Dialysis Flashcards

1
Q

What does dialysis involve?

A

Diffusion of urea, potassium, sodium and creatinine across a semi-permeable membrane into the dialysate

Bicarbonate will diffuse into the blood from the dialysate

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2
Q

Why is sodium present in the dialysate?

A

To prevent excess loss during dialysis

This means only true excess will be lost as the gradient is controlled

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3
Q

What is haemodiafiltration?

A

A form of renal replacement therapy that utilises convective in combination with diffusive clearance, which is used in standard hemodialysis

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4
Q

Which factors can affect the efficiency of convective transport of a molecule across a permeable membrane?

A

Water flux

Membrane pore size

Pressure difference

Charge of molecule

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5
Q

What is the minimum time required for adequate dialysis?

A

4 hours 3 times per week

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6
Q

If a patient cannot pass urine at all (anuric), whay must happen to their fluid intake?

A

Limited to around 1 litre per day

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7
Q

When a patient is on dialysis, they require _____ salt, _____ potassium and _____ phosphate in thier diet?

A

When a patient is on dialysis, they require low salt, low potassium and low phosphate in thier diet?

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8
Q

What is the gold standard for dialysis access?

A

Fistula

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9
Q

What is a fistula?

A

An artery and vein are joined to make an enlarged thick walled arteriovenous fistula

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10
Q

What are the benefits to creating a fistula?

A

Good blood flow

Lower infection risk

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11
Q

What are the downsides to a fistula?

A

Surgery

Required up to 12 weeks before use

Can thrombose or stenose

May limit blood flow to distal arm

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12
Q

What is a common alternative to a fistula?

A

Tunneled venous catheter?

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13
Q

What is a tunneled venous catheter/

A

Catheter inserted into a large vein such as femoral vein or internal jugular vein

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14
Q

What are the main concerns with a tunneled venous catheter?

A

Staph aureus infection (endocarditis, discitis, death)

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15
Q

What may go wrong with dialysis?

A

Hypotension

Blood leaks

Loss of vascular access

Hyperkalaemia and cardiac arrest

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16
Q

How does peritoneal dialysis work?

A

Diffusion of solutes across the peritoneal membrane

17
Q

How is water removed in perironeal dialysis?

A

Osmosis driven by high glucose concntration in dialysate

18
Q

What are the two types of peritoneal dialsysis?

A

Continuous peritoneal dialsysis

Automated peritoneal dialysis

19
Q

What can go wrong with peritoneal dialysis?

A

Peritonitis (contamination - staph, strep, diptheroids; gut bacteria translocation:, E.coli, kelbsiella)

Inability tp remove enough water, or solutes

Hernias

20
Q

Why is dialysis started slowly?

A

Disequilibrium syndrome