Dialysis & Kidney transplant

Question 1

what does dialysis mean ?

Answer 1

movement of fluid/molecules across a semipermeable membrane from one compartment to another

Question 2

what is dialysis used for ?

Answer 2

used to correct fluid and electrolyte imbalance
and
removes waste products from kidney failure

Question 3

interesting to note, can dialysis be used to help treat drug overdoses?

Answer 3

yes

Question 4

what are the two methods of dialysis that are available ?

Answer 4

peritoneal dialysis
hemodialysis

Question 5

when is dialysis normally started on?
typically a criteria that we have to see if a patient is eligible for it

Answer 5

when patients uremia can no loner be adequately treated

gfr < 15ml/min/1,73m^2

Question 6

what do you think is more effective with peritoneal or hemodialysis ?

Answer 6

hemodialysis

Question 7

what are the two general principles of dialysis ?

Answer 7

diffusion and osmosis

Question 8

what does diffusion mean ?
what does osmosis mean ?

Answer 8

movement of solutes from an area of greater concentration to an area of lesser concentration

movement of fluid from an area of lesser concentration of solutes to an area of greater concentration

Question 9

ultrafiltration is fluid and water removal
- results when there is an osmotic gradient or pressure gradient across membrane

pd - glucose in dialystae
hd - pressure gradient

excess fluid moves into dialysate

Question 10

peritoneal dialysis typically is a short term training program, usually how many days ?

Answer 10

3-7 days

Question 11

what are some advantages of peritoneal dialysis ?

Answer 11

simplicity
home based program
increasing patient participation
no need for special water system
equipment set up is simple

Question 12

what is the process of peritoneal dialysis ?
typically how do you insert the catheter ?

Answer 12

peritoneal access is obtained by inserting a catheter through anterior abdominal wall

through surgery

( patients does it at home, can be done overnight )

Question 13

how do patients do peritoneal dialysis ?

Answer 13

there is dialysis solutions, gets instilled into the perineum then clamps it off, then you let it sit

then you have this exchange of fluid and electrolytes, soothed balance out

then you leave it in the abdomen for a certain amount of time (dwell time)

then you unclamp and drain it out

you do several exchanges

Question 14

what are the 3 phase of periotoneal dialysis ?

Answer 14

inflow (fill)-2-3l over 10mins
dwell (equilibration) 20-30mins - 8 Hours
drain 15-30mins

Question 15

most of the time we like to wait until the catheter site is healed before you even start dialysis treatment in order to avoid what?
think basic

even waiting for like going to the pool or anything risky

Answer 15

infection, irritation, tenderness

Question 16

if a patient has an infection on their catheter site for their dialysis, what do we give?

Answer 16

antibiotics

Question 17

what is the biggest concern or complication with peritoneal dialysis ?

Answer 17

peritonitis

Question 18

what are some clinical manifestation of peritonitis ?
dont over think it

Answer 18

abdominal pain
rebound tenderness
diarrhea, vomitting, distention

Question 19

if we are removing fluid from a patient who has a perionteal dialysis, what should the fluid normally be ?

if they have an infection, what does the fluid end up looking like ?

Answer 19

clear

cloudy, pus-y

Question 20

what other 4 complications, not as common but can occur with peritoneal dialysis ?

Answer 20

hernias - increased abdominal pressure from dialysate

lower back problems - increase pressure fromi infusion

bleeding - initial catheter placement, checking for internal bleeding

pulmonary complications
- increase fluid and pain, increase respiratory rate

Question 21

how do we treat hernias ?
how do we treat back pain ?
how do we treat bleeding?
how do we treat pulmonary issues?

Answer 21

hernia repair
binders and exercise
check bloodpresure and stop it
elevate head of bed, deep breathing/slow down fluid

Question 22

what is hemodialysis ?

Answer 22

blood goes out from you then goes to the machine, gets cleaned, then returns back in you

Question 23

hemodialysis, arteriovenous fistula is what?

Answer 23

created in the forearm or upper arm and allows partial blood to flow through vein

Question 24

we often will place the fistula inside the upper arm 3 months in advance in order for to what?

Answer 24

mature

Question 25

patient may end up feeling ____or hear ___due to high velocity of blood flow when having a arteriovenous fistula

Answer 25

thrill bruit

Question 26

what is ateriovenous grafts?

Answer 26

synthetic material surgically placed under the skin to form a bridge between artery (brachial) and vein (antecubital)

Question 27

something i want to add to the hemodialysis is that when a patient is taking medications, what is the procedure or procaustion behind this ? so we do what

Answer 27

if they just received med and on dialysis, its just going to be flushed and filtered out so you want to hold it and then do it after

Question 28

how long is the healing time for arteriovenous grafts?

Answer 28

2-4weeks

Question 29

arteriovenous grafts is more likely to get infected or form clots, so we want to monitor and give antibiotics if infected we usually give some form of heprain during the hemodialysis

Question 30

what is the biggest risk of having an AV fistula and grafts ?

Answer 30

distal ischemia (steal syndrome) - pain distal to access site - numbness or tingling of fingers - poor capillary refill - aneurysms

Question 31

if there is a time where immediate access is needed, we like to do a catheter insertion of the internal what ?

Answer 31

jugular or femoral vein

Question 32

blood is pumped from top into ____ dialysate pumped from bottom and bathes the ____of the fibers

Answer 32

fibers outside

Question 33

Two large bore needles placed in fistula or graft One needle is placed to pull blood from circulation to HD machine Other needle is used to return dialyzed blood to the patient Heparin is added to prevent clotting Dialysate delivery and monitoring system is used Dialyzer/blood lines primed with saline solution to eliminate air Terminated by flushing with saline to return all blood to patient Needles removed and firm pressure applied Most treated in a community-based center Dialyzed for 3 to 4 hours, 3 days/wk

Question 34

what is a major complication of hemodialysis ?

Answer 34

dialysis disequilibrium syndrome

Question 35

what is dialysis disequilibrium syndrome?

Answer 35

neurologic changes during or immediacy followed a hemodialysis, a result of cerebeal edema change in fluid so fast it causes cerebral edema vomiting, headache, blurred vision

Question 36

how do we manage and treat dialysis disequilibrium syndrome? prevention medication ?

Answer 36

slow speed of dialysis mannitol/hypertonic solution decrease cerebral edema

Question 37

hypotension can occur how ? treatment ^ muscle cramps can occur how ? treatment ? loss of blood can occur how ? treatment ? hepatitis can occur how ? treatment ?

Answer 37

remove too much fluid slow down the removal electrolytes slow down fluids blood not rinsed off rinse all the blood from the needle - vaccine

Question 38

continual renal replacement therapy is used for ?

Answer 38

acute kidney injury

Question 39

continual renal replacement therapy helps how ? for how long

Answer 39

acid-base status and electrolyte are adjusted slowly and continuously in hemodynamically unstable patients 24 hours

Question 40

we dont use continual renal replacement therapy for what and who ?

Answer 40

patients who have life threatening manifestation of uremia that require rapid treatment

Question 41

kidney transplant

Question 42

what is the best treatment for end stage renal disease ?

Answer 42

kidney transplant

Question 43

what are some contraindications of a transplant?

Answer 43

cancer chronic respiratory failure chronic infection extensive vascular disease

Question 44

hiv and hep b are not contraindications of kidney transplants

Question 45

Postoperative care Kidney transplant recipient Dehydration must be avoided Assess for hyponatremia/hypokalemia Acute tubular necrosis can occur Monitor urine output; maintain catheter patency Patient education: signs and symptoms of rejection, infection, and surgical complications; follow-up care

Question 46

Postoperative care Kidney transplant recipient Maintenance of fluid and electrolyte balance is first priority Large volumes of urine may be produced soon after transplanted kidney placed due to New kidney’s ability to filter BUN Abundance of fluids during operation Initial renal tubular dysfunction

Question 47

remember you only need 1 good kidney to manage well

Question 48

Live donor Extensive interprofessional evaluation Crossmatches—check antibodies Advantages Better patient and graft survival rates Immediate organ availability Immediate function/minimal cold time Opportunity to have recipient in best possible medical condition since elective surgery Deceased (cadaver) kidney donors are relatively healthy persons that have suffered an irreversible brain injury and are brain dead Must have effective CV functions and on ventilator to preserve organs Permission of next of kin requested even with signed donor card Kidneys removed and preserved up to 72 hours Preferred cold time less than 24 hours