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CIC Exam > Dialysis > Flashcards

Dialysis Flashcards

1
Q
A
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2
Q

What is peritoneal dialysis?

A

-the removal of toxins, electrolytes, and fluid by diffusion through the peritoneal membrane.
-requires placement of catheter into perotneal cavity.
-can be continuous ambulatory peritoneal dialysis, intermittent peritoneal dialysis, or continuous cycling peritoneal dialysis

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3
Q

What are some types of infections caused by peritoneal dialysis (hint: there are 3)

A
  1. exit site infection
  2. subcutaneous tunnel infections
  3. peritonitis
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4
Q

what are some risk factors for peritoneal dialysis infections?

A

-young age
-staph nasal carriage
-lack of compliance with routine procedures (poor exit site care, break in aseptic procedures)
-dialysate leak
-exit site breakdown or poor healing
-trauma to the exit site
-dislodging of the catheter cuff

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5
Q

what pathogens most commonly cause exit site infections with peritoneal dialysis?

A

staphlococci and pseudomonas

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6
Q

what pathogens most commonly cause subcuteanoues tunnel infections with peritoneal dialysis?

A

S. aureus, P. aurginosa, and enterobacteriaceae

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7
Q

what pathogens most commonly cause peritonitis with peritoneal dialysis infections?

A

coagulase-negative staph, s. sureus, and streptococci

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8
Q

what are signs and symptoms of an exit site infection?

A

erythmea, tenderness, exuberant granulation tissue, exit site with purulent and/or bloody drainage

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9
Q

what are signs and symptoms of a subcutaneous tunnel infection?

A

weythmea, edema, or tenderness of the subcutaneous catheter pathway with purulent drainage or cellulitis

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10
Q

what are signs and symptoms of peritonitis?

A

at least two of the following: S & S of peritonitis (abdominal pain or fever), cloudy dialysate with white blood cell counts >100 cells/mm3 and 50 polymorphonuclear leukocytes, positive culture, or gram’s stain of the dialysate

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11
Q

what are some steps to reduce peritoneal dialysis related infections?

A

-proper catheter placement (avoid skin folds, beltline)
-use of a double cuff catheter
-catheter should be placed under sterile conditions in the OR
-proper exit site care of the operative wound and after healing
-being vigilant for early manifestations of infection

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12
Q

what does hemodialysis do?

A

removes toxins, electrolytes, and fluid by circulating the patients blood through a hemodialyzer
-requires a vascular access
-usually a 3-4 hour treatment 3x a week and can be done in center or at home

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13
Q

what are 3 types of hemodialysis vascular access (in order of lowest to highest risk of infection)?

A
  1. arterio-venous fistula (AVF)
  2. arterio-venous graft (AVG)
  3. tunneled, cuffed venous catheter (if catheter is used for more than 3 weeks) or non cuffed catheter for acute hemodialysis less than 3 weeks duration
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14
Q

what is AVF?

A

a surgical creation of anastomosis (connection) between an artry and vein
-causes arterialized blood to flow through the vessel
-results in enforgement and enlargement of the vessel
-lowest risk of infectino

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15
Q

what is an arteriovenous graft?

A

-synthetic material is interposed between an artery and vein
-expanded polytetrafluoroethylene/Teflon
-composite/polyurethane

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16
Q

risk of infection from AVF and AVG may result from what?

A

-break in aseptic technique
-bacterial seeding from another part of the body
-poor hygiene and care of access site
-added risk with AVG is disintegration of graft materials and hemorrhage

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17
Q

how do you lower risk of infection with AVF and AVG?

A

-clean technique with clean barriers and gloves and attention to aseptic technique
-arm should be cleaned with antibactrial soap or scrub with water
-2% chlorhexidine gluconate is the antimicrobial of choice

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18
Q

where does a tunnelled, cuffed CVC get placed and what are indications for use?

A

-placed within right atrium
-indications are long term access (>3 weeks duration)

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19
Q

where does a non-cuffed CVC get placed and what are indications for use?

A

-superior vena cava
-short term or acute dialysis only less than 3 weeks
-use of femoral vein has the highest risk of infection

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20
Q

What is the most common bacterial cause of vascular access site infections?

A

staphlococcus aureus

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21
Q

the majority of CVC bloodstream infections in hemodialysis patients are caused by what organisms?

A

gram positive (coagulase-negative staph and s.aureus)
-usually related to access site care
-can be caused by water associated gram negative organisms (stenotrophamonas, serratia, pseudomonas)

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22
Q

what is the preferred antiseptic that should be used to clean the dialysis catheter exit site?

A

2% chlohexidine gluconate

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23
Q

what antiseptic do you use when prepping for insertion?

A

0.5% chlohexidine with alcohol

24
Q

true or false. when chlorine is removed from water during treatment for hemodialysis, there is little to impede bacterial growth?

A

True

25
Q

what does treating water for hemodialysis remove?

A

-chemical, bacterial, or endotoxin contaminants

26
Q

what type of water is used to prepare product water and dialysate for reprocessing of hemodialyszers?

A

municipal

27
Q

what are some systems used in water treatment for hemodialysis?

A

-water softener
-carbon filter
-particualte filters
-reverse osmosis
-deionizers
-filters, ultrafilters, UV light

28
Q

what is the purpose of water softener?

A

exchanges calcium and magnesium ions for sodium ions

29
Q

what is the purpose of a carbon filter?

A

removes chlorine, chloramine, and organic material
-at least 2 carbon filters recommended

30
Q

what is the purpose of particulate filters?

A

removes sediment from the water that could damage or clog the system

31
Q

what is the purpose of reverse osmosis?

A

-removes ions and organics
-capable of removing 90-99% of eectrolytes and all bacteria, viruses, and endotoxin

32
Q

what is the purpose of deionizers?

A

-removes ions but not bacteria or endotoxins
-must always be preceded upstream by carbon filters
-if DI is the last process in water treatment it must be followed by an ultrafilter
-two tanks in series (worker/polisher)

33
Q

what is the purpose of filters, ultrafilters, or UV light

A

further reduce microbial or endotoxin concentration

34
Q

what are some facts about water distribution and storage systems for hemodialysis?

A

-plastic pipes are used because metal pipes could contaminate water with chemicals like copper, lead, or Zinc
-needs to be a constantly flow of water through all distribution piping (velocity of 1.5 ft/sec)
-should be no dead ends or unused branches

35
Q

how often should chemical monitoring of dialysis water be done?

A

at least yearly if RO and DI are used more often if other treatment methods are used

36
Q

what are some chemicals that are tested during chemical monitoring?

A

-aluminum
-arsenic
-antimony
-calcium
-chlorine
-chloramine
-copper
-cadium
-chromium
-barium
-beryllium
-fluoride
-sodium
-magnesium
-nitrate
-potassium
-thallium
-sulphate
-zinc
-lead
-silver
-mercury
-selenium

37
Q

what adverse event can aluminum in water cause?

A

anemia, bone disease, dialysis dementia

38
Q

what adverse event can chloramines (combined chlorines) in water cause?

A

hemolysis, hemolytic anema, methemoglobinemia

39
Q

what adverse event can fluroide in water cause?

A

bone disease, pruritis, chest pain, N/V, cardiac arrest

40
Q

what adverse event can copper in water cause?

A

chills, anemia, liver damage, hemolysis

41
Q

what adverse event can zinc in water cause?

A

fever and anemia

42
Q

what adverse event can calcium or magnesium in water cause?

A

muscular weakness, hyper/hypotension

43
Q

what adverse event can sodium in water cause/

A

hypernatremia, increased thirst, excess water intake

44
Q

how is bacteria and endotoxins tested for?

A

water and dialysate samples

45
Q

what can the presence of endotoxins cause?

A

-pyrogenic (fever), bacterimic symptoms, flu like symptoms, chills, fever, hypotension, and increase the chance of infection

46
Q

how often should the water distribution or dialysate system be tested?

A

at least monthly (weekly for 1 month when changes made)

47
Q

total viable bacterial counts and endotixin concentrations must not exceed what?

A

<100 cfu/mL and <0.25 EU/mL

48
Q

How do you prevent bloodborne pathogens in hemodialysis?

A

-items taken to the dialysis station should be disposed of, dedicated to a single patient, or cleaned and disinfected
-avoid multiple dose med vials
-prepare individual patient doses in a designated med prep area
-do not use common med carts
-do not carry med vials, syringes, alcohol swabs, or supplies in pockets
-clean and disinfect the dialysis station between patients (tables, machines, beds)

49
Q

How to you manage HBV in hemodialysis?

A

-test for HBsAG prior to or on first session. If negative recommend vaccination
-susceptible patients (including those with no vaccine response) should be tested monthly for the virus
-dialysize positive patients in a separate room with dedicated equipment
-do not include positive patients in reuse programs
-staff members caring for positive patients should not care for susceptible patients at the same time

50
Q

true or false. Hep B antibody response to vaccine is poorer in hemodialysis patients therefore larger vaccine doses or an increased number of doses is required?

A

True

51
Q

who is HBV vaccination recommended for?

A

all susceptible hemodialysis patients and staff

52
Q

booster doses are necessary when?

A

antibody levels decline below 10 mIU/mL

53
Q

what precautions are required for hemodialysis or Hep C and HIV patients?

A

-routine
-not as easily transmitted

54
Q

how often is HCV testing of hemodialysis patients recommended?

A

every 6 months along with ALT

55
Q

how often is HIV testing of hemodialysis patients recommended?

A

not necessary or recommended

CIC Exam (9 decks)

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