Dialysis Flashcards
With an AV fistula you want to feel the ? and listen to the ?
feel the thrill and listen to the bruit
bp / sticks in arm with AV fistula- what ya gonna do?
NOT gonna do it!
how long does a it take for an AV fistula to be ready to use?
6 months
but like what is an av fistula?
surgocal connection of artery and vein that increases blood flow in that area
But how is an AV fistula different than an AV graft- how is the same?
all the same precatuions,
AV Graft. = synthetic material instead of your own arteries/veins connecting
how often should you feel for thrill and listen for a bruit on fistula?
every few hours
assessments for AV fistula?
-distal pulses
-infection
-thrill/bruit
AV fistula complicartions
thrombosis
strictures
infection
ischemia
who has greater risk for infection: vas cath or perm cath?
Vas Cath !
vas - nontunneled, short term
perm - tunneled, several months
can we use a vas/perm cath for stuff other than dialysis?
only if its an emergency
biggest risk for vas/perm cath is —-? what we gonna do about it?
infection!
–>sterile access/dressing changes
peritoneal dialysis - why do we like it?
flexible schedule, less dietary restrictions, done at home, managed by patient
peritoneal dialysis complications
infection
peritonitis(cloudy effluent)
discomfort
bowel perforation (brown effluent)
re: peritoneal diaylsis: signs of peritonitis?
Monitor for cloudy outflow/ effluent **
Abdominal tenderness
Fever
what kind of technique do we use when accessing peritoneal dialysis ?
fucking sterile
this type of dialysis passes the patient’s blood through artificial semipermeable membrane to filter and excrete (to mimic kidneys)
hemodialysis
when do we start dialysis ?
stage 4/5 ckd
- No response to diuretics
- Symptomatic Hyperkalemia
- Calciphylaxis (vascular calcification and skin necrosis)
- Ingestion of toxins that require dialysis for removal
hemodialysis uses what scientific property to function?
diffusion
–> molecules move from high (blood) to low (dialysate) concentration
hemodialysis care
-patients get hypothermic
-changes in loc/fatigue common
-risk for SEIZURES
- large voulme shifts –> hemodynamic instability
-cardiac arrest
-psychosocial issues
what is continuous renal replacement therapy
“dialysis for unstable patient”
continuously for 24 hours a day and slowly runs a small amount of blood thru
where is continuous renal replacement therapy done?
icu - 1:1 nurse ratio
how is continuous renal replacement therapy different from hemodialysis in terms of its mechism of action?
Uses a filter with fine pores (unlike HD’s diffusion process) resulting in hemofiltration
–> avoids large volume shifts but provides same results
