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)
what is the empiric tx for G(+) peritonitis?
vanc
what is the empiric tx for G(-) peritonitis?
aminoglycoside, ceftazidime, cefepime, carbapenem, FQ (if local susceptibilities) or aztreonam (PCN/ Ceph allergy)
enterococcus
ampicillin
21 days
MSSA
nafcillin or oxacillin
21 days
MRSA
vanc or clindamycin
21 days
single org other than Pseudomonas or Stenotrophomonas
start tx based on sensitivities
14 days!!
Pseudomonas
can D/C vanc
antipseudomonal tx
21 days
Stenotrophomonas
Bactrim
21 days
multiple G(-) and/or anaerobes
D/C vanc
metronidazole
21 days
culture negative
measure clinical improvement at 96 hours
if improved= narrow tx
no improvement= repeat cultures and gram stain; consider removal of catheter
fungal org
newer agents in combo (fluconazole & flucytosine)
fungal org
newer agents in combo (fluconazole & flucytosine)
when should you consider removal of cath from fungal org?
pt does not respond after 4-7 days of tx → remove catheter and continue tx for extra 7 days → no response then continue tx for 4-6 weeks
