Part 2 Dialysis Flashcards
HD Intradialytic Complications
HypoTN Cramps Pruritis N/V Headache Chest pain Fever and chills
Causes of hypoTN
Hypovolemia
Anti-HTN meds or meal prior to HD
Dry weight set too low
Acetate dialysis (dilation)
Acute management of hypoTN
Trendelenburg position
Decrease ultrafiltration rate
100-200 mL of IV NS
Non-pharm prevention of hypoTN
Bicarbonate dialysate
Avoid food before or during HD
Pharm prevention of hypoTN
Midodrine before HD
Fludrocortisone before HD
Levocarnitine after HD
Sertraline daily
Causes of muscle cramps
Dehydration
Sodium too low
Treatment of cramps
100-200 mL IV NS
Prevention of cramps
Dialysate sodium
Stretching, massage, flexing
Vit E
Management/prevention of pruritis
Biocompatible dialyzers Capsaicin cream Antihistamines Cholestyramine Charcoal
Vascular access complications
Dysfunction (decreased blood flow)
Fistulas/grafts: aneurysm and stenosis
Catheters: thrombosis or infection
Intrinsic thrombosis
Within the lumen
Prevention/treatment of intrinsic thrombosis
Saline, heparin, alteplase lock to prevent
Saline flush or alteplase instillation to treat
Extrinsic thrombosis
At the tip
Fibrin sleeve
Prevention/treatment of extrinsic thrombosis
Replacement of catheter
PD complications
Mechanical Pain Metabolic Membrane damage Infections
Peritonitis
Higher in CAPD than APD Staph epidermidis (G+)
Peritonitis diagnostic tests
Cloudy fluid and/or ab pain and/or fever
WBC >100
Start abx
Empiric therapy for G+
Vanco
Empiric therapy for G-
AG, cephtazidime, cefepime, carbapenem, FQ or aztreonam
Empiric therapy adminstration
Intraperitoneal
Enterococus treatment
Ampicillin 125mg/L
Add AG
Treat for 21 days***
MSSA treatment
Nafcillin/oxacillin
Treat for 21 days***
MRSA treatment
Vanc or clindamycin
Treat for 21 days***
MRSA treatment
Vanc or clindamycin
Treat for 21 days***
G- not pseudo or stenotrophomonas treatment
Treat for 14 days
Pseudo treatment
Treat for 21 days
Stenotrophomonas treatment
Bactrim
Treat for 21 days
Multiple G- and/ore anaerobes treatment
Add metro
Treat for 21 days
Multiple G- and/ore anaerobes treatment
Add metro
Treat for 21 days
