Dialysis Flashcards

1
Q

all patients with CKD will end up with ESKD without treatment T or F

A

F, most will probably die before then

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2
Q

name the 3 concepts of dialysis

A

diffusion
convection
adsorption

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3
Q

why is diffusion used in dialysis?

A

allows toxins that build up to exit the blood eg urea, K+, Na+

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4
Q

what do you want to infuse in dialysis and why?

A

bicarb to fix metabolic acidosis

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5
Q

what substances do you want to remove in dialysis?

A

K
urea
Na
creatinine

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6
Q

what does a dialysis machine try to imitate?

A

a functional kidney

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7
Q

how much Na do you want to remove and why?

A

not much as dont want lots of salt and water to leave

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8
Q

what is ultrafiltration?

A

solutes moving with water across a semi-permeable membrane in response to a pressure gradient

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9
Q

what happens in a high flux membrane?

A

pores get bigger to allow bigger substances eg protein bound solutes in

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10
Q

a high flux membrane is present at what stage of dialysis?

A

adsorption

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11
Q

plasma protein movement across the membrane is principally achieved in what stage of dialysis?

A

adsorption

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12
Q

what is a convective solute drag?

A

dissolved solutes in water will move with it in response to pressure

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13
Q

dialysis only has access to the ___ of the body

A

circulation

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14
Q

haemodialysis is primarily a __ process

A

diffusive

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15
Q

haemodiafiltration is primarily a __ process

A

convective

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16
Q

haemodiafiltration relies on what process?

A

convective solute drag

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17
Q

what affects how well a substance is transported across the membrane in HDF?

A
water flux
membrane pore size (big/small holes)
pressure difference
viscosity
size, shape and charge of molecule
18
Q

minimum dialysis time per week?

A

4hrs 3 times per week

19
Q

what dietary changes does a patient on dialysis have to make?

A

low salt diet
low potassium diet
if anuric can only drink 1l of water
low phosphate diet

20
Q

gold standard method of accessing the circulation for dialysis?

A

fistula

21
Q

what is a fistula?

A

joining and artery and a vein to make an enlarged vessel - the arteriovenous fistula (AVF)

22
Q

most common vessels chosen for a fistula?

A

brachial artery and cephalic vein

23
Q

what was the original form of circulatory access for dialysis?

A

scribner shunt

24
Q

complications of an arteriovenous fistula?

A

steal syndrome - ischaemia of the hand

25
Q

what dialysis circulatory access is used for late presenting patients?

A

tunnelled venous catheter

26
Q

what circulatory dialysis access method puts the patient at highest risk of infection?

A

tunnelled venous catheter

27
Q

what vein is the tunnelled venous catheter inserted into?

A

jugular or subclavian vein

28
Q

untreated tunnelled venous catheter infection can lead to what problems?

A

endocarditis
discitis
death

29
Q

what organism is most likely to cause a tunnel venous catheter infection?

A

staph aureus or other gram +ves

30
Q

Tx of a tunnelled venous catheter infection?

A

vancomycin +/- gentamicin

31
Q

main complications of dialysis?

A
hypotension
blood leaks from fistulae
loss of vascular access
hyperkalaemia
cardiac arrest
32
Q

what causes hypotension in dialysis patients?

A

myocardial stunning from dialysis

losing large volumes of water

33
Q

how is solute removed in peritoneal dialysis?

A

diffusion

34
Q

how is water removes in peritoneal dialysis?

A

osmosis

35
Q

what drives the water out in peritoneal dialysis?

A

the high glucose conc in dialysate fluid

36
Q

does glucose move in or out of the peritoneal cavity in peritoneal dialysis?

A

in

37
Q

standard prescription of continual peritoneal dialysis?

A

4 2l bag exchanges per day

38
Q

how is automated peritoneal dialysis different from continual?

A

only 1 bag is used rather than 4

39
Q

main complications of peritoneal dialysis?

A

infection
peritoneal membrane failure
hernias (inc abdo pressure)

40
Q

what investigation should you do for a peritonitis caused by dialysis?

A

culture peritoneal dialysate fluid

41
Q

how long should the first HD session be? what should this build up to

A

2hrs

build up to 4hrs

42
Q

what medical conditions should prompt withdrawal from dialysis?

A

PVD
stroke
CVD
cancer