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Perf Tech Final > Topic 14 > Flashcards

Topic 14 Flashcards

1
Q

Hemoconcentration=

A

an increase in the number of red blood cells resulting from a decrease in plasma volume.
–Increases Hct

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2
Q

Conventional Ultrafiltration (CUF)=

A

a technique that removes plasma water and low molecular weight solutes by a convective process using HYDROSTATIC PRESSURE forces across a semipermeable membrane

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3
Q

Zero Balance Ultrafiltration (ZBUF)=

A

technique utilizing an hemoconcentrator to maintain a controlled EQUALIZED INPUT and OUTPUT
–IN = OUT

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4
Q

Slow Continuous Ultrafiltration (SCUF)=

A

a technique utilizing a slow, steady ultrafiltration during the CPB pump run

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5
Q

Modified Ultrafiltration (MUF)=

A

ultrafiltration occurring AFTER THE SEPARATION FROM CPB

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6
Q

how is Ultrafiltration achieved?

A

(using a hemoconcentrator) in the CPB circuit and allows the filtration of body water across a semi-permeable membrane utilizing a hydrostatic pressure gradient

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7
Q

Hollow Fiber Hemoconcentrators:
Blood flow path is ____ the fibers
Effluent path is ____ the fibers

A

Blood flow path is inside the fibers

Effluent path is outside the fibers

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8
Q

Hemoconcentration involves letting the pressure gradient “push” body water to the effluent side, can be used with or without a?

A

vacuum

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9
Q

Dialysis will use a dialysate solution on the _____ side to control precise solute excretion

A

effluent

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10
Q

HOW DO ULTRAFILTERS WORK?

A

diffusion
–Exchange of things dissolved in fluid (solutes) across a membrane due to differences in amount of the solutes on the two sides (concentration gradient)

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11
Q

If a higher concentration of a given solute is on one side, then diffusion will try to do what?

A

make the concentrations across the membrane the same

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12
Q

fluid flow through the membrane, forced by a difference in _____ on two sides of the membrane

A

pressure

–referred to as convection

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13
Q

Osmosis=

A

the NET MOVEMENT OF WATER across a selectively permeable membrane

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14
Q

Osmosis is driven by what?

A

a difference in the amounts of solute on the two sides of the membrane.

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15
Q

In dialysis, this refers not to water movement across the hemodialyzer membrane, but across…

A

cell membranes

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16
Q

Achieving filtration across a membrane requires what 2 things?

A

blood flow and hydrostatic (pressure gradient)

–Pressure /flow and resistance is key

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17
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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18
Q

The rate of solute removal through the membrane depends on what?

A

the flow rate and transmembrane pressure (TMP)

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19
Q

A dalton quanitates mass, defined as 1/12 the mass of a carbon-12 nucleus. It’s also called the atomic mass unit, abbreviated as either “amu” or “u”. You can convert kg into u using this conversion factor:

A

1 u = 1.6605655(86) × 10-27 kg

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20
Q

Removing body water will allow an elevation in the Hct without doing what?

A

transfusion

–This is what you can do when you have extra volume in your reservoir

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21
Q

Sieving Coefficient=

A

Ratio of blood solute concentration to plasma concentration. Ranges from 0 to 1.0

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22
Q

Sieving Coefficient of 1=

A

the solute concentrations equilibrate on both sides of the membrane

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23
Q

Sieving Coefficient of 0=

A

no solute passed the membrane (large molecular weight/size)

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24
Q

Sieving Coefficient of Ca++

A

0.55 (so it will dilute systemic calcium)

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25
Q

Sieving Coefficient of K+

A

1

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26
Q

Sieving Coefficient of Mg++

A

1

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27
Q

Sieving Coefficient of Aprotinin

A

1

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28
Q

Sieving Coefficient of Heparin

A

0.20 (so it will decrease your ACT)

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29
Q

Sieving Coefficient of furosemide

A

0.05

30
Q

Sieving Coefficient of digoxin

A

0.75

31
Q

how do you find net pressure gradient of membrane

A

add positive and negative pressures

32
Q

what does pink effluent mean

A

red cells are being lysed so decrease occlusion or vacuum pressure

33
Q

Diffusion in dialysis=

A

movement of solutes from a area in which they are in high concentration to one of a lower concentration – along an electrochemical gradient

34
Q

Diffusion in dialysis:
An electrolyte solution runs _____ to blood flowing on the other side of the membrane. Small molecules such as ___ move along the into the dialysate fluid. Larger molecules are ____ removed by this process. Solute removal is _____ proportional to the dialysate flow rate

A

countercurrent
urea
poorly
directly

35
Q

describe the process known as solvent drag

A

Convection / ultrafiltration – solute is carried (in solution) across a semipermeable membrane in response to a transmembrane pressure gradient

36
Q

Ultrafiltration: This is very effective in removal of ___ and ___, which are thought to cause ___. Moreover, most of the ____ involved in ____ are “middle molecules”

A

fluid and middle-sized molecules
uremia
cytokines
sepsis

37
Q

Transmembrane Pressure=

A

the pressure across the filter capillary tubes

38
Q

Pore Size=

A

the molecular weight cut off the filter is designed for (in Daltons)

39
Q

Transmembrane pressure is NOT

A

pressure drop

40
Q

transmembrane pressure (TMP)= [formula]

A

[ (Filter P(in) + Return P(out)) / 2] + Vacuum

*Treat vacuum as an absolute number (so just drop the negative sign and treat as a positive number)

41
Q

membrane surface area ranges

A

0.09-1.3m2

42
Q

max transmembrane pressure

A

500 mmHg

43
Q

what ultrafiltration method will improve potential for increasing adequate oxygen delivery to tissue (increases Hct)

A

Conventional Ultrafiltration (CUF)

44
Q

what ultrafiltration method will Draws in extravascular fluid

A 
Conventional Ultrafiltration (CUF)
--Your level in the venous reservoir will drop
45
Q

what ultrafiltration method has a Slow rate over longer time

A

Slow Continuous Ultrafiltration (SCUF)

46
Q

what ultrafiltration method may utilize the existing cannulas and allows concentration of the circuit contents to be hemoconcentrated (allows post-op reduction in total body water)

A

Modified Ultrafiltration (MUF)

47
Q

what ultrafiltration method is Considered a “standard of care” in pediatrics

A

Modified Ultrafiltration (MUF)

48
Q

PRACTICE DRAWING THE DIFFERENT CIRCUITS

A

NOW :)

49
Q

with ULTRAFILTRATION 3 main parameters are critical to monitor?

A

Flow
Pressure
Volume

50
Q

The blood flow through the ultrafilter should be monitored, it will be easier to control when?

A

a roller pump is used exclusively for the ultrafilter

51
Q

When the blood to the ultrafilter is removed directly from the arterial line, flow depends on the characteristics of the ultrafilter and may be reduced by doing what?

A

partially clamping the inlet

52
Q

The mean pressure on the inside of the fibers depends on what?

A

the pressure drop through the ultrafilter.

53
Q

We can vary the TMP by varying what?

A

the negative pressure applied. In general, negative pressures (vacuum) of 100 to 200 mmHg may be applied

54
Q

The effluent flow can be augmented by regulating what?

A

the vacuum source

55
Q

More vacuum equals what?

A

more H2O removal

56
Q

increased resistance (clamping) with increase effluent flow- this relationship is _____ proportional

A

directly

57
Q

greater ultrafiltration can be achieved by what 3 things?

A
  1. increasing the TMP
  2. partially clamping the outlet line of the ultrafilter
  3. increasing in vacuum applied to the external surface of the membranes
58
Q

CPB causes increased capillary permeability, including the systemic inflammatory reaction–>Capillary permeability increases total body water–>This increase of the extravascular fluid affects the functions of what?

A

the major organs

59
Q

ultrafiltration effects on the lungs=

A

Pulmonary edema may reduce the efficiency of gas exchange and pulmonary complacency

60
Q

ultrafiltration effects on the heart=

A

Myocardial edema may affect ventricular function making (diastolic filling difficult and reducing the efficiency of systole)

61
Q

ultrafiltration effects on the brain=

A

Cerebral edema may have serious consequences

62
Q

ultrafiltration effects on the kidney=

A

Renal function may also be impaired and the renal immaturity may make elimination of liquids more difficult

63
Q

The most severe systemic inflammatory response may manifest as what?

A

multiple system organ failure (MSOF)

64
Q

CPB activates the leucocytes and several proteic systems of the plasma. Activation results in the production of a large number of what 3 things?

A

cytokines, complement fractions and vasoactive substances

65
Q

The main pro-inflammatory cytokines are? (4)

A

tumor necrosis alpha factor
IL-1 beta
IL-6
IL-8

66
Q

The residues of the activation of complement system is the activation of what?

A

C3a and C5a
–These substances with the vascular endothelium and neutrophils produce a set of alterations that result in a systemic inflammatory reaction of the organism

67
Q

When you filter you are losing volume- so make sure to…

A

watch your level

68
Q

Pink effluent is often a result of what?

A

too high TMP

69
Q

Vacuum will increase effluent and increase hemolysis but…

A

more is not necessarily better

70
Q

Hemoconcentration is usually a SHUNT… so you need to

A

turn it off when the pump is off (compensate for it)

Perf Tech Final (2 decks)

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