Term
|
Definition
•Removal of soluble substances and water from the blood by diffusion through a semi-permeable membrane.
|
|
|
Term
|
Definition
•Blood removed from patient into the extracorporeal circuit.
•Diffusion and ultrafiltration take place in the dialyzer.
•Cleaned blood returned to patient.
|
|
|
Term
| blood pump during hemodialysis |
|
Definition
| during dialysis, the blood pump acts like the human heart, pushing blood through the lines (vessels), the dialyzer, or artificial kidney, cleans the blood which is then returned to the patients own circulation |
|
|
Term
| vascular access for dialysis |
|
Definition
•Arterio-venous shunt
•Arterio-venous (AV) Fistula
•PTFE Graft
•Temporary catheters-shiley port (sepis, infection risk)
|
|
|
Term
arterio venous (AV) fistula
-what is it?
-advantages (3) ad disadvantages (2) |
|
Definition
•Patients own artery and vein surgically anastomosed.
•Advantages
•patients own vein
•longevity
•low infection and thrombosis rates
•Disadvantages
•long time to mature, 1- 6 months
•requires needle sticks
|
|
|
Term
| PTFE (Polytetraflourethylene) Graft |
|
Definition
•Synthetic “vessel” anastomosed into an artery and vein.
•Advantages
•for people with inadequate vessels
•can be used in 7-14 days
•prominent vessels
•Disadvantages
•clots easily
•still requires needle sticks
•infection may necessitate removal of graft
•Infection can be a strep which can cause endocarditis
|
|
|
Term
| temporary catheters/shiley ports |
|
Definition
•Dual (double) lumen catheter placed into a central vein-subclavian, jugular or femoral.
•Advantages
•immediate use
•no further needle sticks
•Disadvantages
•high incidence of infection-line sepsis
•poor flow-inadequate dialysis
•clotting
|
|
|
Term
|
Definition
•No BP’s or needle sticks to arm with vascular access. This includes finger sticks.
•Palpate thrill and listen for bruit.
•Over the site of anastomosis.
•Teach patient nothing constrictive (tight clothes), feel for thrill.
|
|
|
Term
| complications of hemodialysis during dialysis |
|
Definition
•Fluid and electrolyte related
•Hypotension***
•Cardiovascular
•Arrhythmias-electrolyte imbalances-why it takes so long
•Associated with the extracorporeal circuit
•Exsanguination-patient could bleed out from machine
•Neurologic
•Seizures-DDS
|
|
|
Term
| disequilibrium syndrome (DDS) |
|
Definition
•Fluid removal and decrease in BUN during hemodialysis which cause changes in blood osmolarity.
•These changes trigger a fluid shift from the vascular compartment into the cells.
•In the brain, this can cause cerebral edema, resulting in increase intracranial pressure and visible signs of decreasing level of consciousness.
•Symptoms: Sudden onset of headache, nausea and vomiting, nervousness, muscle twitching, palpitation, disorientation and seizures.
•Treatment: Mannitol (osmotic diuretic) and hypertonic saline (3% 5%)-slow rate. Key is to prevent occurrence by dialyzing slowly.
•
|
|
|
Term
| complications of hemodialysis b/w treatments |
|
Definition
•Hypertension
•Hyperkalemia
•Edema
•Pulmonary edema
•Bleeding
•Clotting of venous access
patients can easily miss tx's if need to go 3x per week for rest of life
|
|
|
Term
| dietary restrictions of hemodialysis |
|
Definition
•Fluid restrictions (~1000ml/day)*****
•Phosphorous restrictions
•Potassium restrictions
•Sodium restrictions
•Protein to maintain nitrogen balance
•too high – increase in waste products (nitrogen)
•too low - decreased albumin, increased mortality
•Calories to maintain or reach ideal weight***
|
|
|
Term
|
Definition
•Removal of soluble substances and water from the blood by diffusion through a semi-permeable membrane that is intra-corporeal (inside the body).
•Continuous and intermittent
•Usually daily treatments, sometimes up to 4-5 times/day
•Solution remains in peritoneal cavity except when it is time to drain.
•Works by gravity, 12 hours every day
|
|
|
Term
| complications of peritoneal dialysis |
|
Definition
•Infection
•Peritonitis****washboard, firm abd, fever, near septic presentation
•Catheter exit site
•Hypervolemia/Hypovolemia
•Hypertension/hypotension
•Pulmonary edema
•Hyperglycemia
•Malnutrition (albumin)
•Hypokalemia
|
|
|
Term
| advantages periotoneal dialysis |
|
Definition
•Immediate initiation
•Less complicated
•Short training time
•Portable – Home tx
•Fewer dietary restrictions
•Less cardio stress
|
|
|
Term
| disadvantages periotneal dialysis |
|
Definition
•Peritonitis
•Protein loss (albumin)
•Site infection
•Self image issues
•Hyperglycemia
•Surgical placement of catheter
|
|
|
