Dialysis

Question 1

Indications for ACUTE dialysis?

Answer 1

• Acidosis
  
  • severe and not responding to rx
• Electrolyte abnormalities
  
  • severe & unresponsive hyperkalaemia
• Intoxication
  
  • overdose of certain medications
• Oedema
  
  • severe and unresponsive pul oedema
• Uraemia symptoms
  
  • ie reduced consciusness / seizures

Question 2

Indications for LONG-TERM dialysis?

Answer 2

• ESRF
  
  • CKD stage 5
• any acute indications continuing long-term

Question 3

options for long-term dialysis?

Answer 3

• Peritoneal dialysis
  
  • continuous ambulatory or
  • automated
• Haemodialysis

Question 4

what is needed for haemodialysis?

Answer 4

good access to abundant blood supply:

• Tunnelled cuffed catheter
• AV fistula

Question 5

what is a tunnelled cuffed catheter?

Answer 5

tube inserted into subclavian or jugular vein with a tip that sits in SVC or Right Atrium

can stay in long-term

Question 6

What is an AV fistula?

Answer 6

artificial connection between an artery and vein- bypasses capillary system and allows blood to flow under high pressure directly from artery to vein. Typically in patient’s forearm.

Question 7

what should you look for when examining an AV fistula?

Answer 7

• skin integrity
• palpable thrill
• aneurysms
• stereotypical “machinery murmur” on auscultation

Question 8

A-V fistula complications?

Answer 8

• aneurysm
• infection
• thrombosis
• stenosis
• STEAL syndrome
• High output HF

Question 9

What is STEAL syndrome?

Answer 9

AV fistula “steals” blood from distal limb –> inadequate blood flow to the limb distal to AV fistula –> distal ischaemia

Question 10

why does high-output HF happen?

Answer 10

blood flowing v quickly from arterial to venous system –> increased pre-load–> hypertrophy of heart muscle and heart failure