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Flashcards in Dialysis - the practicalities Deck (28):
1

What are the two forms of dialysis performed?

Haemodialysis

Peritoneal dialysis

2

What is haemodialysis?

Countercurrent flow in dialysis machine

Blood moves from the patient to the dialysate

Small molecules move via convection/ diffusion out of the blood into the dialysing fluid

3

What is peritoneal dialysis?

Uses the peritoneal membrane as a semipermeable membrane across which diffusion occurs

4

What is the advantage of peritoneal dialysis as opposed to haemodialysis?

Can be done at home - patient retains independence

5

What is renal replacement therapy?

Umbrella term that includes different treatment options for kidney disease patients

Kidney transplant
Hemodialysis
Peritoneal dialysis

6

How many times a week does haemodialysis take place?

4 hours 3 times a week

7

What conditions do patients undertake when performing haemodialysis?

Restriction to fluid intake

Medication

Dietary restriction to sodium, potassium and phosphate

8

What infrastructures need to be set in place for dialysis patients to receive treatment?

Need somewhere to dialyse - hospital unit, satellite or a home


Transport - take patient between unit and home

Medical and nursing unit

9

What types of vascular access exist for dialysis to be performed on patients?

Temporary

Tunnelled haemodialysis lines

10

What does temporary vascular access entail?

Dialysis lines are inserted into the large veins of the neck and groin

Immediate access to patients' circulation in emergecy situation

11

What do tunnelled haemodialysis lines entail?

Line is tunnelled under the skin and emerges in chest wall

12

What are the advantages of tunneled haemodialysis lines?

Last longer - months to years

Infection rates are lower

13

What are complications of vascular access?

Infections - commonest

Dialysis line can become infected and spread to the bloodstream

Venous stenosis and thrombosis

14

What complications arise from fistulas?

Can be unsightly

Can infect

Form high cardiac output or vascular steal if overdeveloped, thrombosed or stenosed

15

What is a fistula?

Form from operations to join artery and vein

Anastomoses forms between artery and vein

Blood from the artery goes straight into the vein

Vein increases in size/ becomes arterialised

16

What is the point of Fistula formation?

Makes it possible to put needles into enlarged veins

Blood can be taken out of the body

Sent through to the dialysis machine

Blood is returned through dialysis machine

17

Complications of haemodialysis

Acute - hyperkalaemia

Fluid overload - peripheral oedema and fluid accumulation in the lungs

Tertiary hyperthyroidism - many years to develop

18

What causes the quality of life to diminish in haemodialysis patients?

Fluid and diet restrictions

Medications

Delays in transportation to and from the hospital

Dialysis - takes 4 hours a week

19

What is home haemodialysis?

Compact, small and easy to use dialysis units

Used in group of carefully selected patients

Gives greater autonomy for motivated patients

20

What is peritoneal dialysis?

Uses the peritoneum in the abdomen as a membrane across which fluids and dissolved substances are exchanged from the blood

21

How does peritoneal dialysis work?

Fluid is introduced through a permanent tube in the abdomen and flushed out

22

What are the two types of peritoneal dialysis that exist?

Continuous ambulatory peritoneal dialysis

Automated peritoneal dialysis

23

What are the characteristics of continuous ambulatory peritoneal dialysis?

1. Tunneled catheter into the abdomen

2. Dialysate fluids are drained into the abdomen via the peritoneal catheter by gravity

3. Fluid is retained in the peritoneal cavity for around 4 hours = dwell time

4. At the end - dialysate fluid is drained out via catheter and takes wastes from the body with it

24

How many exchanges of dialysis fluid a day in continuous ambulatory peritoneal dialysis?

4 exchanges a day

25

What are the advantages of continuous ambulatory peritoneal dialysis?

Can be done at home - patient remains independent

26

What are the advantages of automated peritoneal dialysis?

Portable

Makes patients free and independent during the day

The peritoneal waste removal happens during the night

Day time = dwell time

27

Complications of peritoneal dialysis

Infections - most common

Mechanical - catheter malposition, hernias or leaks

Constipation

Air under diaphragm

Peritoneal membrane failure

28

What is the infection of the peritoneal space called?

Peritonitis