What are the cons for dialysis catheters? (4)

  1. Highest infection risk
  2. High rate of dysfuncion/low blood flows
  3. Requires insertion site care
  4. Associated with high mortality in dialysis patients

15

What are complications of dialysis that can happen during treatment? (5)

  1. Muscle cramps
  2. Hypotension
  3. Headache
  4. Chest pain
  5. Air embolism (very rare)

16

What bacteria most commonly causes dialysis infection?

Staph aureus (or other skin organisms)

17

What are some limitations of dialysis?

  • Difficulty achieving euvolemia
    • During in-center hemodialysis treatments, it may be difficult to remove enough volume to achieve "dry weight"
  • Abnormal bone and mineral disorders
    • Despite regular dialysis, most patients will still exhibit hyperphosphatemia and require oral phosphorous binders.

18

What are pros and cons for doing frequent or nocturnal dialysis?

Pros

  • It can be performed at home
  • longer total dialysis time per week
    • improved blood pressure/left ventricular hypertrophy
    • improved phosphorous control

Cons

  • Associated with a higher risk of vascular access complications

19

What is peritoneal dialysis?

Catheter is placed into peritoneal cavity and exits the abdominal wall. Fluid with a high glucose concentration is instilled in the peritoneal cavity. Water moves into the peritoneal cavity by osmosis and uremic solutes are removed by convection. Patients perform at least 3-4 exchanges per day.

This is usually done at home every day.

It's common in other countries but not as much in the US (8% of cases)

20

What is continuous ambulatory peritoneal dialysis (CAPD)?

It's the type of peritoneal dialysis where the patient manually performs exchanges

21

What is continuous cycling peritoneal dialysis (CCPD)?

It's the type of peritoneal dialysis where a cycler machine performs exchanges at night when the patient is sleeping and leaves dialysate in the abdomen in the morning.

22

What is nocturnal intermittent peritoneal dialysis (NIPD)?

It is the type of peritoneal dialysis where a cycler performs dialysis overnight but does not leave dialysate in the abdomen in the morning.

23

What are complications for peritoneal dialysis?

  • Infection
    • peritonitis (PMNs in dialysate, abdominal pain, fever)
      • Due to both gram positive and negative organisms
    • Exit site infections (purulence and pain at exit site)
  • Catheter dysfunction/problems draining
    • may be due to constipation
    • may need surgical revision
  • Hernias
  • Metabolic complications
    • Hyperglycema (because you are giving a high dextrose solution)
    • Hypertriglyceridemia
    • Hypokalemia
  • Scarring of the peritoneal membrane

24

Compare and contrast hemodialysis vs peritoneal dialysis

A image thumb