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Renal > Renal Replacement Therapy (RRT) > Flashcards

Renal Replacement Therapy (RRT) Flashcards

1
Q

Define dialysis

A

Process that removes substances from the blood that cannot be cleared due to decreased renal function

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2
Q

At what stage should the eGFR be to consider initiating renal dialysis?

A

eGFR < 30 mL/min/1.73^2

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3
Q

What are the criteria to initiate dialysis on a patient?

A
  1. Signs/Sx of attributes to renal function
  2. Inability to control volume and/or BP
  3. Deterioration of nutritional status
  4. Cognitive decline
  5. Uncontrolled acid/base abnormalities
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4
Q

What are the signs/Sx that attribute to renal function?

A

Seizures, hiccups, anorexia, cramps, fatigue, electrolyte abnormalities, pruritus

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5
Q

When should you be worried about BP not being controlled?

A

BP > 170 or 180 mmHg

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6
Q

What are factors to consider when you want to initiate dialysis?

A
  1. Age
  2. Vascular accessibility
  3. Transplantation option
  4. Lifetime expectancy
  5. Compliant w/ medications
  6. Dialysis accessibility
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7
Q

What are the two most common dialysis procedures patients use?

A

Hemodialysis and peritoneal dialysis

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8
Q

What are the advantages of hemodialysis?

A
  1. Higher solute clearance (intermittent use)
  2. Less rates of technique failure
  3. Closer monitoring to patient
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9
Q

What are the disadvantages of hemodialysis?

A
  1. Require patients to drive to the dialysis center several (3) times a week
  2. Can cause hypotension, cramps, and disequilibrium
  3. Vascular accessibility complications
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10
Q

What are the advantages of peritoneal dialysis?

A
  1. Patient can be hemodynamically stable
  2. More independence (no machine needed)
  3. Patients who cannot tolerate hemodialysis
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11
Q

What are the disadvantages of peritoneal dialysis?

A
  1. Loss of proteins and amino acids leading to decreased appetite (malnutrition)
  2. Catheter malfunction and/or infection
  3. Patient burnout (less compliant)
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12
Q

There are several steps in hemodialysis. What are the steps? (HINT: 8 steps)

A
  1. Vascular accessibility
  2. Blood leaves the patient and enters the blood pump
  3. Heparin is used for the blood not to coagulate
  4. Blood enters the dialyzer countercurrent to the dialysate
  5. Dialysate enters the dialyzer countercurrent to the blood
  6. Ultrafiltrate leaves the dialyzer
  7. Blood leaves the dialyzer and enters back to the patient
  8. This process is repeated 3 times a week for 3-4 hours
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13
Q

What are the 3 main components for a hemodialysis?

A
  1. Blood circuit
  2. Dialyzer
  3. Dialysate circuit
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14
Q

(T/F) - Heparin and LMWH (both) can be used to avoid coagulation in the blood

A

False - ONLY heparin can be used during hemodialysis

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15
Q

How many mL is the blood being pumped out from the blood pump per minute?

A

300-600 mL/min

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16
Q

What is ultrafiltrate defined as?

A

The solutes and fluid removed from blood

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17
Q

How many mL is the dialysate being pumped out from the dialysate pump per minute?

A

500 mL/min

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18
Q

What is dialysate defined as?

A

Purified buffers, water, and electrolytes

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19
Q

What are the three common vascular access for hemodialysis procedure?

A
  1. Arteriovenous (AV) fistula
  2. AV graft
  3. Cuffed or tunneled venous catheters
20
Q

Which vascular access sews the artery to the vein? (on the forearm preferably)

A

AV fistula

21
Q

(T/F) - Cuffed and tunneled venous catheter can be used for permanent use in hemodialysis

A

False - cannot be used permanently for HD

22
Q

Which vascular access uses synthetic material to correct artery and vein?

A

AV graft

23
Q

(T/F) - AV graft heals after each stick

A

False- AV fistula is the only vascular access that heals after each stick

24
Q

(T/F) - AV fistula creates a strong/high blood flow making the vein bigger and thickens wall

A

True

25
Q

Which vascular access can be used for emergent use in hemodialysis?

A

ONLY cuffed or tunneled venous catheter

26
Q

(T/F) - Cuffed or tunneled venous catheter is placed in the subclavian or internal jugular vein

A

True

27
Q

What component in hemodialysis is considered the semipermeable membrane?

A

Dialysate

28
Q

What are the types of semipermeable membrane that can be used in hemodialysis?

A
  1. Low-flux

2. High-flux

29
Q

(T/F) - High flux has larger pores but has limited solute clearance (< 500 daltons)

A

False - Low flux has limited solute clearance (<500 daltons) BUT high flux does have larger pores

30
Q

(T/F) - High flux can remove more and larger solutes such as drugs and shortens the time for dialysis

A

True

31
Q

(T/F) - Low flux is more commonly used for hemodialysis

A

False - high flux is more commonly used

32
Q

During hemodialysis, what is the concentration gradient between blood and dialysate?

A

Passive diffusion

33
Q

What does the rate depend on? (HINT: 4 things)

A
  1. Concentration gradient
  2. Solute characteristics
  3. Dialyzer composition
  4. Flow rates (blood and dialysate)
34
Q

(T/F) - Hemodialysis can control the flow rate

A

True

35
Q

What kind of process is ultrafiltration/convection?

A

Active process (primarily removes fluid)

36
Q

(T/F) - Ultrafiltration moves fluid across the membrane by hydrostatic/osmotic pressure

A

True

37
Q

Define convection

A

Dissolved solutes are “dragged” across the membrane w/ water

38
Q

What are some complications of hemodialysis?

A
  1. Infection
    - AV fistula, AV graft, cuffed/tunneled venous catheters
  2. Hypotension
  3. Muscle cramps
  4. Thrombosis
39
Q

What are the steps in peritoneal dialysis? (HINT: 7 steps)

A
  1. Patient connects the dialysate bag to the dialysate catheter
  2. Dialysate enters the peritoneal cavity
  3. Patient disconnects dialysate bag from catheter
  4. Dialysate dwells in peritoneal cavity for 4-6 hours
  5. Patient connects dialysate catheter to the empty bag
  6. Ultrafiltrate/dialysate is removed via gravity into empty bag
  7. Process is repeated continuosly throughout the day
40
Q

(T/F) - Peritoneal cavity can change flow rates

A

Fales - only hemodialysis can change flow rates

41
Q

What does the dialysate consist of in peritoneal dialysis?

A
  1. Electrolytes

2. Osmotic gradients

42
Q

In peritoneal dialysis, what induces ultrafiltration by crystalline osmosis?

A

Dextrose in hyperosmolar concentrations

43
Q

What are the types of peritoneal dialysis that are commonly used?

A
  1. Continuous ambulatory peritoneal dialysis (CAPD)

2. Automated peritoneal dialysis (APD)

44
Q

(T/F) - Peritoneal dialysis does not make intimate contact with blood and dialysate

A

True

45
Q

(T/F) - Peritoneal dialysis is a faster process than hemodialysis

A

False - HD is faster than PD

46
Q

(T/F) - Peritoneal dialysis does not have a countercurrent flow

A

True

47
Q

What are some complications of peritoneal dialysis?

A
  1. Catheter obstruction or kinking (mechanical issues)
  2. Exacerbation of DM
  3. Catheter infection
  4. Peritonitis

Renal (4 decks)

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