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What is dialysis?
removal of fluid and uremic waste products from the body when kidneys fail.
What are other uses for dialysis?
pts unresponsive to med therapies or toxin overdoses
What types of dialysis are there?
2) CRRT (Continuous Renal Replacement Therapy)
3) Peritoneal Dialysis
4) Indications for dialysis
What are the two general principals of dialysis?
Diffusion and Osmosis
Movement of solutes across semi-permeable membrane from an area of higher to lower concentration
Movement of water across a semi-permeable membrance from area of low solute to higher solute concentration
Facts about hemodialysis
-Most common form of dialysis
-Short term cases
-Acute cases (ARF, Poisening)
-Long term maintenance (ESRD)
-Out-pt hospital based, satelite center or can be done in the home.
-Adults and children
How does hemodialysis work?
Blood is separated from a dialysis solution (dialysate) by a semi-permeable membrane
What are the essential components for hemodyalysis?
1)dialyzer or "artificial kidney"
2)dialysate or "bath"-maintains body's buffer system. (bicarbonate or acetate)
3)vascular access
4)Dialysis Machine
What types of vascular access are there?
Temporary and permanent
Where are temporary access locations, how long can they be used and what are their risks?
Locations: subclavian, internal jugular, femoral artery, DOUBLE lumen catheter.
-Can be used for several weeks.
-Rosks from insertion-hematoma, pneumothorax, infection, thrombosis
What are permanent types of vascular access for hemodialysis?
1)Arteriovenous fistula (AV fistula)
2)Arteriovenous graft (AV graft)
Arteriovenous fistula (AV fistula)
1) Created by anastomosis of artery and a vein (usually forearm)
2) Takes 4-6 weeks to mature before use
Arteriovenous graft (AV graft)
1) synthetic or biologic graft created subcutaneously between artery/vein (Usually forearm, upper arm or upper thigh)
2) risk infection and thrombosis
Hemodialysis Process
1) Blood continuously removed at a rate of 200 to 800 ml/min and flows though dialysate solution
2)diffusion, osmosis, ultra filtration
3)Blood is heparinized as it leaves pt to prevent clotting in dialyzer
4)tx 3x weekly for 3-4 hours
Possible complications during hemodialysis treatment.
dialysis disequilibrium syndrome, hypotension, muscle cramping, blood loss, dysrhythmias, chest pain, air embolism, HA, malaise
dialysis disequilibrium syndrome
Dialysis disequilibrium syndrome (DDS) is a central nervous system disorder, which occurs during hemodialysis (HD) or within 24 h following the first HD. DDS commonly occurs in patients suffering from end-stage renal failure undergoing HD for the first time. In a critically ill patient suffering from severe sepsis or septic shock, the combined effects of post-HD brain edema and changes in the brain due to septic encephalopathy, may become amplified leading to DDS
What are complications of hemodialysis treatment?
-Ischemia-steal syndrome
-infection/infectious disease
-Thrombosis/stenosis/aneurysm formation
-High output heart failure
-Altered Calcium Metabolism
-Depression, Anemia, Fatigue
-Major sleeping issues
Medication use
-All drugs need to be evaluated (dose, frequency, toxic levels)
-May need to hold anti-hypertensives day of dialysis to avoid hypotension
Fluid and dietary restrictions
1)Protein (1 g/kg day),
2)Na+ (2 to 3 g/day),
3)K+ (2.5g/day)
4)Fluids = previous 24 hour output + 500 cc
5) goal to keep weight
hemodialysis psychosocial needs
-provide opportunities to express feelings, concerns, fears
-refer to counseling or support groups
-assist to identify effective coping strategies to use
Hemodialysis patient / family education
-keep breif (10-15 min sessions
-team conferences
-keep open communication
What are the 5 Es to renal rehab?
What are the different types of Continuous Renal Replacement Therapies?
1)CAVH-Continuous arteriovenous hemofiltration
2)CAVHD-Continuous arteriovenous henodialysis
3)CVVHD-Continuous Venovenous Hemodialysis
4)CVVH-Continuous venovenous hemofiltration
When and where is continuous renal replacement therapies used?
-Used in critical care units
-dialysis staff work with nurses to maintain
-indicated for pts with acute or chronic failure clinically unstable for standard hemodialysis
what is the goal of PERITONEAL DIALYSIS?
Goal of PD is to remove waste products and re-establish normal fluid and electrolyte balances
Peritoneal Dialysis is LESS EFFICIENT than hemodialysis so why would it be used?
-PT preference
-hemodyalisis is not an option
How does Peritoneal dialysis work?
1)Peritoneum is the semi-permeable membrane
2)Sterile dialysis solution instilled through a catheter into peritoneal cavity
3)Diffusion and Osmosis Occurs between periotoneal blood vessels and dialysis solution
4)Dextrose, heparin, insulin, ATB, K+, may be added to the dialysis solution
5)Concentration of dextrose varies dependingon volume of fluid to be infused.
Essential components of Peritoneal Dialysis
1) Peritoneum
2) Peritoneal Catheter
3) Dialysis Solution
Facts about dialysis solution
*Warm to body temperature but never use a microwave
*often medication is added (KCL, insulin, heparin, ATB)
*instilled and drained by gravity
*machine or cycler can be used to regulate
What is the PD Process?
*involves a number of exchanges or cycles
*Infusion of dialysis solution usually 2 L
*Dwell time in peritoneal cavity
*Drain time (10-30 min)
What types of peritoneal dialysis regimens are there?
1)Acute, Intermittent
2)Continuous ambulatory (CAPD)
3)Continuous cyclic (CCPD)
Acute, Intermittent PD
10 Min Infusion, 30 min dwell, 20 min drain time-done on unstable pts
Continuous Ambulatory (CAPD)
24 Hours 7 days per week with 4-5 exchanges per 24 hours at intervals (before meals and HS)
Continuous Cyclic (CCPD)
*3-5 exchanges of 2L at night using a cycler
*One exchange am (without cycler), dwell time all day when reattached to cycler HS
Possible complications of Peritoneal Dialysis?
-Peritonitis (cloudy dialysate drainage, ABD pain with rebound tenderness progressing to hypotension, shock)
-Pain -Infection-site, tunnel -leakage around catheter -bleeding -hernias -perforations
Nursing managment of PD
-VS -Protect dialysis access -Precaustion with IV fluids -monitor for worsening anemia -detect cardiac and lung problems prevent infection -care of PD catheter
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