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Renal > Dialysis > Flashcards

Dialysis Flashcards

1
Q

Name three types of dialysis

A
  • Haemodialysis
  • Haemodiafiltration
  • Peritoneal Dialysis
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2
Q

What three process is dialysis based on?

A

Diffusion
Adsorption
Convection

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3
Q

How is diffusion involved in dialysis?

A

Moves solutes from a high to low concentration allowing the removal of toxins and infusion of bicarbonate

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4
Q

What is added/removed in dialysis?

A

Removed - urea, potassium, sodium, creatinine, toxins

Added - pure water, sodium, bicarbonate, potassium, glucose

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5
Q

What rate does blood flow in dialysis?

A

300-350mls/min

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6
Q

How does convection help dialysis?

A

Moves the water across the membrane in response to a pressure gradient

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7
Q

What is ultrafiltration?

A

Convection solute drag pulls the solute with the water

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8
Q

How does adsorption play a role in dialysis?

A

Affects plasma proteins and solutes bound to them. Proteins stick to the membrane and are removed by binding

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9
Q

What time of membrane adsorbs protein better?

A

High flux membranes

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10
Q

How is haemodiafiltration different?

A

Increasing convection allows a larger volume of ultra filtrate. This adds to the solute drag.

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11
Q

Name the factors affecting efficiency of haemodialysis

A
  • water flux
  • membrane pore size
  • pressure difference
  • viscosity of fluid
  • size/shape/charge of molecule
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12
Q

If a lot of ultra filtrate is removed what must be done?

A

Replacement of extra-convective fluid

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13
Q

Define high volume

A

> 20 litres

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14
Q

How often is haemodialysis given?

A

4 hours 3 times a week

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15
Q

What are the restrictions a patient but follow if on dialysis?

A

Fluid 1 litre a day
Low salt to help fluid balance
Low potassium
Low phosphate (with phosphate binders with meals)

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16
Q

Name three ways vascular access can be obtained for dialysis

A
  • tunneled venous catheter
  • fistula
  • haemodialysis reliable outflow graft
17
Q

Describe a tunnelled venous catheter

A

Inserted into large vein - typically internal jugular

18
Q

What are the pros of catheter?

A

Easy to insert and can be used immediately

19
Q

What are the cons of a catheter?

A

Infection (staph aureus can lead to endocarditis, discitis and death)
Blockage
Damage to central veins which may cause future problems

20
Q

How are catheter infections managed?

A

Blood cultures, FBC, CRP and exit site swab

Line should be removed and vancomycin +/- gentamicin

21
Q

Describe a fistula

A

Artery and vein surgically connected - the venous part develops to create an enlarged thick walled vessel known as an arteriovenous fistula

22
Q

Where can a fistula be formed?

A

Radio-cephalic
Brachio-cephalic
Brachia-basilic transposition

23
Q

What are the advantages of a fistula?

A

Good blood flow and lower risk of infection

24
Q

What are the disadvantages of a fistula?

A

Requires surgery and can take up to 12 weeks to be fit for use, can limit blood flow to distal arm, thrombose or stenose

25
Q

State five complications of haemodialysis

A
  • hypotension (underselling of intravascular space)
  • haemorrhage (ruptured AVF)
  • loss of access (thrombosis/stenosis)
  • arrhythmia (electrolyte imbalance)
  • cardiac arrest
26
Q

How does peritoneal dialysis work?

A

Solute removal by diffusion across the peritoneal membrane. Water is removed by osmosis and driven by high glucose concentration in dialysate fluid

27
Q

What are the two types of peritoneal dialysis?

A
  • continuous ambulatory

- automated

28
Q

Describe continuos ambulatory peritoneal dialysis

A

4 2 litre bag exchanges per day, each lasting 20-30 minutes. Dialysate is drained by gravity and discarded

29
Q

Describe automated peritoneal dialysis

A

1 bag of fluid stays in all day and overnight APD machine controls fluid drainage in and out for 9/10 hours

30
Q

What are the complications of peritoneal dialysis?

A
  • infection
  • membrane failure
  • hernias
31
Q

How may infection arise in peritoneal dialysis?

A

Peritonitis or from exit site, contamination can occur (staph/strep/diptheroids) or translocation from gut (e.coli, klebsiella)

32
Q

What might happen if the membrane fails?

A

Unable to remove enough water or solute may need switched to HD

33
Q

Why does peritoneal dialysis increase risk of hernias?

A

Increased intra-abdominal pressure requires repair and smaller fill volumes

34
Q

When might dialysis be started?

A 
Acute Kidney Injury
eGFR<7ml/min
Urea >40
Unresponsive metabolic acidosis/hyperkalaemia 
Systemic symptoms
35
Q

What happens if dialysis is too fast in the beginning?

A

Disequilibrium syndrome - cerebral oedema, confusion, seizures, death

Renal (20 decks)

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