Dialysis

Question 1

What are the indications for acute dialysis?

Answer 1

AEIOU

Acidosis
-persistant and cannot be corrected

Electrolytes
-persistant hyperkalaemia

Intoxication

Overload

Uraemia
-when causing encephalopathy or pericarditis

Question 2

What are indications for long-term dialysis?

What are the 3 main options for long-term dialysis?

Answer 2

End-stage renal failure
When any acute indications continue long term

3 types:

• continuous ambulatory peritoneal dialysis
• automated peritoneal dialysis
• haemodialysis

Question 3

What is the process of peritoneal dialysis?

Answer 3

Peritoneal membrane acts as the filtration membrane

Dialysis solution containing dextrose is added to peritoneal cavity

Ultrafiltration occurs from the blood across peritoneal membrane

Dialysis solution replaced to remove the filtered waste products

Question 4

What are the possible complications of peritoneal dialysis?

Answer 4

Bacterial peritonitis
-glucose solution makes the peritoneum ideal for bacterial growth

Peritoneal sclerosis
-thickening and scarring of peritoneal membrane

Ultrafiltration failure
-patient starts to absorb filtration solution reducing the filtration gradient and meaning ultrafiltration is less effective

Weight gain
-due to absorbing the carbohydrates in the solution

Psychosocial effects

Question 5

What is the process of haemodialysis?

What are the 2 options for gaining access to adequate blood supply for dialysis?

Answer 5

Blood filtered by dialysis machine 4 hrs a day 3 days a week

Tunnelled cuffed catheter
-tube into the subclavian or jugular vein

Arterio-venous fistula

• artifical connection between artery and vein bypassing the capillary system to allow blood to flow under high pressures
• radio-cephalic most commonly

Question 6

What would you look for in a AV fistula on examination?

Answer 6

Skin integrity

Aneurysms

Palpable thrill -> fine vibrations over the anastomosis

Machinery murmur on auscultation