DIALYSIS

Question 1

General principle of dialysis

Answer 1

Remove excess fluids and waste products. Restores F&E balance and A&B balance.

Question 2

Diffusion

Answer 2

high to low concentration

Question 3

Osmosis

Answer 3

low to high concentration

Question 4

Ultrafiltration

Answer 4

fluid removal

Question 5

Advantage of peritoneal dialysis

Answer 5

• Flexible schedule for exchanges
• Few hemodynamic changes during and after exchanges
• Fewer dietary and activity restrictions

Question 6

Advantages of hemodiaylsis

Answer 6

• More efficient clearance of wastes
• Shorter treatment time

Question 7

Peritoneal dialysis access

Answer 7

• Catheter Placement - no need for vascular access
• Tenckhoff Catheter – intra abdominal catheter placed in IR or at bedside

Question 8

Hemodialysis access

Answer 8

• Arteriovenous (AV) Fistula- do not use for anything other than
  dialysis. Formed by connecting an artery to a vein. Vessels used
  most often are the radial, brachial artery or the cephalic vein of nondominant arm.
  1. Allen test done before procedure
  2. Monitor for steal syndrome (pallor, decreased pulse,
  pain)
  3. Fistula less likely to clot than a graft
• AV graft – more thrombogenic & increased risk of infection
• Temporary Vascular Access

Question 9

Caring for pt with Arteriovenous Fistula (AV Fistula)

Answer 9

-do not take BP readings using the extremity in which the AV fistula is placed
-Do not perform venipunctures or start an IV in the extremity in which the AV fistula is placed
-Palpate for thrills and auscultate for bruits over the site while the pt is awake
-Assess pt’s distal pulses and circulation n the arm with the access
-Elevate extremity after surgery
-Encourage routine range of motion exercises
-check for bleeding at needle insertion sites
-Assess for indications of infection at needle sites
-Instruct patient not to carry heavy objects or anything that compresses the extremity
-Instruct pt not to sleep with body weight on top of the extremity

Question 10

Peritoneal vs hemodialysis training/procedure

Answer 10

Peritoneal is less complex, managed by one person, can be done at home

vs

Hemodialysis requires a professional w/specialized training to manage

Question 11

Treatment time for peritoneal dialysis

Answer 11

24 hr

Question 12

Treatment time for hemodialysis

Answer 12

-Three 4hr treatments/day
-Two 5-6hr treatments/day

Question 13

Indications of peritonitis AKA hot belly

Answer 13

Cloudy, dialysate outflow (effluent), fever, abd tenderness, abd pain, general malaise, and NV

Cloudy or opaque effluent is the earliest sign of peritonitis

Question 14

Manifestations of peritonitis AKA hot belly

Answer 14

Fever
NV
Anorexia
“Board-like” abd
Abd distention and rigidity
Rebound tenderness
^HR & BP
Dehydration
Decreased bowel sounds
Increased WBC

Question 15

Nursing care for peritonitis

Answer 15

IV and electrolyte balance (IV fluids)
Decrease infection process (antibiotics)
Prevent complications

Question 16

Contraindications for peritoneal dialysis

Answer 16

• Extensive peritoneal adhesions, fibrosis, active inflammatory GI disease
• Ascites or central obesity
• Recent abdominal surgery

Question 17

Contraindications for hemodialysis

Answer 17

• Hemodynamic instability
• Severe vasc disease preventing vasc access
• Bleeding disorders
• Uncontrolled diabetes

Question 18

The radial and ulnar arteries are occluded by firm pressure while the fist is clenched until the hand blanches.

The hand is opened and the pressure is released from the ulnar artery.

Color should return within 15 seconds to imply adequate circulation.

Answer 18

Allen test

Question 19

Types of Peritoneal dialysis systems

Answer 19

1. Continuous Ambulatory PD (CAPD)
   ▪ 24 hr dialysis. 7 days a week, 2L exchanges,
   done by patient – no machine, connect or
   disconnect system
2. Continuous-cycling PD (CCPD)
   ▪ 24 hr dialysis. By machine at night when
   sleeping, final exchange dwells all day and
   emptied before bedtime. Sterile catheter is
   opened less often
   ▪ Multiple-bag continuous ambulatory PD
   ▪ Automated PD (APD)
   ▪ Programmed for specific patient needs.
   Dialysis during sleep. Delivers large volumes.
   Dialysis free during waking hours.
3. Intermittent PD (IPD)
   ▪ Auto or Manual

Question 20

Hemodialysis equipment

Answer 20

1. 4 parts – blood compartment, a dialysate compartment, a semipermeable membrane, and an enclosed support structure.
2. HD Dialysate is not sterile! Bacteria and other organisms are too large to pass through the membrane.
3. Machine has a built-in safety feature such as the ability to record VS, blood & dialysate flow, arterial and venous pressures, delivered dialysis dose, plasma volume changes, and temperature changes. If any are detected, an alarm sounds to protect the patient from life-threatening complications.
4. Aseptic technique
5. Blood clotting can occur – heparin is delivered during
   HD & remains active for 4-6 hours after dialysis. Risk
   for hemorrhage during this timeframe. Protamine sulfate should be readily available during this time.