Dialysis

Question 1

5 indications for acute dialysis:

Answer 1

AEIOU

A – Acidosis (severe and not responding to treatment)
E – Electrolyte abnormalities (severe and unresponsive hyperkalaemia)
I – Intoxication (overdose of certain medications)
O – Oedema (severe and unresponsive pulmonary oedema)
U – Uraemia symptoms such as seizures or reduced consciousness

Question 2

Indications for long-term dialysis:

Answer 2

End stage renal failure (CKD stage 5)

Any of the acute indications continuing long term

Question 3

Options for maintenence dialysis: (x3)

Answer 3

Continuous Ambulatory Peritoneal Dialysis
Automated Peritoneal Dialysis
Haemodialysis

Question 4

What type of catheter is used in peritoneal dialysis:

Answer 4

tenckhoff catheter

Question 5

Continuous ambulatory peritoneal dialysis:

Answer 5

dialysis solution is in the peritoneum at all times.

There are various regimes for changing the solution.

One example is where 2 litres of fluid is inserted into the peritoneum and changed four times a day.

Question 6

Automated peritoneal dialysis:

Answer 6

This involves peritoneal dialysis occurring overnight. A machine continuously replaces dialysis fluid in the abdomen overnight to optimise ultrafiltration. It takes 8-10 hours.

Question 7

Complications of peritoneal dialysis:

Answer 7

Bacterial peritonitis
Peritoneal sclerosis
Ultrafiltration failure
Weightgain
Psychosocial effects

Question 8

Bacterial peritonitis in peritoneal dialysis:

Answer 8

Infusions of glucose solution make the peritoneum a great place for bacterial growth.

Bacterial infection is a common and potentially serious complication of peritoneal dialysis.

Question 9

Peritoneal sclerosis - in peritoneal dialysis

Answer 9

involves thickening and scarring of the peritoneal membrane

Question 10

Ultrafiltration failure in peritoneal dialysis

Answer 10

This occurs when the patient starts to absorb the dextrose in the filtration solution.

This reduces the filtration gradient making ultrafiltration less effective.

This becomes more prominent over time.

Question 11

Weight gain in peritoneal dialysis:

Answer 11

can occur as they absorb the carbohydrates in the dextrose solution.

Question 12

Typical reigeme for haemodialysis:

Answer 12

4 hrs a day for 3 days a week

Question 13

2 main types of access to abundant blood supply in haemodialysis:

Answer 13

Tunneled cuffed catheter

A-V fistula

Question 14

Tunnelled cuffed catheter:

Answer 14

Tube inserted into the:

• Subclavian or jugular vein
• • tube that sits in SVC or right atrium

Tube has 2 lumens - one where blood exits and one where it enters

Can stay in long-term and be used regularly

Main complications:
- infection and blood clots in the catheter

Question 15

Purpose of dacron cuff

Answer 15

found on tunnelled cuffed catheter

sits around the catheter and promotes healing and adhesion of tissue to the cuff

• Makes catheter more permanent and provides a barrier to bacterial infection

Question 16

3 typical A-V fistulae:

Answer 16

Radio-cephalic
Brachio-cephalic
Brachio-basilic (less common and more complex operation)

Question 17

A-V fistula specifics:

Answer 17

A-V connection that allows blood to bypass the capillary system and allows high pressure flow.

Requires surgical operation and then a 4week-4month maturation period without use

Question 18

Examinations of A-V fistula should look for:

Answer 18

• skin integrity
• aneurysms
• palpable thrill - (fine vibration found over anastomosis)
• Stereotypical “machinery murmur” on auscultation

Question 19

Complications of A-V fistula:

Answer 19

Aneurysm
Infection
Thrombosis
Stenosis
STEAL syndrome
High output heart failure

Question 20

Steal syndrome:

Answer 20

Inadequate blood flow to limb distal to fistula.

blood stolen from distal limb

Causes distal ischaemia

Question 21

High output heart failure in A-V fistula

Answer 21

Rapid return of blood to heart

Increases pre-load

Can lead to hypertrophy and heart-failure