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Saaliha 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

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)
(3) Sclerosing peritonitis

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

Saaliha Part 4 – PM4B (73 decks)

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