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nephrology fellowship reviewer > Peritoneal Dialysis > Flashcards

Peritoneal Dialysis Flashcards

1
Q

critical barrer for transport

A

peritoneal capillary

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2
Q

Aquaporin in peritoneum

A

AQP1

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3
Q

collectionof dialysate in modified PET

A

0, 120 and 240 minutes

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4
Q

purulent discharge +- erythema of skin

A

exit site infection

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5
Q

clinical inflammation and ultrasonographic evidence

A

tunnel infection

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6
Q

3-7 cycles 1.5-2L dwell over 9h at night

A

CCPD

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7
Q

incomprete drain of a portion of infused fluid before filling

A

Tidal PD

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8
Q

Target Kt/V in PD

A

1.7

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9
Q

D/P of 0.82-1.03

A

high transporter

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10
Q

D/P of 0.65-0.81

A

high average transporter

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11
Q

D/P of 0.5-0.64

A

low average transporter

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12
Q

D/P of 0.34 to 0.49

A

low transporter

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13
Q

which transporter good UF

A

low transporter

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14
Q

which transporter better clearance

A

high transporter

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15
Q

dose of cefazolin

A

LD 500 mg/L MD 125 mg/L

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16
Q

dose of vancomycin

A

LD 30 mg/kg MD 1.5 mg/kg/bag

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17
Q

dose of amikacin

A

LD 25 mg/L MD 12 mg/L

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18
Q

when to return to PD after peritonitis

A

2 weeks of catheter removal

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19
Q

bowel obstruction, encapsulation due to fibrosis, bloody ascites

A

encapsulating pertineal sclerosis

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20
Q

duration of draining

A

20-30 mins

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21
Q

fill duration

A

5-10 mins

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22
Q

surface are of peritoneum

A

1-2 m2

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23
Q

more important surface area

A

parietal

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24
Q

blood flow of peritoneum

A

50-100

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25
Q

sodium sieving only occurs at

A

ultrapores

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26
Q

greatest hydrostatic pressure in

A

sitting position

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27
Q

visceral peritoneum

A

80%

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28
Q

effective peritoneal surface area = peritoneal vascularity

A

Distributed Model

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29
Q

direction of external catheter

A

lateral and inferior

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30
Q

exit site in females

A

below umbilicus

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31
Q

exit site in males

A

above umbilicus

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32
Q

break in period

A

2-4 weeks

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33
Q

leakage at the skin exit site

A

pericatheter leak

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34
Q

most common cause of outflow failure

A

kinks

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35
Q

heparin to be placed when with fibrin

A

250-500 u/L

36
Q

buffer in low gdp

A

bicarbonate

37
Q

Adequate solute clearance, poor UF - transporter/pd modality

A

High transporter, APD

38
Q

Inadequate solute clearance, very good UF - transporter/modality

A

Low transporter, capd

39
Q

When to do pet?

A

4-8 weeks after initiation; Clinically stable and at least 1 month after resolution of an episode of peritonitis

40
Q

evaluation of suspected ultrafiltration faioure

A

Modified PET

41
Q

evidence that peritoneal membrane has lost its capability to remove uf

A

net uf less than 400 ml

42
Q

when to measure kt/V in pd

A

Within 1st month after initiation, atleast once q4 months, 1

month after peritonitis episode

43
Q

target kt/V in pd

A

1.7/week

44
Q

target uf in pd

A

Target UF of 1L per day

45
Q

erythema, edema and tenderness over the subcutaneous pathway of the catheter

A

Tunnel infection

46
Q

exit site scoring system

A

swelling, crust, redness, pain, drainage

47
Q

infection should be assumed with exit site score of

A

> =4

48
Q

sufficient to indicate infection

A

purulent drainage

49
Q

indications for catheter removal for exit site and tunnel infection

A

Pseudomonas aeruginosa infection, tunnel infection, exit site infection + peritonitis

50
Q

antibiotic prophylaxis prior to colonoscopy and invasive gynecologic procedures

A

IV ampicillin + amino glycoside +/- metronidazole

51
Q

antifungal prophylaxis when pd receive antibiotic courses

A

oral nystatin 500k u 4x/day or fluconazole 200 mg q48h throughout duration of antibx therapy

52
Q

clinical presentation and dx of peritonitis

A

atleast 2 of the ff:

Clinical features + effluent > 100 mcgL for 2 hrs with > 50% pmn + positive dialysis effluent culture

53
Q

duration from collection to lab

A

6 hours

54
Q

gram positive coverage for pd peritonitis

A

First generation cephalosporin or vancomycin

55
Q

Gram neg coverage

A

3rd gen ceph or aminoglycosides

56
Q

initial dwell of antibx

A

6hrs

57
Q

episode that occurs within 4 weeks of completion of therapy of a prior episode but with a different organism

A

recurrent

58
Q

Episode that occurs within 4 weeks of completion of therapy of a prior episode with the same organism or one sterile episode

A

Relapsing

59
Q

Episode that occurs more than 4 weeks after completion of therapy of a prior episode with the same organism

A

Repeat

60
Q

failure of the effluent to clear after 5 days of appropriate antibiotics

A

refractory

61
Q

Peritonitis on conjunction with an exit site or tunnel infection with the same organism or one sterile site

A

catheter related

62
Q

Coag neg staph tx

A

IP cephalo or vanco x 2 weeks

63
Q

Tx strep sp

A

ip ampicillin x 2 weeks

64
Q

Enterococcus

A

Vanco x 3 weeks + aminoglycoside if severe

65
Q

VRE

A

Ampicillin x 3 weeks

66
Q

Staph aureus

A

Cephalo x 3 weeks (mssa), ip vanco x 3 weeks (mrsa)

67
Q

Corynebacterium

A

Vanco x 3 weeks

68
Q

pseudomonas

A

cephalo + amino or oral fluoro x 3 weeks

69
Q

polymicrobial

A

Surgical eval

amino + 3rd gen/carbapenem + anaerobic coverage with metronidazole or clindamycin x 3 weeks

70
Q

Fungal

A

Catheter removal + antifungal x 2-3 weeks after removal

flucytosine + amphotericin B

71
Q

Tuberculous

A

HRZe x 4 months, HR x 12-18 mos

72
Q

may consider return to pd later

A

refractory, relapsing, fungal

73
Q

tx for culture negative peritonitis

A

discontinue gram neg coverage, continue cefaz or vanco for 2 weeks

74
Q

blind insertion of pd catheter

A

seldinger technique

75
Q

most widely used pd catheter

A

Tenckhoff catheter followed by swan neck

76
Q

most widely used as osmotic agent

A

dextrose

77
Q

physiologic concentratoon of Ca and pH in pd solution

A

2.5 meq/L

pH 5.4

78
Q

administration of an effective dossage of dialysis solution, clinically asymptomatic patient

A

Adequate dialysis

79
Q

dose capable of reducing mortality and morbidity, dose above which increase does not justify burdeb

A

Optimal dialysis

80
Q

when to remove catheter

A 
fungal peritonitis 
intraabdominal disease 
refractory tunnel and or exit site infection 
relapsing 
refractory
81
Q

catheter removal and sinuktaneous placement of a new catheter is most successful

A

exit site or tunnel infection
relapsing infections once with normal effluent counts
success - infections that do not involve s. aureus, pseudomonas, mycobacteria or fungi

82
Q

how to apply mupirocin in the nares

A

5 days a month

83
Q

most common cause of uff, increase in peritoneal effective surface area

A

type 1 high transporter with uff

84
Q

reduced small solute clearance and uf, decreased membrane surface area

A

low transporter with uff II

85
Q

type 3 uff

A

uff with transport in the normal range

nephrology fellowship reviewer (29 decks)

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