Dialysis Flashcards
What are the three different hemodialysis access points?
- ) Arteriovenous fistula
- ) Arteriovenous graft
- ) Central Venous catheter
What form of hemodialysis has the lowest risk of infection or thrombosis?
Fistula
Which hemodialysis access has the highest risk of infection and thrombosis and when is it used?
Catheter; used for short-term when pt is getting bridge to AV fistula
Which factors influence drug removal by dialysis?
- Molecular weight
- protein binding
- volume of distribution
Which factors increase drug removal through dialysis?
- small molecular weight
- low protein binding
- small volume of distribution
- high-flux hemodialysis
- semi-synthetic and synthetic dialysis membranes
When should drugs be dosed in a hemodialysis patient?
post-dialysis if possible
Formula to determine need for supplemental dose
supplemental dose= normal dose x fraction removed by HD
What are the complications of hemodialysis?
- hypotension
- cramping
- fatigue
- infection
- thrombosis
- bleeding
What is the first step to deal with hypotension and dialysis?
- give small fluid bolus of 100-250mL normal saline
- hold antihypertensive meds prior to hemodialysis
What is the second option to deal with hypotension during dialysis if fluid maintenance and dry weight isn’t enough?
-give pt midodrine 2.5-10mgPO 30 min prior to HD
-
What is the MOA of Midodrine?
- alpha 1 agonst
- causes peripheral vasoconstriction
- increases blood pressure
When should Quinine 324mg PO be used for cramping in HD or leg cramps?
NEVER
- FDA warning
- side effects of cardiac arrhythmias
What is the second leading cause of mortality in HD?
-infection
Complications of Peritoneal Dialysis
- Peritonitis
- Fluid Overload
- Hyperglycemia
About what percent of vancomycin is cleared unchanged in the kidneys?
-90%
