Lect 7 Flashcards
HD complications
- hypotension
- muscle cramps
- pruritis
- N/V
- HA
- chest pain
- fever/ chills
causes of hypotension in HD
hypovolemia, anti-HTN meds or meals prior to HD, target dry weight set too low, acetate dialysis solution base
acute management of hypotension in HD
Trendelenburg position
decrease ultrafiltration rate
fluid bolus: 100-200 mL IV NS
pharm tx for hypotension
- midodrine before HD
- levocarnitine after HD
- fludrocortisone before HD
- sertraline DAILY
muscle cramps causes in HD
dehydration
Na in dialysate too low
acute management of muscle cramps in HD
fluid bolus
NS 100-200 mL IV
prevention of muscle cramps
dialysate sodium > serum Na
vit E at bedtime
vascular access complications
dec blood flow through the access site over days-weeks (less than 300 mL/min)
vascular access complications
dec blood flow through the access site over days-weeks (
prevention and treatment of intrinsic thrombosis in catheter
saline, heparin, alteplase locks to prevent
saline flush or alteplase to treat
prevention and treatment of extrinsic thrombosis in catheter
replacement of catheter
PD complications
- mechanical
- pain
- metabolic complications
- peritoneal memb damage
- infections (peritonitis; exit-site)
peritonitis is higher in ___
CAPD than APD
which org is predominant in peritonitis?
Staph epidermidis (G(+))
when do you start empiric abx in peritonitis pts?
cloudy fluid and/or abd pain and/or fever
WBC >100
*intraperitoneal admin preferred
(in asymptomatic pts w/ cloudy effluent, just wait for differential/culture return)
