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Renal > Haemdialysis / Peritoneal Dialysis > Flashcards

Haemdialysis / Peritoneal Dialysis Flashcards

1
Q

What does haemodialysis involve [2]

A

Diffusion
Ultrafiltration

Blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction; blood is meeting a less concentrated solution so solutes diffuse down a concentration gradient whereas large solutes do not clear
ultrafiltration then creates a negative transmembrane pressure to clear excess fluid;

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2
Q

What does haemodialysis require [6]

Duration?

A 
Semipermeable membrane (dialyser) 
Dialysate pumped counter current to blood (contained electrolyte) 
Artificial kidney 
Adequate blood exposure 
Anti-coagulation
Dialysis access

3x a week 3-5h

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3
Q

When do you not use haemodialysis [2]

A

If haemdynamic instability

Use if kidney is the only issue

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4
Q

When do you use haemofiltration [2]

A

ITU if haem-dynamic instability
Continuous but may delay mobilisation
GFR 8-10

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5
Q

What can be used for access [3]

A

Central line in emergency
AV fistula
AV prosthetic graft

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6
Q

What can you use whilst waiting for fistula / graft [2]

A

Tunneled venous catheter (Permcath)

Temporary non-tunnelled venous catheter

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7
Q

What does a Permcath do [5]

A 
Tunneled catheter
Goes underneath skin
Runs into vein
Reduce infection
Lasts months - 1 year
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8
Q

What does a non-tunnelled do [2]

A

Direct into vein if fistula not ready

Lasts 2 weeks

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9
Q

What are the risks of lines [4]

A

Infection
Thrombosis
Pneumothorax
Central venous stenosis

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10
Q

What veins are used for catheter

A

R+L jugular

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11
Q

What veins / artery are used for fistula [4]

A

Snuff box - younger as may need to use more
Brachiocephalic - most common
Radiocephalic
Brachiobasilic

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12
Q

What do you need for fistula [3]

A

Adequate artery
Adequate vein to connect to artery to train fistula
8 weeks before

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13
Q

What do you do before fistula [2]

A

Examination

Duplex USS

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14
Q

What are indications for graft / tunnelled catheter over fistula [4]

A

Vein not suitable - congenital or been used
Frailty
Heart issues
Fistula failure

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15
Q

What causes fistula failure [7]

A 
Thrombosis
Hypotension
Hypercoagulable
Proximal venous or arterial stenosis 
Trauma
Steal syndrome
Infection
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16
Q

What is steal syndrome

Features [5]

A 
Too much blood goes through fistula leading to ischaemia of the hand
Cold
Pain
Cramps 
Paresthesia
Gangrene
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17
Q

What are signs of thrombosis

A

Absence of thrill or bruit

18
Q

What are signs of stenosis

A

High pitched bruit

19
Q

How do you manage failure of fistula [4]

A

Address hypotension
Urgent thrombectomy if thrombosis
Fistuloplasty if stenosis
Temporary line

20
Q

How do you monitor renal function on dialysis [2]

A

URR (urea reduction ratio) - urea before and after dialysis

KTV = more accurate

21
Q

Why can’t you use creatinine or eGFR

A

Fluctuates when on and off dialysis

22
Q

What do you worry about

Daily requirement

A

K levels

1ml/kg/day

23
Q

How do you work out how much to lose each dialysis [2]

A

Patients have target weight which is considered euvolemic

Reduce target weight if overload

24
Q

How does diet change when start dialysis [6]

A 
Fluid restriction 
Salt, K and phosphate restriction 
Protein and calories restriction 
Phosphate binder
Vitamin supplements as lose water soluble 
Iron as lose when on dialysis
25
Q

Why might you not need BP meds

A

Dialysis deals with salt and fluid retention if this is the cause of high BP

26
Q

What fluid restriction measures [3]

A

600ml if anuric
1l HD
1.5l PD

27
Q

What are complications of dialysis [11]

A 
IHD - high risk
Intra-dialytic hypotenion, Hypertension
Arrythmia, Endocarditis
Infection 
Clotting,  Bleeding due to anti-coag
Allergy
Altered drug pharmacokinetics
Altered nutrition
28
Q

What causes hypotension

A

Become too dry

Feel crampy

29
Q

What is catastrophic dialysis [5]

A 
Massive haemorrhage
Air embolism
Acute allergy
Acute haemolytic 
Dialysis disequilibrium syndrome
30
Q

What is dialysis disequilibrium syndrome [3]

A

Between cerebral and blood solutes
Leads to cerebral oedema
Start dialysis gradually
Early signs include nausea, headache, vomiting, and restlessness.

31
Q

How can PD be carried out [2]

A

Continuous ambulatory PD 4x daily
Automated BP overnight

peritoneum is used as a semi-permeable membrane; a permanent Tenckoff catheter is inserted across the peritoneal cavity and fluid is infused in a dwell time for 4-8h allowing solutes to diffuse slowly across; ultrafiltration achieved by dextrose solution

32
Q

How long can you do PD for [2]

2 types of PD

A

5 years
High complications

Types:

  1. continuous ambulatory where exchange lasts 30-40 mins and dwell time 4-8h
  2. automated where pt sleeping and 3-5 exchanges performed overnight
33
Q

What does PD require [5]

A 
Semipermeable dialyser membrane = peritoneal
Mesenteric blood
Access 
Fill bag
Drain bag
34
Q

What access for PD

A

Tunnelled venous catheter in abdomen

35
Q

How does PD work [3]

A

Dialysis solution (high dextrose) into peritoneal cavity
Drains out waste
Fresh dialysate instilled

36
Q

What does dialyse contain

A

Balance of electrolyte

Glucose most common

37
Q

What are complications of PD [9]

A 
Exit site infection
Tunnel infection 
PD peritonitis
Tube malfunction 
Abdominal wall hernia
Ultrafiltration failure as membrane destoryed
Encapsulating peritoneal sclerosis
Metabolic
Fluid retention
38
Q

What causes tube malfunction

A

Constipation

39
Q

What metabolic issues [4]

A

Obesity
Hyperglycaemia
Malnutrition
Protein wasting

40
Q

What are symptoms of PD peritonitis [6]

A 
Cloudy fluid - WCC + neutrophils
Abdo pain
N+V
Fever
GI upset
Systemic upset
41
Q

What is the best way to treat ESRD

A

Kidney transplant into R iliac fossa

42
Q

What are common organisms in PD infection [2]

A

S epidermis

S aureus

Renal (29 decks)

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