Dialysis Primer

Question 1

What is dialysis?

Answer 1

• Method of filtration w/movement of blood across a semipermeable to remove undesired artifacts

Question 2

What is dialysis used for?

Answer 2

• Correct fluid/electrolyte imbalances
• Remove waste products in renal failure
• Treat drug overdoses

Question 3

What are the two types of dialysis?

Answer 3

• Peritoneal dialysis (PD)

* Hemodialysis (HD)

Question 4

When is dialysis generally initiated?

Answer 4

• When GFR (or creatinine clearance) = <15mL/min

Question 5

Dialysis uses diffusion and osmosis for filtration.

Diffusion is the movement of fluid from an area of _____ to an area of _____ concentration of solutes.

Answer 5

• greater, lesser

Question 6

Dialysis uses diffusion and osmosis for filtration.

Osmosis is the movement of fluid from an area of _____ to an area of _____ concentration of solutes.

Answer 6

• lesser, greater

Question 7

What are some conditions that call for immediate dialysis?

Answer 7

• Uremic complications
• Neuropathies
• Uncontrolled hyperkalemia
• Pericarditis
• Accelerated HTN

Question 8

What are the components of dialysis?

Answer 8

• Blood
• Semi-permeable membrane
• Dialysate

Question 9

What is the purpose of dialysate?

Answer 9

• To control filtration gradients of osmosis

Question 10

The patient preparation for dialysis consists of…

Answer 10

• Emptying the bladder and bowel
• Weighing the patient
• Obtaining a signed consent form.

Question 11

What is used more often, peritoneal dialysis or hemodialysis?

Answer 11

• Hemodialysis, PD is only used in apprx 12% of pts

Question 12

What is the basic concept of peritoneal dialysis?

Answer 12

• A dialysis catheter is surgically placed through the abdomen into the peritoneal cavity
• A dialysis solution bag is hung higher than insertion point to drain into peritoneal cavity
• Dialysate draws impurities into the peritoneal cavity
• A drain bag is hung below the insertion point to remove fluids

Question 13

What is the care for a newly placed PD catheter?

Answer 13

• Site clean to heal (This can be w/ or w/out a dressing pending particulars of the individual)
• Pt is taught to observe for signs of infection
• Site should not be submerged in bathwater
• Once healed, the pt may shower and pat dry

Question 14

With peritoneal dialysis, what serves as the semi-permeable membrane?

Answer 14

• The peritoneum (lining of the peritoneal cavity)

Question 15

What is the active component in dialysate that helps control rates of osmosis?

Answer 15

• Glucose

Question 16

What are the basics to keep in mind re: dialysate for peritoneal dialysis?

Answer 16

• Available in 1 or 2 L plastic bags w/ glucose concentrations of 1.5, 2.5 and 4.25% (3L can be given pending size of pt)
• Electrolyte compositions is similar to plasma
• Solution is warmed to body temperature

Question 17

What are the 3 phases of the PD cycle?

Answer 17

• Infill
• Dwell
• Drain

Question 18

Describe the infill phase of PD.

Answer 18

• Prescribed amount of solution infused through established catheter over about 10 minutes
• After solution infused, inflow clamp closed to prevent air from entering tubing

Question 19

Describe the dwell phase of PD.

Answer 19

• Diffusion and osmosis occur between patient’s blood and peritoneal cavity.
• Duration of time varies, depending on the method.
• 20 – 30 minutes to 8 hours or more

Question 20

Describe the drain phase of PD.

Answer 20

• Peritoneal fluids are drained over 15 to 30 minutes

* May be facilitated by gently massaging abdomen or changing position

Question 21

One cycle = one ______.

Answer 21

• Exchange

Question 22

For manual PD, a period of about __ to __ minutes, minimum, is required to complete an exchange.

Answer 22

• 30 to 50

Question 23

What is automated peritoneal dialysis?

Answer 23

• An automated mechanical Cycler delivers the dialysate, times and controls fill, dwell, and drain

Question 24

APD is the most popular form of PD, as it allows patients to accomplish dialysis while they sleep. The machine cycles four or more exchanges per night with __ to __ hours per exchange.

Answer 24

• 1 to 2

Question 25

What are some complications that may occur with PD?

Answer 25

* Exit site infection * Lower back problems * Peritonitis * Hernias * Bleeding * Pulmonary complications * Protein loss

Question 26

Because of increased intraabdominal pressure secondary to dialysate infusion, hernias can develop in predisposed individuals such as _____ women and _____ men.

Answer 26

• Multiparous, older

Question 27

What are some Pro’s of PD over HD?

Answer 27

* Short training program (3 to 7 day training program) * Independence * Ease of traveling * Fewer dietary restrictions * Greater mobility than with HD

Question 28

Mortality rates are about equal between in-center hemodialysis patients and peritoneal dialysis patients for the first few years. However, after about 2 years, mortality rates for patients receiving _____ dialysis are higher, especially for the elderly with diabetes and patients with a prior history of cardiovascular disease.

Answer 28

• Peritoneal

Question 29

How is circulatory access gained for hemodialysis?

Answer 29

• Via an Arteriovenous Fistula (AVF)- an anastomosis between an artery and a vein (usually cephalic)

Question 30

For acute (temporary) hemodialysis when an AVF is not available, what type of catheter may be used and where would it be placed?

Answer 30

• Double lumen, Y hub catheter in the right jugular

Question 31

What is the basic procedural flow for hemodialysis?

Answer 31

* Two needles placed in fistula or graft * Needle closer to fistula or red catheter lumen pulls blood from patient and sends to dialyzer. * Blood is returned from dialyzer to patient through second needle or blue catheter.

Question 32

_____ may be infused as a bolus predialysis or through a _____ pump continuously to prevent clotting.

Answer 32

• Heparin

Question 33

Dialyzer/blood lines are primed with _____ solution to eliminate ___.

Answer 33

• Saline, air

Question 34

HD is terminated by…

Answer 34

* Flushing dialyzer with saline to remove all blood | * Needles removed and firm pressure applied

Question 35

Before HD treatment, the nurse should

Answer 35

``` Complete assessment of • fluid status • condition of access • temperature • skin condition ```

Question 36

During HD treatment, the nurse should

Answer 36

* Be alert to changes in condition | * Perform vital signs every 30 to 60 minutes

Question 37

What are the main complications for HD?

Answer 37

* Hypotension * Muscle cramps * Loss of blood * Hepatitis

Question 38

How does hypotension occur during HD?

Answer 38

• From rapid removal of vascular volume (hypovolemia), decreased cardiac output, and decreased systemic intravascular resistance

Question 39

What are some factors that contribute to the development of muscle cramps during HD?

Answer 39

* hypotension, * hypovolemia, * high ultrafiltration rate (large interdialytic weight gain), and * use of low-sodium dialysis solution

Question 40

How can blood loss occur during HD?

Answer 40

* From blood not being completely rinsed from the dialyzer * Accidental separation of blood tubing * Dialysis membrane rupture * Bleeding after the removal of needles at the end of dialysis

Question 41

True or False | At one time, hepatitis B had an unusually high prevalence in dialysis patients, but the incidence today is quite low.

Answer 41

• True

Question 42

Why does individual adaptation to maintenance HD vary considerably?

Answer 42

• Initially, many patients feel positive about the dialysis because it makes them feel better and keeps them alive, but often great ambivalence is expressed about whether it is worthwhile.

Question 43

What are the advantages of peritoneal dialysis over hemodialysis?

Answer 43

* Immediate initiation * Less complicated * Portable system * Fewer dietary restrictions * Usable in patients with vascular access problems * Less cardiovascular stress * Home dialysis possible

Question 44

What are the advantages of hemodialysis over peritoneal dialysis?

Answer 44

* Rapid fluid removal * Rapid removal of urea and creatinine * Effective K+ removal * Less protein loss * Lowers serum triglycerides * Home dialysis is possible as temporary access can be provided at home