Dialysis Flashcards
What is the purpose of dialysis?
To preform the filtration tasks of the kidneys artificially
What are the indications for dialysis?
A – Acidosis
E – Electrolyte abnormalities
I – Intoxication
O – Oedema
U – Uraemia symptoms
What type of acidosis requires dialysis?
Severe and not responding to treatment
What electrolyte abnormalities require dialysis?
Severe and unresponsive hyperkalaemia
What type of oedema requires dialysis?
Severe and unresponsive pulmonary oedema
What is the most common form of renal replacement therapy?
Haemodialysis
What does haemodialysis involve?
Regular filtration of the blood through a dialysis machine in hospital
How often do patients require haemodialysis a week?
3 times per week
How long does each session of haemodialysis last?
3-5 hours
What are the options for access to blood supply for patients undergoing haemodialysis?
Tunnelled cuffed catheter
Arterio-venous fistula
What is a AV fistula?
An artificial connection between an artery to a vein
When does an AV fistula need to be created prior to starting haemodialysis?
8 weeks
Where is the AV fistula for haemodialysis usually created?
Radio-cephalic
Brachio-cephalic
What is a tunnelled cuff catheter?
A tube inserted into the subclavian or jugular vein with a tip that sits in the superior vena cava or right atrium.
What is peritoneal dialysis?
Renal replacement therapy where the filtration occurs within the patient’s abdomen
What is used as the filtration membrane in peritoneal dialysis?
The peritoneal membrane
How is the dialysis solution administered in peritoneal dialysis?
It is injected into the abdominal cavity through a permanent catheter
What is the dialysis solution made up of for peritoneal dialysis?
High dextrose concentration
What happens in peritoneal dialysis?
The high dextrose concentration of the solution draws waste products from the blood into the abdominal cavity across the peritoneum
What happens after dwell time in peritoneal dialysis?
The dialysis solution is drained removing waste products and exchanged for new dialysis solution
What are the two different types of peritoneal dialysis?
Continuous ambulatory peritoneal dialysis (CAPD)
Automated peritoneal dialysis (APD)
What is continuous ambulatory peritoneal dialysis (CAPD)?
There is dialysis solution in the abdomen at all times
What is Automated peritoneal dialysis (APD)?
A dialysis machine fills and drains the abdomen while the patient is sleeping
How often is fluid changed and how long does APD take?
3-5 exchanges over 8-10 hours each night
How often is the fluid in CAPD changed?
2 litres changed 4 times a day
What is the main complication of peritoneal dialysis?
Bacterial peritonitis
What bacterial usually causes bacterial peritonitis?
Staphylococcus epidermidis.
How does a patient with bacterial peritonitis present?
Abdominal pain
Fever
Cloudy dialysis bag
What are the possible complications of haemodialysis?
Cardiovascular disease- endocarditis and arrhythmias
Disequilibration syndrome
What are the possible complications of an AV fistula
STEAL syndrome
Stenosis
Aneurysm
High output heart failure
What is STEAL syndrome?
Inadequate blood flow to the limb distal to the AV fistula
What does steal syndrome cause?
Diverts blood away from where it was supposed to supply and straight into the venous system
What does STEAL syndrome result in?
Distal limb ischaemia
What is Disequilibration syndrome?
Acute cerebral oedema due to rapid extraction of osmotically active substances
How can an AV fistula result in high output hear failure?
Blood flows quickly from arterial to the venous system through the fistula
There is rapid return of blood to the heart
Increases the pre-load in the heart
What is the most common cause of death on dialysis?
Ischaemic heart disease
