Dialysis - Exam 2 Flashcards Preview

SEMESTER FOUR!! Nursing 214 > Dialysis - Exam 2 > Flashcards

Flashcards in Dialysis - Exam 2 Deck (15):
1

Arteriovenous Native Fistula (AVF)

Usually created in the forearm by a side-toside, end-to-side, or end-to-end anastomosis between an artery and a vein. The fistula provides arterial blood flow thought the vein, essential to provide the rapid blood flow required by hemodialysis. Requires health blood vessels

2

Arteriovenous grafts (AVG)

A synthetic graft may be required for clients requiring arteriovenous (AV) access, but who do not have health blood vessels. Grafts are placed surgically and are self healing. Grafts are more likely that fistulas to clot off and become infected.

3

Thrills and Bruits

Thrills can be felt by palpating over the AV anastomosis. Bruits can be auscultated using a stethoscope. Arterial blood rushing into the vein creates the bruit and thrill

4

Protection of the Access Extremity

Blood pressures, IV insertion and venipuncture should not be performed on the affected extremity. This prevents infection and clotting.

5

Temporary Vascular Access VIA Central line (Quinaton, Permacath)

Subclavian, internal jugular and femoral veins can be used to provide quick, temporary vascular access. These central catheters must be double lumen and can be left  in for several weeks. Temporary access can be used while waiting for permanent access to be created and to mature for usage.

6

AV Fistula Access Pros/Cons

Direct connection of artery and vein under the skin, best long-term, less risk, less complications, better blood flow, located in forarm or upper arm, needs 3-4 months to mature

Advantages:

  1. Augments BF
  2. Lasts many years
  3. Best vascular access
  4. Best perfusion
  5. Reduces infection rate

Disadvantages

  1. Non aesthetic
  2. No indicator
  3. Time to mature
  4. Fail to develop
  5. Complications include aneurysm and stenosis

7

AV graft (permanent) Assess Pros/Cons

Connection between artery and vein is through a synthetic tube. Implanted by a surgeon  under the skin. Takes 2-3 weeks to develop

Advantages:

  1. Use faster
  2. Use repeatedly

Disadvantages:

  1. Short life
  2. high probability of clotting
  3. High possibility of infection

8

Venous catheter (temporary)

Termpoary catheter (locally: quinton, permacath) for up to 3 weeks. If fistula fails. Neck9 jugular, chest (subclavian), leg (femoral, two chambers (in and out)

Advantages:

  1. No needles
  2. Emergency places easily, replaced and removed

Disadvantages:

  1. Temporary
  2. Narrow veins
  3. No swimming
  4. Elevated infection rates
  5. Increased clotting
  6. Complications: infection, low blood flow (clogging) catheter caps can fall off, air embolism, leaks, kinking

 

9

Purposes of Peritoneal and Hemo dialysis

Peritoneal Dialysis:

The large natural surface area of the peritoneum makes it a good semipermeable membrane for performing dialysis. Removal of wastes

Hemodialysis:

The dialyser provides dibers (cellulose of synthetic) as a semipermeable membrane. Blood passes through the lumen of thousands of these fibers and are bathed in dialysate. Removal of wastes.

10

Basic procedures of peritoneal dialysis and hemodialysis

Peritoneal Dialysis:

Dialysis solution is instilled into the peritoneum for a prescribed period of time. Water and fluid are removed from the body into the dialysate because of the pressure gradient that is created by the addition of glucose to the dialysate. Three phases of the dialysis are inflow (fill), dwell (equilibration), and drain. One cycle of inflow, dwell, and drain is called an "exchange"

Hemodialysis:

Excess fluid is removed by creating a pressure differential between the blood and the dialysate solution with a combination of positive pressure in the blood compartment or negative pressure in the dialysate compartment.

11

Contraindications of peritoneal and hemodialysis

Periotoneal Dialysis:

Adhesions, perionitis (lots of scar tissue)

Hemodyalysis:

none, but hemodynamic changes may not be tolerated by all

12

Access method of peritoneal/hemodialysis

Peritoneal Dialysis:

Obtained by inserting a catheter through the anterior abdominal wall. The tip of the catheter rests in the peritoneal cavity and has many perforations to allow fluid to flow in and out. Usually placed surgically.

Hemodialysis:

Arteriovenous fistulas, arteriovenous grafts, temporary vascular access VIA central line

13

How often for peritoneal/hemodialysis

Peritoneal Dialysis:

4 or more exhanges per day, possibly overnight

Hemodialysis:

3 times per week for 3 or 4 hours

14

Assessment required for peritoneal/hemodialysis

Peritoneal Dialysis:

  1. Exit site inspection
  2. Clarity of peritoneal effluent
  3. Teaching/learning assessment, can client perform these tasks?: cath care,assessment and dialysis exchanges
  4. Complications include: exit site infection, abdominal pain, hernias, lower back problems, bleeding, pulmonary complications, protein loss, carbohydrate and lipid abnormalities, peritonitis

Hemodialysis:

  1. Fluid balance: weight, BP, peripheral edema, lung and heart sounds
  2. Vascular access condition
  3. Temperature and condition of skin
  4. VS
  5. Complications include: hypotension, muscle cramps (electrolytes shifting), loss of blood, hepatitis, sepsis, disequilibrium syndrome

15

Dialysis Equilibrium Syndrome

Hemodialysis: results from rapid changes in the composition of the extracellular fluid leading to shift of fluid into the brain, causing cerebral edema. Can result in seizures. Rare.

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