Renal 3 - Dialysis

Question 1

5 indications for dialysis

Answer 1

all mustn’t be responding to treatment + severe AKI

Acidosis 
Electrolyte (potassium high mainly)
Intoxication (overdose)
Oedema (pulmonary)
Uraemia symptoms

(and obviously ESRF)

Question 2

3 options for maintenance dialysis

Answer 2

continuous amublatory - 2 L in peritoneum + changed 4x daily

automated peritoneal dialysis - overnight 8 hr replacement

haemodialysis

Question 3

complications of peritoneal dialysis x 5

Answer 3

bacterial peritonitis 
peritoneal sclerosis 
ultrafiltration failure 
weight gain (Carbs)
psychosocial

Question 4

peritoneal dialysis

Answer 4

works by ultrafiltration, dextrose rich (conc) solution in peritoneum draws out waste products from blood

Tenckhoff catheter

Question 5

haemodialysis maintenance

Answer 5

tunnelled cuffed catheter or AV fistula

4hrs a day for 3 days a week

Question 6

AV fistula + examining it

Answer 6

surgical procedure to form + 4month maturation period

look at:
skin integrity
aneurysms
palpable thrill
ausc machinery murmur

Question 7

AV fistula complications

Answer 7

aneurysm
infection
thrombosis
stenosis 
STEAL syndrome
heart failure

Question 8

what is STEAL syndrome?

Answer 8

in renal AV fistula patients

distal limb ischaemia from loss of blood via fistula

Question 9

why may AV fistula patients get high output heart failure

Answer 9

increase in preload from fistula leads to hypertrophy

Question 10

KEY thing to remember about fistulas

Answer 10

NEVER EVER take blood from them

they should be protected like Gods