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nephrology fellowship reviewer > Hemodialysis > Flashcards

Hemodialysis Flashcards

1
Q

most appropriate referral to nephrology

A

stage 3b or 4

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2
Q

rule of 6 in AVF

A

at least 6 mm in diameter
at least 6 cm of overall needle accessible length
no more than 6 cm below the surface

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3
Q

higher arterial steal phenomenon

A

side to side anastomososis

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4
Q

advantage of end ro side appeoach

A

avoidance of venous htn

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5
Q

ideal hd access

A 
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
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6
Q

duration of lack of change on physical examination prognostic of nonmaturation

A

4 to 6 weeks

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7
Q

most impt monitoring technique

A

good pe of av shunt

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8
Q

avf has bounding pupsation, inc aneurysm size, does not flatten when arm raised above the head

A

venous outflow or central venous stenosis

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9
Q

acess placement

A

gfr < 20

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10
Q

factors influencing effective clearance: small molecules

A 
Small FATmembrane 
flow (blood/dialysate) 
area (membrane surface) 
Time (treatment time) 
membrane permeability
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11
Q

most impt intrinsic physical feature governing removal

A

size of molecule

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12
Q

guards against excessive suction on the vascular access

A

arterial pressure

normal: -20 to 80

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13
Q

gauges resistance to blood return

A

venous pressure

+ 50 to + 200

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14
Q

affect solute clearance of a hemodialyzer

A

Increase clearance
- porosity, surface area, hydrophilicity, blood/dialysate flow

decrease clearance
- thickness, molecular weight/size, lipid solubility, protein binding, unstirred layer

varies
-membrane charge

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15
Q

degree to which membrane activates blood components

A

biocompatibility

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16
Q

min accetable internal fiber diameter

A

180 mcm

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17
Q

target aluminum level in water

A

< 10 mg/L

osteomalaciac microcytic anemia, encephalopatjy

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18
Q

direct exposure to this causes hemolysis and methemoglobinemua

A

chloramine

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19
Q

cardiac arrhythmia and acute death

A

Fluoride

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20
Q

Hard water syndrome - nausea vomiting weakness flushing labile bp

A

Excess ca and Mg

21
Q

target temp of water

A

77F-100F

22
Q

quality of dialysis water

A

lower maximal level of 100 cfu/ml bacteria and a max concn of less than 0.25 eu/ml for endotoxin

23
Q

action levels

A

25 cfu

0.125 eu/ml

24
Q

ultra pure dialysate

A

bacterial count of less than 0.1 cfu/ml

endotoxin less than 0.03 eu/ml

25
Q

monitoring of water quality

A

monthly

26
Q

post bun sampling

A

slowing the blood pump to 100 ml/min for 15s, stopping the dialysate flow for 3 mins, drawing sample from dialysate inflow port

27
Q

clinical conditions with no anticoagulation or reginal anticoagulation

A 
actively bleeding 
significant risk for bleeding 
major thrombi static defect 
major sx within 7 fays 
intracranial sx 14 days
biopsy of visceral organs with 72h
pericarditis
28
Q

Low dose heparin clinical conditions

A

Major sx beyond 7 days
biopsy if visceral organs beyond 72h
minor sx 8h prior
minor sx within 72h

29
Q

either low dose or no anticoagulation

A

major sx 8h prior

30
Q

to prevent clotting

A

rinse circuit with heparinized saline
less thrombogenic dialyzer
flush the circuit with 100 to 200 ml 0.9% Nacl every 30 mins
avoid blood or platelet transfusion through circuit
high blood flow rate
limit uf

31
Q

Mg for persistent intradialytic hypotension

A

Higher dialysate Mg

32
Q

Adynamic bone disease

A

lower dialysate Mg

33
Q

major complication of bicarbonate dialysate

A

bacterial contamination and precipitation of Ca and Mg salts

34
Q

surrogate marker for cardiovascular disease in hd

A

carotid intimal thickness

35
Q

reduce plasma isoprostanes and isofurans, markers of oxidative stress and endothelia function

A

coenzyme q10

36
Q

surrogates of overall bp status

A

prehd and post hd bp

37
Q

htn meds removed poorly with hd

A

losartan, fosinopril, ramipril, carvedilol, bisoprolol, propranolol

38
Q

when can false positive hbsag occur

A

3 weeks

39
Q

decrease in sbp 20 mmhg or more or a decrease in map of 10 mmhg with clinical events

A

hypotension

40
Q

interventions to consider in recurrent intradialytic hypotension

A 
reassess dry wt 
reduce id Na gain
assess id hypoca, hypoK, hypoNg
avoid food intake during hd 
adjust antihtn 
assess cardiac function 
cool dialysate 
extend dialysis time or add sessions 
sequential Uf or uf remodeling 
midodrine
41
Q

measures in dds

A
  1. shorter tx times of 1-2h
  2. lowering blood flow rates to 200-250 ml/min
  3. Reducing dialysate flow rate, concurrent flow
  4. dialyzer with small surface area
  5. Mannitol
42
Q

pericaridits that occurs within 8 weeks of initiation of hd

A

uremic pericarditis

43
Q

dialyzer reaction that occur within 5 to 20 mins and present with pruritus, urticaria, bronchospasm or anaphylactic shock

A

type A reactions

44
Q

cause of first use syndrome

A

IgE antibodies to membrane material or ethylene oxide

45
Q

Complement mediated, occur later, chest and back discomfort

A

Type B

46
Q

chest tightness, back pain, shortness of breath with acute pigmentation of the skin and port wine appearance of the blood in venous line

A

acute hemolysis
discontinue without blood return
check K, peripheral smear, hgb
screen dialysate and blood tubing for contaminants

47
Q

foam in venous line

A

air embolism

48
Q

tx of air embolism

A 
Stop blood pump 
clamp venous dialysis line to prevent further air entry 
administer O2 
volume resuscitation 
keep patient supine

nephrology fellowship reviewer (29 decks)

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