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Perf tech II > Test 3 > Flashcards

Test 3 Flashcards

1
Q

what is Conventional ultrafiltration (CUF)

A

-a technique that removes plasma water and low molecular weight solutes by a convective process using
transmembrane pressure gradient across a semipermeable membrane
-lvl in reservoir will drop

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2
Q

hemoconcentration is

A

-an increase in the number of red blood cells resulting from a decrease in plasma
volume
-blood cannot cross the membrane so this is why it just pulls the water molecules and not the RBC

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3
Q

Advantages of

Ultrafiltration/ Hemoconcentration

A
  • Increased protein and red cell concentration
  • Removal of inflammatory mediators
  • Decreased lung waters
  • Improved perioperative hemostasis
  • Reduced postoperative ventilatory support
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4
Q

how are Hemoconcentrator Designed

A

-hollow fiber made up of plastic polymer that doesn’t activate compliment

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5
Q

Ultrafiltration/Hemoconcentration flows

A
  • Blood flow through the fibers (180-200 um in diameter) creates a positive pressure within in the fibers
  • Pressure differential between blood side and atmospheric pressure on the ultrafiltrate side of membrane drives water across the membrane
  • Microporous membrane – 5-10 um
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6
Q

hollow fiber hemocon

A
  • Blood flow path is inside the fibers
  • Effluent path is outside the fibers
  • Hemoconcentration involves letting the pressure gradient “push” body water to the effluent side (can be used with or without vacuum)
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7
Q

Ultrafiltration (change in pressure)

A

•Referred to as convection, is fluid flow through the membrane, forced by a difference in pressure on two sides of the membrane

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8
Q

Diffusion (change in concentration)

A

• If a higher concentration of a given solute is on one side, then diffusion will try to make the concentrations across the membrane the same.

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9
Q

Achieving filtration across a membrane requires

A

-blood flow and a pressure gradient

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10
Q

The ability of a solute to be filtered through the membrane depends on what

A

-the molecular weight compared to the pore size of the filter (sieving coefficient)

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11
Q

The rate of solute removal through the membrane depends on what

A

-flow rate and transmembrane pressure(TMP)

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12
Q

Transmembrane Pressure (TMP)

A

• Pressure gradient between blood path and ultrafiltrate compartment
-TMP = (Pin –Pout)/2 + |negative pressure applied to effluent side|
• TMP should not exceed 500 – 600 mmHg

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13
Q

Ultrafiltration Coefficient (Kuf)

A

•KUF relates the volume removed to pressure applied

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14
Q

Rate of fluid removal depends on

A

membrane permeability, blood flow, TMP, and hematocrit

•Typical rates are between 2 and 50 ml/hr/mmHg

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15
Q

increase BF and/or TMP does what to rate of fluid removal

A

increase

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16
Q

decrease in Hct and/or plasma proteins does what to rate of fluid removal

A

increase

17
Q

what is Sieving Coefficient and its range

A
  • Represents ease with which a given solute will travel across hemoconcentrator membrane
  • Ranges from 0 to 1.0
  • A coefficient of 1 means solute will pass the membrane
  • A coefficient of 0 means solute will not pass the membrane
18
Q

will albumin or bilirubin cross the membrane

A

no

19
Q

Zero-Balanced Ultrafiltration (Z-BUF)

A
  • Technique that utilizes a hemoconcentrator to maintain controlled EQUALIZED input and output over the CPB pump run
  • Ultrafiltrate volume is replaced by an equal amount of a balanced electrolyte solution
20
Q

reason for using z-buf

A
  • Used to reduce cytokines and complement levels

* Inflammatory markers peak at rewarming so z-buf during rewarming phase

21
Q

z-buf used to treat

A

-hyperkalemia
•Need a solution that contains no potassium
•Need to add bicarb
•Monitor sodium levels to avoid hypernatremia

22
Q

Modified Ultrafiltration (MUF)

A

• This technique may utilizes the existing cannulas and allows hemoconcentration of the residual circuit contents and then transfused back to patient
• Occurs following termination of CPB
-peds

23
Q

Where Can Ultrafilters Go?

A
  • Oxygenator recirculation line

* Cardioplegia circuit

24
Q

using untrafiltration Post-CPB Pump Blood

A
  • Residual pump blood is hemoconcentrated
  • Put in bag
  • Transfused to patient via the arterial cannula
  • Accomplished by creating a small recirculating circuit through the hemoconcentrator
25
Q

Parameters to Think About While Ultrafiltrating

A
  • Flow
  • Pressure
  • Volume
26
Q

Things To Be Wary Of while hemoconcetrating

A

• When you hemoconcentrate you are losing volume – watch your level
• Pink effluent is often a result of too high TMP
• Vacuum will increase effluent removal and can increase hemolysis – more is not necessarily better
•Hemoconcentrator is a shunt – it must be off if the
pump is off (compensate for it)

27
Q

what is dialysis

A
  • Removal of diffusible solutes based on the principles of a concentration gradient and solute drag established by dialysate solution (countercurrent flow)
  • Uses a semipermeable membrane for selected diffusion
  • Concentration gradient is established by using a dialysate solution
28
Q

Dialysate Solution

A
  • Contains chemicals in concentration similar to blood

* A mixture of purified water and measured electrolytes which flows countercurrent

29
Q

What is the Purpose of Dialysis?

A
  • Treat renal failure
  • Remove waste products from blood
  • Return blood chemistry to normal values
30
Q

acute renal failure

A

-sudden loss of kidney function caused by injury (CPB)

31
Q

What is renal failure

A
  • A decrease in glomerular filtration rate (GFR)
  • GFR- how well your kidneys are filtering
  • Typically detected by an ELEVATED serum BUN (10-20 mg/dL) and creatinine (<1.5 mg/dL) level
32
Q

Normal glomular filtration rate

A

90 and above

33
Q

Dialysis access

A
  • Arteriovenous (AV) fistula – connection of an artery to a vein
  • Used to remove and return blood during hemodialysis

Perf tech II (16 decks)

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