dialysis2 Flashcards
what type of access is used in hemodialysis
- arrterial venous graft
- arterial venous fistula
- catheter
blood that leaves the patient in hemodialysis undergoes what
- pressure
- anticoagulant
- dialyzer (filter)
what is the urine looking leftovers from hemodialysis?
ultrafiltrate and dialysate
how often is hemodialysis for CKD? how long are each
3x’s a week
4 hours
what is the blood flow rate of hemodialysis
200-500 mL/min
what is the dialysate flow rate?
500-800 ml/min
a dialysis prescription contains what
- flow rates
- type of dialyzer
- type of solution
- time of dialysis
- anticoagulant regimen
- pt’s dry weight
what is the most common type of vascular access for dialysis
arteriovenous fistula
where are temproary access ports inserted
catheter into jugular, femoral or subclavian vein
usually only when have complications w fistula
what is one of the number one complications with pt’s with CKD on dialysis
vascular access complications
what are the most common type of vascular access complications
- stenosis
- thrombosis
- infection
how is thrombosis prevented in dialysis access?
- cathaters are locked with heparin
patients with an elevated bleeding risk (on warfarin) should not have what? what should be done instead
avoid systemic anticoagulation
flush with saline
what is regional citrate anticoagulation
anticoagulation by binding ionized calcium so clotting cascade is inhibited
what are nonpharm therapies for cathater related thrombosis
forced saline flush
what are pharm therapies for management of catheter related thrombosis
alteplase (clot breaker)
what is the leading cause of mortality in dialysis patients (other than CV)
vascular access infection
what is the difference in a local infection vs. extensive infection
local infection - catheter infection
extensive infection - kidney is infected
what can happen from vascular access infection
- endocarditis (heart valve infection)
- osteomyelitis (bone infection)
- septic arthritis (joint infection)
- septic pulmonary emboli
- septic syndrome
what should be done if a dialysis pt. has a fever during HD
immediately take blood culture
what should be done for AV fistula infection
long term antibiotic treatment
what is an infection localized to catheter site?
how should it be treated
tunneled cuffed cathater
use bactrim if no drainagewho
who has a high risk for intradialytic hypotension
- Diabetes
- autonomic insufficiency
- heart disease
- elderly