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Year 3 - Met3b > Dialysis > Flashcards

Dialysis Flashcards

1
Q

Since the use of long term dialysis the …

A

UK renal replacement therapy population is increasing

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2
Q

what are the types of renal replacement therapy

A
  • Haemodialysis
  • Peritoneal dialysis
  • kidney transplant
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3
Q

What is the function of the kidneys

A
  • Salt removal
  • Water removal
  • Electrolyte balance
  • Acid-base balance
  • Toxin removal
  • Make erythropeitin
  • 1-α hydroxylate vitamin D
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4
Q

What can dialysis do that the kidney can also do

A
  • Salt removal
  • Water removal
  • Electrolyte balance
  • Acid-base balance
  • Toxin removal

SWEAT

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5
Q

How do you replace the erythropoietin that the kidney makes

A
  • can give EPO subcutaneously or intravenously to replace what the kidneys would have made
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6
Q

How can you give 1 alpha - hydroxylate vitamin D

A

Give oral 1 alpha hydroxylate vitamin D

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7
Q

Name the two types of dialysis

A
  • Haemodialysis

- Peritoneal dialysis

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8
Q

where can you give Haemodialysis

A

• Can be done at home but (in the UK) is usually done haemodialysis units (either standalone or in hospital)

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9
Q

where can you give peritoneal dialysis

A

at home

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10
Q

What are the two types of peritoneal dialysis

A

Continuous ambulatory peritoneal dialysis (CAPD)

Ambulatory peritoneal dialysis (APD)

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11
Q

when is continuous veno-venous haemofiltration used

A
  • Usually an inpatient treatment in a critical care setting
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12
Q

What is continuous veno-venous haemofiltration

A

Continuous Veno-Venous Hemofiltration (CVVH) is a temporary treatment for patients with acute renal failure who are unable to tolerate hemodialysis and are unstable

  • used in critical care when HD is not possible due to low blood pressure
  • not used for chronic RRT unless in combination with HD
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13
Q

How is haemodialysis done basically

A

• Blood is filtered across a membrane using a machine

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14
Q

How many times does haemodialysis have to be done a week and for how long

A

• Minimum of 4 hours three times per week

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15
Q

Describe the mechanism of action of haemodialysis

A
  • Blood is exposed to fluid dialysate across a biocompatible membrane
    • Small molecules pass through the pores, large molecules such as albumin do not
    • A concentration gradient allows diffusion of molecules across the membrane, enabling removal of waste products and replacement of desirable molecules or ions
    • Water is driven through the membrane by hydrostatic force (ultrafiltration or UF)
    • UF can also clear some solutes via convection
  • pressure monitors keep an eye on the flow rate and any sign of pressure change which means bleeding
  • dialyser - this is the membrane and where the diffusion takes place
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16
Q

what does haemodialysis require

A

– vascular access (a means of taking blood to and from the patient)
– Anticoagulation (prevent clotting in the circuit)

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17
Q

What should you take while you are on haemodialysis

A

– Anticoagulation (prevent clotting in the circuit)

18
Q

What is the area in the dialysis machine where the semipermeable membrane is

A
  • dialyser - this is the membrane and where the diffusion takes place
19
Q

what are the three types of vascular access used in haemodialysis

A
  • AV fistula - most common and most optimum
  • AV graft
  • Tunnelled catheter
20
Q

Describe an AV fistula

A
  • most common used

- most optimum

21
Q

How do you form an AV fistula in the arm

A
  • surgical procedure takes place between an artery and vein in the arm

Can be:

  • Radial Cephalic fistula.
  • Brachial Cephalic.
  • Brachial Basilic Transposition.
22
Q

What are the types of AV fistulas

A

Radial Cephalic fistula.
Brachial Cephalic.
Brachial Basilic Transposition.

23
Q

Describe how an AV graft works

A
  • when PTFE graft is placed between the artery and the vein and the graft can be used for dialysis
  • plastic tube that links the artery and vein
24
Q

described tunnelled Catheter

A
  • Cather that sits in the central vessels

- tunneled under the skin and comes up in the chest wall

25
Q

What is the advantages of AV fistulas and grafts versus tunnelled catheter

A

= Provide better dialysis

  • safer
  • used long term
  • less complications
26
Q

What is the advantages of tunnelled catheter versus AV fistulas and grafts

A

can be used immediately - don’t need to wait for it to heal and mature like the other two

27
Q

What are the two main headings of complications of haemodialysis

A

access complications

dialysis complications

28
Q

What are access complications in haemodialysis

A
  • Thrombosis - all three
  • Infection - more common in tunnelled catheters
  • Failure of access - stenosis in the central vessels or thromboses or there is no option for AV fistula formation
  • Aneurysm (AVF/G)
  • Distal ischaemia (AVF/G) - stills syndrome
  • Central venous stenosis (Tunnelled catheter)
29
Q

what are the dialysis complications

A
  • Hypotension - where the blood pressure drops during dialysis
  • Reactions to dialysis (cramps, headache)
  • Inadequate dialysis dose and doesn’t deliver adequately
30
Q

How many times a day is peritoneal dialysis done

A

• Done every day

31
Q

how does peritoneal dialysis work basically

A
  • Dialysis solution is infused and drained via a catheter that is surgically placed in the peritoneal cavity
  • The peritoneal membrane acts as the filter
  • The action of draining and infusing dialysis solution is called an exchange
32
Q

Describe how peritoneal dialysis works

A
  • The semi-permeable peritoneal membrane lines the abdominal cavity and covers the abdominal viscera.
  • The membrane allows (via diffusion) the passage of toxins and electrolytes into the dialysis solution.
  • Ultrafiltration (removal of fluid) occurs via osmosis.
  • A “steady state” of toxin clearance and fluid management is achieved due to daily performance of dialysis.
33
Q

how many times a day do you have to do Continuous ambulatory peritoneal dialysis (CAPD)

A

• 4-5 exchanges a day

34
Q

How does Continuous ambulatory peritoneal dialysis (CAPD) work

A
  • Starts with fluid in peritoneal cavity
  • DRAIN- through a closed system the fluid is drained by gravity
  • FLUSH - small amount flushed into drain bag to clear line
  • FILL – new fluid run into peritoneal cavity via the closed system
  • DWELL – fluid dwells 4-6 hours before another exchange
35
Q

How does ambulatory peritoneal dialysis (APD) work

A
  • Alternative to CAPD
  • Patient has a cycler machine
  • Dialysis takes place over night usually ~8 hrs • Usually better for someone that works
36
Q

what peritoneal dialysis is better for those that work

A

APD

• Dialysis takes place over night usually ~8 hrs • Usually better for someone that works

37
Q

What are the complications of peritoneal dialysis

A
  • Infection (usually peritonitis, exit site infection)
  • Catheter dysfunction/malposition - because it is blocked or it is in the incorrect position in the abdominal caity
  • Peritoneal leak - around the exit site or in the pleural space
  • Pain - usually self-limiting and settles down
  • Membrane failure - becomes thickened and less effective
  • Inadequate dialysis
  • Encapsulating peritoneal sclerosis
38
Q

What is a rare by severe complication of peritoneal dialysis

A

• Encapsulating peritoneal sclerosis - thickened sclerosis’s peritoneal which causes malabsorption

  • life threatening
  • occurs after several years of dialysis or after recurrent episodes of peritoneum
39
Q

Who cannot tolerate dialysis

A

Not everyone wants to tolerate dialysis
– Heart disease - health is unstable on haemodialsysis
– Terminal diagnosis with short prognosis - may not want it
– Frailty - can be difficult
– Quality of life
– Patient choice

40
Q

What is the alternative management of symptoms to people who don’t want dialysis

A

medication

41
Q

How do we decide which dialysis to use

A
  • Patient and clinician shared care decision-making
  • Lifestyle (eg travel)
  • Personal choice
  • Technical

• Patient factors
– Technical (eg PD not possible after major abdominal
surgery which would be a contraindication)
– Comorbidities (heart failure or instability)
– Frailty

42
Q

What patient factors come into thought when determining which dialysis to use

A

– Technical (eg PD not possible after major abdominal
surgery which would be a contraindication)
– Comorbidities (heart failure or instability)
– Frailty

Year 3 - Met3b (26 decks)

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