Hemodialysis Flashcards
most appropriate referral to nephrology
stage 3b or 4
rule of 6 in AVF
at least 6 mm in diameter
at least 6 cm of overall needle accessible length
no more than 6 cm below the surface
higher arterial steal phenomenon
side to side anastomososis
advantage of end ro side appeoach
avoidance of venous htn
ideal hd access
high prrimary patency rate instant usability long survival low thrombosis rate low infection rate high blood flow rate patient comfort bathing/hygiene minimize needles minimal cosmetic effect
duration of lack of change on physical examination prognostic of nonmaturation
4 to 6 weeks
most impt monitoring technique
good pe of av shunt
avf has bounding pupsation, inc aneurysm size, does not flatten when arm raised above the head
venous outflow or central venous stenosis
acess placement
gfr < 20
factors influencing effective clearance: small molecules
Small FATmembrane flow (blood/dialysate) area (membrane surface) Time (treatment time) membrane permeability
most impt intrinsic physical feature governing removal
size of molecule
guards against excessive suction on the vascular access
arterial pressure
normal: -20 to 80
gauges resistance to blood return
venous pressure
+ 50 to + 200
affect solute clearance of a hemodialyzer
Increase clearance
- porosity, surface area, hydrophilicity, blood/dialysate flow
decrease clearance
- thickness, molecular weight/size, lipid solubility, protein binding, unstirred layer
varies
-membrane charge
degree to which membrane activates blood components
biocompatibility
min accetable internal fiber diameter
180 mcm
target aluminum level in water
< 10 mg/L
osteomalaciac microcytic anemia, encephalopatjy
direct exposure to this causes hemolysis and methemoglobinemua
chloramine
cardiac arrhythmia and acute death
Fluoride