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Flashcards in Dialysis- Final Exam Deck (84)
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61

What are some convection based alternative hemodialytic techniques?

CAVH (continuous arteriovenous hemofiltration)
CVVH (continuous venovenous hemofiltration)

62

What are some diffusive therapy based alternative hemodialytic techniques?

CAVHD (continuous arteriovenous hemodialysis)
CVVHD (continuous venovenous hemodialysis)

63

How does blood circulate in continuous arterio-venous hemofiltration?

With or without a blood pump thrugh a small hollow-fiber hemofilter; through the hemofilter wherein the plasma and water is filtered and collected in the collection bag

64

Where do you get access in CAVH?

Femoral artery and vein

65

Where is heparin infused in CAVH?

Proximal to the dialyzer

66

Where is replacement volume infused in CAVH?

Into venous return line

67

Why is CVVH replacing CAVH mode?

Pump assisted and achieves higher clearance. Because of its effectiveness, it is replacing the pumpless CAVH mode

68

Where do you get access in CVVH?

Double lumen catheter in the femoral, SC, or IJ vein

69

How is continuous diffusive solute transport achieved in CVVH?

Infusing a dialysate flui

70

What is the counter-current rate in CVVH?

15 ml/min or 1 L/hr

71

CAVH/CVVH Mechanism of Action

Convection
-Solute removed by solvent drag
-roller pump creates hydrostatic pressure
-drives solute through membrane
-pore size limits transfer
-more efficient removal of larger molecules than diffusion
-enhanced cleared of autologous cytokines

72

CAVH/CVVH has enhanced clearance of what?

Autologous cytokines

73

Describe the technique of CAVHD.

Infusion pump, dialyzer membrane and dialysate solution.

Infusion pump pushes a flow of dialysis fluid dialyzer. The blood/dialysate interfaces on the membrane. CAVHD uses the process of diffusion dialysis to rid the body of fluid, electrolytes and nitrogenous wastes.

74

What process does CAVHD use to rid the body of wastes?

Diffusion dialysis

75

What wastes does CAVHD get rid of?

Fluid, electrolytes, nitrogenous wastes

76

What is the preferred arterial access site for CAVHD?

Femoral artery

77

What is more effective: CAVHD or CVVHD? Why?

CAVHD, becuase the lower pressure venous system does not filter as much blood per unit of time

78

CAVHD/CVVHD Mechanism of Action

Diffusion (predominantly)
-Solute diffuses electrochemical gradient
-diffusive movement; smaller molecule have greater KE removed based on size of gradient
-convection due to UF
-solute removed proportion to size
-dialysate flow is low that BFR
-solute removal directly proportion to dialysate flow rate

79

What type of cannulas are used for dialysis access?

duel lumen dialysis catheters

80

Arteriovenous fistula

Surgically created arteriovenous fistulas are preferred over catheters for patients with chronic renal failure for ease of access and a lower infection risk

81

What is one the most common errors of dual lumen cathters?

Placement of arterial and venous ports on the catheters

82

What is used for anticoagulation?

Citrate (CPD)
heparin

83

What are some advantages of Citrate as an anticoagulant?

Citrate has the effect of anticoagulating the CVVVH system itself.
Citrate interrups the clotting cascade by soaking up (chelating) free ionized calcium. the citrate is cooked off (metabolized) into the form of bicarb

84

What systems use heparin as an anticoagulant?

CVVH and CVVHD