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HANA Part 4 – PM4B > (SYNOPTIC) Dialysis + Drugs > Flashcards

(SYNOPTIC) Dialysis + Drugs Flashcards

1
Q

What types of dialysis are there?

A

(1) Haemodialysis - HD
(2) Haemofiltration - HF
(3) Haemodiafiltration - HDF
(4) Peritoneal dialysis - PD

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2
Q

What is dialysate?

A

The filtered liquid in dialysis

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3
Q

What is haemodialysis?

A

Patient is connected to a haemodialysis machine to create a circuit

Thousands of hollow synthetic fibres

Dialysate flows in opposite direction of blood

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4
Q

What is haemofiltration?

A

Blood pumped through dialyser

Negative pressure applied to the dialysate, causing solutes to move across a pressure gradient

More aggressive than haemodialysis

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5
Q

What is haemodiafiltration?

A

Combination of haemodialysis and haemofiltration

Removes the middle molecular weight

Increases clearance of larger toxins

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6
Q

How can access to a patient’s blood be achieved in dialysis?

A

(1) Arteriovenous fistula
(2) Arteriovenous graft
(3) Central venous catheter (CVC)

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7
Q

What is an arteriovenous fistula?

A

Surgeon connects an artery to a vein

- usually in your arm

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8
Q

Which dialysis blood access method is the best for long term?

A

Arteriovenous fistula

  • provides highest blood flow for dialysis
  • less likely to become infected/ clot
  • lasts longer
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9
Q

What is an arteriovenous graft?

A

Usually inserted if a patient’s veins are not suitable for a fistula

Strong artificial tube inserted by a surgeon underneath the skin

One end connects to an artery, one to a vein

Needs 2-4 weeks to mature

Prone to infection and blood clots

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10
Q

What is a central venous catheter (CVC)?

A

Pair of hollow tubes called catheters/ lines

Catheter is placed into the jugular vein in the neck
- ends of the tubes are left on the outside

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11
Q

How is the jugular vein found for insertion in CVC?

A

Ultrasound is used on the neck

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12
Q

What is a Tesio?

A

Branded name given to CVC tubes left in the neck

Used in dialysis

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13
Q

What timeframe are most Tesios used for?

A

Short term

Emergency use or bridging (waiting for AV graft/ fistula)

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14
Q

What are the two main ways patients can receive dialysis?

A

(1) Home dialysis

(2) Conventional dialysis

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15
Q

How often is conventional dialysis done?

A

3 times per week

3-4 hours for each treatment

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16
Q

What rate is blood drawn out through a tube in conventional dialysis?

A

200-400mL/min

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17
Q

What are some advantages of conventional dialysis?

A
  • Efficient
  • Improves compliance
  • Allows professionals to manage complications more efficiently
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18
Q

What are some disadvantages of conventional dialysis?

A
  • Strict diet/ fluid restrictions
  • Aggressive strategy can cause drop in BP
  • Aggressive strategy can cause muscle cramps (+pain, from fluid removal)
  • 3x a week is limiting on freedom
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19
Q

What are some benefits of home dialysis?

A

Flexible schedule

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20
Q

What is the standard schedule for home dialysis?

A

3x per week OR every other day 3-5hrs

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21
Q

What is the daily schedule for home dialysis?

A

5-7 days per weak for 2-4hrs

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22
Q

What is the nightly schedule for home dialysis?

A

3-6 times per week

While you sleep

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23
Q

What are some advantages of home dialysis?

A
  • Aids flexibility, improves quality of life
  • Daily/ nocturnal dialysis is less aggressive (less muscle cramps/ hypertension)
  • Allows a more normal diet
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24
Q

What are some disadvantages of home dialysis?

A
  • Increased risk of infections, if poor aseptic technique
  • Delayed access to healthcare staff if there are issues
  • Risk of poor compliance
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25
Q

What is peritoneal dialysis?

A

Form of dialysis that occurs in the body

Sterile dialysate is pumped in through catheter

Catheter is surgically placed into the abdomen

Peritoneal membrane acts as a filter

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26
Q

Why is a filter not needed in peritoneal dialysis?

A

Peritoneal membrane acts as a natural filter

27
Q

How does dialysate function in peritoneal dialysis?

A

Contains glucose

Creates an osmotic gradient

Removes excess waste and water

28
Q

What are the types of peritoneal dialysis?

A

(1) Continuous Ambulatory Peritoneal Dialysis (CAPD)

2) Ambulatory peritoneal dialysis (APD

29
Q

What is continuous ambulatory peritoneal dialysis?

A

Continuous + machine free

Bag containing the dialysate is attached to the catheter in the abdomen

Waste is then drained into a waste bag

Done 3-5 times a day

30
Q

How does the dialysate enter the abdominal cavity in CAPD?

A

via gravity

From the bag

31
Q

How often is CAPD done?

A

3-5 times a day

32
Q

When do patients using CAPD tend to time their dialysis for?

A

During meal times + bedtime

33
Q

What does CAPD stand for, with regard to kidney failure?

A

Continuous ambulatory peritoneal dialysis

34
Q

What does APD stand for?

A

Ambulatory peritoneal dialysis

35
Q

What is ambulatory peritoneal dialysis?

A

Similar to CAPD, but a machine is used to control the exchange of fluid

36
Q

When is APD done?

A

Attached before going to sleep

37
Q

How long is a patient using APD attached for?

A

8-10 hours

38
Q

What are some advantages of peritoneal dialysis?

A
  • Patient-centred
  • Increased flexibility
  • Less diet restriction
  • Fewer side effects
  • Most similar to kidneys
  • Can be done at night (APD)
  • Skilled HCP only required for initial training
39
Q

What are some disadvantages of peritoneal dialysis?

A
  • 4 exchanges a day
  • Permanent external catheter
  • Risk of infection
  • Tied to machine at night (APD)
  • Requires a self-motivated and competent patient
  • Not as efficient as HD
  • Greater loss of albumin
40
Q

Which type of dialysis has a greater loss of albumin?

A

Peritoneal dialysis

is a protein found in blood plasma that is produced by the liver

maintain the oncotic pressure in the blood vessels

plays a role in regulating the pH of the blood and in binding and transporting certain ions, such as calcium and magnesium. It is also involved in the immune response, as it can bind to and transport certain antibodies in the blood.

levels can be seen by blood test

41
Q

What are some complications of peritoneal dialysis?

A

(1) Increased risk of infections within the peritoneum
(2) Developing diabetes (usually occurs due to high dialysate concentration of glucose) This occurs due to the glucose in the dialysate (the fluid used in peritoneal dialysis) being absorbed into the bloodstream and increasing blood glucose levels. Over time, this can contribute to the development of diabetes.
(3) Sclerosing peritonitis: inflammation and scarring of peritoneum membrane

42
Q

What is sclerosing peritonitis?

A

Thickening of peritoneum

Leads to partial/ complete small bowel obstruction

43
Q

What type of dialysis leads to an increased risk of developing diabetes? Why?

A

(1) Peritoneal dialysis

(2) Dialysate has a high concentration of glucose

44
Q

What are two hormones excreted by the kidneys?

A

(1) EPO - erythropoietin

(2) Renin

45
Q

What are the two aims of dialysis?

A

(1) Removal of waste

(2) Removal of fluid

46
Q

What is a dialyser?

A

Filtration tube used in dialysis

Comprising hollow fibres

47
Q

What is an essential nutrient in the dialysate used in haemodialysis?

A

Sodium bicarbonate

48
Q

What is a more aggressive form of dialysis, haemofiltration or haemodialysis?

A

Haemofiltration

49
Q

Which type of dialysis improves clearance of larger toxins?

A

Haemodiafiltration

50
Q

How does an arteriovenous fistula work?

A

Connect an artery to a vein by a surgeon

To thicken the walls of the vein over time, so that it can withstand dialysis

51
Q

How long does an arteriovenous graft take to mature?

A

2-4 weeks

52
Q

When does a CVC tend to be used in dialysis?

A

Short term for:

  • Emergency
  • Bridging (waiting for AV graft/ fistula)
53
Q

Why does the dialysate of peritoneal dialysis contain glucose?

A

To create an osmotic gradient

To remove excess waste + water

54
Q

What is a Tenchkoff catheter?

A

Catheter surgically inserted into the abdomen

In peritoneal dialysis

55
Q

What type of dialysis does not require a machine?

A

Continued ambulatory peritoneal dialysis

Uses gravity

56
Q

How many exchanges per day are required for peritoneal dialysis?

A

4

57
Q

What is peritonitis?

A

Infection of the peritoneum

58
Q

What is the treatment of peritonitis?

A

IV Abx

Hospital admission

59
Q

Why are patients on peritoneal dialysis at a higher risk of diabetes development?

A

High glucose concentration of dialysate

60
Q

Which type of dialysis is not suitable for diabetic patients?

A

Peritoneal dialysis

Due to high concentration of glucose in the dialysate

61
Q

What is a good source to find out if a drug is dialysed or not?

A

Renal Drug Database

62
Q

What factors are important to consider when deciding if a drug is dialysed or not?

A

(1) Type of dialysis

(2) Molecular weight of drug
- high = unlikely
- low = more likely

(3) Hydro/lipophilic
(4) Level of protein binding
(5) Is the drug renally cleared?

(6) Active/ toxic metabolites
- time metabolism of drug into metabolites so that toxic metabolites are removed by dialysis

(7) Therapeutic index of the drug?
- ideally wide

(8) OD vs multi-dose
- adjust around dialysis sessions

63
Q

Is a drug that is highly protein bound likely to be dialysed?

A

No

Proteins are too large to be dialysed

64
Q

Are drugs that are highly renally cleared likely to be removed by dialysis?

A

Yes

HANA Part 4 – PM4B (28 decks)

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