Dialysis and Renal Replacement Therapies Flashcards
Renal Replacement Therapies
-Hemodialysis
-Peritoneal Dialysis
-CAPD
-CCPD
-NIPD
-NTPD
-CAVH
-CVVH
-CVVHD
Renal Replacement Therapy indications (AEIOU)
-Acid/base balance (metabolic acidosis)
-Electrolytes (Na and K)
-Intoxication (poison)
-Overload of fluid
-Uremia
RRT does NOT tx
-mineral bone disorder
-anemia
-phosphorus
Hemodialysis
-intermittent
-3-4 hour sessions MWF or TRS
-for ESRD
When to initiate hemodialysis
-BUN > 100
-SCr > 10
-s/sx of uremia
Goal of hemodialysis tx
-remove middle molecules (500-5000Daltons)
-B2 microglobulin
-Uric Acid
-Creatinine
-etc
Vascular access for HD
-AV fistula
-AV graft
-no needle sticks or BP cuffs on access arm
AV fistula
-anastamosis between radial artery and cephalic vein for HD access
-longest survival rates (~20 years)
-less complications
-1-2 months to mature
AV graft
-alt to fistula
-graft created from connecting artery and vein with polytetrafluoroethylene tube
-shorter survival (higher infection rate)
-2-3 weeks to mature
Steal Syndrome
-issue with AV fistula
-restricts too much blood from hand
-might prefer graft for diabetes patients with PVD
Dialysis Procedure
-blood and dialysate in hemodialyzer
-blood back to body
-dialysate to waste
-concentration gradient (semipermeable membrane)
-K out of blood
-bicarb into blood
Fishbone diagram?
Fishbone diagram?
Higher rate of dialysis
-pulls more fluid out of patient
-good for edema
Substances NOT removed by dialysis
-high Vd (in tissue not blood)
-high lipophilicity
-large molecular weight
-Highly protein bound
Take meds before or after dialysis
after
Effectiveness of dialysis session
-Kt/v = 1.4 or more
-URR = 70% or more
Kt/v
-fraction of body water that is cleared of urea
-K= clearance of urea
-V= volume of urea
-T= time
-goal: 1.4 or more
-time only factor we can change
Urea Reduction Ratio (URR)
-measure reduction of BUN
-goal over 70%
Complications of hemodialysis
-hypotension
-pruritis
-muscle cramps (fluid leaving muscle too fast)
Peritoneal Dialysis
-peritoneal membrane is the filter
-solution bag, drainage bag, catheter
-keeps working w kidney function
-dif molecules might need longer dwell times
-continuous therapy
-CAPD
-CCPD
-NIPD
-TPD
CAPD
-short wells throughout day
-one long well at night time
-only one that does NOT require cycler
-cheapest
CCPD
-one long dwell all day
-connect to cycler at night
NIPD
-nothing during day
-fast cycles at night on cycler
-not gonna get rid of things that need longer dwell time
TPD
-most expensive
-nothing all day
-quick dwells and long dwells at same time during the night
-cycler
Peritonitis
-infection from PD
-staph epi
-gm neg
-some gram +
Sx of Peritonitis
-cloudy effluent
-ab pain
-fever
-NV
-chills
Peritonitis tx
- empiric therapy for gm + and -
2.obtain cultures and modify tx - route of admin (IP, IV, PO)
Empiric therapy options
-1st gen cephs (Cefazolin or Cephalothin) + 3rd gen cephs (ceftazidime) +pseudomonas
-aminoglycoside + pseudomonas (dont use if there is still kidney function?)
Why can antibiotics admin be intraperitoneal?
-where infection is
-NV from peritonitis eliminates oral route
-pt may have poor vascular access
Continuous Renal Replacement Therapies (CRRTs)
-CAVH
-CVVH
-CVVHD
-CVVHDF
-turn down rate and let it run 24/7
-rely on HR to pump
CRRT use
-acute renal failure
-mostly pt in the hospital
-hemodynamically unstable patients
Continuous arteriovenous hemoFILTRATION (CAVH) and CVVH
-blood + ultrafiltrate replacement solution
-FILTRATION not dialysis
-ultrafiltrate keeps blood volume up to go through filter
-need heparin to prevent coagulation
Continous Venovenous HemoDIALYSIS
-blood + ultrafiltrate
-into dialyzer
-waste and URS rate the same
Continuous Venovenous hemoDIAFILTRATION
-dialyzer and filtration
-preffered?
-waste rate > URS rate
-get more fluid out of body bc we can’t use diuretics
