Peritoneal Dialysis Flashcards
(85 cards)
1
Q
critical barrer for transport
A
peritoneal capillary
2
Q
Aquaporin in peritoneum
A
AQP1
3
Q
collectionof dialysate in modified PET
A
0, 120 and 240 minutes
4
Q
purulent discharge +- erythema of skin
A
exit site infection
5
Q
clinical inflammation and ultrasonographic evidence
A
tunnel infection
6
Q
3-7 cycles 1.5-2L dwell over 9h at night
A
CCPD
7
Q
incomprete drain of a portion of infused fluid before filling
A
Tidal PD
8
Q
Target Kt/V in PD
A
1.7
9
Q
D/P of 0.82-1.03
A
high transporter
10
Q
D/P of 0.65-0.81
A
high average transporter
11
Q
D/P of 0.5-0.64
A
low average transporter
12
Q
D/P of 0.34 to 0.49
A
low transporter
13
Q
which transporter good UF
A
low transporter
14
Q
which transporter better clearance
A
high transporter
15
Q
dose of cefazolin
A
LD 500 mg/L MD 125 mg/L
16
Q
dose of vancomycin
A
LD 30 mg/kg MD 1.5 mg/kg/bag
17
Q
dose of amikacin
A
LD 25 mg/L MD 12 mg/L
18
Q
when to return to PD after peritonitis
A
2 weeks of catheter removal
19
Q
bowel obstruction, encapsulation due to fibrosis, bloody ascites
A
encapsulating pertineal sclerosis
20
Q
duration of draining
A
20-30 mins
21
Q
fill duration
A
5-10 mins
22
Q
surface are of peritoneum
A
1-2 m2
23
Q
more important surface area
A
parietal
24
Q
blood flow of peritoneum
A
50-100
25
sodium sieving only occurs at
ultrapores
26
greatest hydrostatic pressure in
sitting position
27
visceral peritoneum
80%
28
effective peritoneal surface area = peritoneal vascularity
Distributed Model
29
direction of external catheter
lateral and inferior
30
exit site in females
below umbilicus
31
exit site in males
above umbilicus
32
break in period
2-4 weeks
33
leakage at the skin exit site
pericatheter leak
34
most common cause of outflow failure
kinks
35
heparin to be placed when with fibrin
250-500 u/L
36
buffer in low gdp
bicarbonate
37
Adequate solute clearance, poor UF - transporter/pd modality
High transporter, APD
38
Inadequate solute clearance, very good UF - transporter/modality
Low transporter, capd
39
When to do pet?
4-8 weeks after initiation; Clinically stable and at least 1 month after resolution of an episode of peritonitis
40
evaluation of suspected ultrafiltration faioure
Modified PET
41
evidence that peritoneal membrane has lost its capability to remove uf
net uf less than 400 ml
42
when to measure kt/V in pd
Within 1st month after initiation, atleast once q4 months, 1
| month after peritonitis episode
43
target kt/V in pd
1.7/week
44
target uf in pd
Target UF of 1L per day
45
erythema, edema and tenderness over the subcutaneous pathway of the catheter
Tunnel infection
46
exit site scoring system
swelling, crust, redness, pain, drainage
47
infection should be assumed with exit site score of
>=4
48
sufficient to indicate infection
purulent drainage
49
indications for catheter removal for exit site and tunnel infection
Pseudomonas aeruginosa infection, tunnel infection, exit site infection + peritonitis
50
antibiotic prophylaxis prior to colonoscopy and invasive gynecologic procedures
IV ampicillin + amino glycoside +/- metronidazole
51
antifungal prophylaxis when pd receive antibiotic courses
oral nystatin 500k u 4x/day or fluconazole 200 mg q48h throughout duration of antibx therapy
52
clinical presentation and dx of peritonitis
atleast 2 of the ff:
| Clinical features + effluent > 100 mcgL for 2 hrs with > 50% pmn + positive dialysis effluent culture
53
duration from collection to lab
6 hours
54
gram positive coverage for pd peritonitis
First generation cephalosporin or vancomycin
55
Gram neg coverage
3rd gen ceph or aminoglycosides
56
initial dwell of antibx
6hrs
57
episode that occurs within 4 weeks of completion of therapy of a prior episode but with a different organism
recurrent
58
Episode that occurs within 4 weeks of completion of therapy of a prior episode with the same organism or one sterile episode
Relapsing
59
Episode that occurs more than 4 weeks after completion of therapy of a prior episode with the same organism
Repeat
60
failure of the effluent to clear after 5 days of appropriate antibiotics
refractory
61
Peritonitis on conjunction with an exit site or tunnel infection with the same organism or one sterile site
catheter related
62
Coag neg staph tx
IP cephalo or vanco x 2 weeks
63
Tx strep sp
ip ampicillin x 2 weeks
64
Enterococcus
Vanco x 3 weeks + aminoglycoside if severe
65
VRE
Ampicillin x 3 weeks
66
Staph aureus
Cephalo x 3 weeks (mssa), ip vanco x 3 weeks (mrsa)
67
Corynebacterium
Vanco x 3 weeks
68
pseudomonas
cephalo + amino or oral fluoro x 3 weeks
69
polymicrobial
Surgical eval
| amino + 3rd gen/carbapenem + anaerobic coverage with metronidazole or clindamycin x 3 weeks
70
Fungal
Catheter removal + antifungal x 2-3 weeks after removal
| flucytosine + amphotericin B
71
Tuberculous
HRZe x 4 months, HR x 12-18 mos
72
may consider return to pd later
refractory, relapsing, fungal
73
tx for culture negative peritonitis
discontinue gram neg coverage, continue cefaz or vanco for 2 weeks
74
blind insertion of pd catheter
seldinger technique
75
most widely used pd catheter
Tenckhoff catheter followed by swan neck
76
most widely used as osmotic agent
dextrose
77
physiologic concentratoon of Ca and pH in pd solution
2.5 meq/L
| pH 5.4
78
administration of an effective dossage of dialysis solution, clinically asymptomatic patient
Adequate dialysis
79
dose capable of reducing mortality and morbidity, dose above which increase does not justify burdeb
Optimal dialysis
80
when to remove catheter
```
fungal peritonitis
intraabdominal disease
refractory tunnel and or exit site infection
relapsing
refractory
```
81
catheter removal and simultaneous placement of a new catheter is most successful
>exit site or tunnel infection
>relapsing infections once with normal effluent counts
>success - infections that do not involve s. aureus, pseudomonas, mycobacteria or fungi
82
how to apply mupirocin in the nares
5 days a month
83
most common cause of uff, increase in peritoneal effective surface area
type 1 high transporter with uff
84
reduced small solute clearance and uf, decreased membrane surface area
low transporter with uff II
85
type 3 uff
uff with transport in the normal range
