Dialysis (Exam 3) Flashcards
Dialysis
removes excess fluids and waste products and restores F&E balance and acid-base balance
diffusion (high to low concentration)
osmosis
ultrafiltration
Osmosis (Dialysis)
low to high concentration
water is removed from blood; K and Na typically move out of plasma into the dialysate
bicarb and Ca generally move the dialysate into the plasma
large molecules like RBCs and plasma proteins cannot pass through membrane
Peritoneal Dialysis
flexible schedule for exchanges
few hemodynamic changes during and after exchanges
fewer dietary and activity restrictions
catheter placement (no need for vascular access)
tenckhoff catheter (intra abdominal catheter placed in IR or at bedside)
Peritoneal Dialysis Training
3-7 day training program
less complex training, managed by pt (1 person)
simple and often done at home
24 HR TREATMENT TIME!!
Peritoneal Dialysis Equipment
dialysate contains glucose; makes solution hypertonic and creates the pull
continuous ambulatory PD (CAPD)*
continuous-cycling PD (CCPD)*
intermittent PD (IPD): auto or manual
urea clearance based on exchange of waste, fluid and electrolytes into peritoneal cavity
CAPD (Dialysis)
24/7 dialysis
2L exchanges done by patient; no machine, connect or disconnect system
CCPD (Dialysis)
24 hr dialysis
by machine at night when sleeping, final exchange dwells all day and emptied before bedtime; sterile catheter is opened less often
multiple-bag continuous ambulatory PD
automated PD (APD)
programmed for specific pt needs; dialysis during sleep; delivers large volumes; dialysis free during waking hours
Dialysis Complications
exit site infection
hyperglycemia
carb and lipid abnormalities
resp distress
bowel perforation
infection
weight gain
peritonitis (hot belly)
hernias
lower back pain
bleeding
pulmonary complications
protein loss
Dialysis Contraindications
extensive peritoneal adhesions, fibrosis, active inflammatory GI disease
ascites or central obesity
recent abdominal surgery
Self Management (Dialysis)
for any problems with outflow, ensure clamps are open and not kinked or twisted, turn from side to side, stand or cough
flexibility in time for exchanges, but treatment is ongoing instead of over a quick 4 hrs compared to hemodialysis
Hemodialysis
more efficient clearance of wastes
shorter treatment time
AV fistula*
AV graft (more thrombogenic and increased risk of infection)
temporary vascular access
Arteriovenous (AV) Fistula (Hemodialysis)
don’t use for anything other than dialysis
formed by connecting an artery to a vein; vessels used most often are radial, brachial or cephalic vein of nondominant arm
allen test done before procedure
monitor for steal syndrome (pallor, decreased pulse, pain)
fistula less likely to clot than graft
Hemodialysis Training
procedure is complex; trained professional must perform procedure at center or at home
special training for center personnel and in home use
commonly administered by LPNs or dialysis tech outpatient
Hemodialysis Treatment Time
most receive 3, 4 hr treatment over course of week
for those with ongoing urine production, 2 5-6 hr treatments a week
Hemodialysis Equipment
dialyzers*
blood clotting can occur (heparin is delivered during HD and remains active for 4-6 hrs after dialysis; risk of hemorrhage; protamine sulfate should be available)
urea clearance: passive transfer of toxins by diffusion; Na moves from blood to dialysate and extra fluid is pulled by osmosis; dialysate is similar to blood
Dialyzers (Hemodialysis)
4 parts; blood compartment, dialysate compartment, semipermeable membrane and an a exposed support structure
HD dialysate isn’t sterile! bacteria is too large to pass through membrane (aseptic technique)
machine has a built in safety feature as ability to record VS, blood and dialysate flow, arterial and venous pressures, delivered dialysis dose, plasma volume changes and temp changes; alarm will sound if detected
Hemodialysis Complications
muscle cramps and back pain
loss of blood
hepatitis
disequilibrium syndrome
HA
pruritis
hemodynamic and cardiac complications (hypotension, cell lysis, anemia, dysrhythmias)
infection
increased risk subdural and intracranial bleeding from anticoagulation and BP changes
Hemodialysis Contraindications
hemodynamic instability
severe vascular disease preventing vascular access
bleeding disorders
uncontrolled diabetes
Hemodialysis Nursing Goals
weight is inportant before and after dialysis; remember 1kg=1L of fluid
collab with dialysis nurse on dialyzable drugs and antihypertensive drugs
