What is the target weight?
A physician prescribed weight post-dialysis that the patient can safely and reasonably achieve
What is the maximum ultra-filtration (UF) rate that should not be exceeded?
13 mL/kg/hr
What is the interdialytic weight gain (IDWG) calculation formula?
Pre weight - last post weight
What is the UF goal calculation formula?
Pre weight - target weight + normal saline prime&rinseback + oral intake, infusions = UF GOAL
What is the UFR Calculation formula?
UF Goal / Treatment hours = UFR
What are the 4 consequences of sodium loading during dialysis?
- increased thirst
- large fluid gains
- more hypotension
- ischemic events during the hemodialysis treatment
State 3 ways the clinic might contribute to sodium loading during dialysis?
- giving patient broth
- administering normal saline, hypertonic saline
- increased sodium in dialysate (could be a high setting in machine or sodium modeling)
What are the consequences if a patient is consistently fluid overloaded (hypervolemia)? (6)
- Left ventricular hypertrophy
- Increased central venous pressure (CVP)
- hypertension
- increased mortality
- pulmonary edema
- increased hospitalization rate
What are the consequences and risks of hypovolemia/hypotension during the treatment? (4)
- increases mortality
- ischemia
- damage to vital organs (organ stunning)
- loss of residual kidney function
What is the difference between the AVF and AVG?
AVF: Connection of the patient’s native artery to native vein
AVG: uses artificial or biological material and requires 2 connections
What is the point where an artery and a vein are connected to create an AVF?
anastomosis
What are the 4 things in the rule of 6s
- Maturation of 6-8 weeks
- less than or equal to 0.6 cm in depth
- greater than or equal to 0.6 cm in diameter
- greater than or equal to 600 blood flow through access
What is the difference between a tunneled and a non-tunneled CVC?
*Tunneled CVC has a cuff that the patient’s skin grows to for anchoring and is kept in longer
- Non-tunneled CVC is only used temporarily and are held in place by sutures only
Define what to do during each step for Look, Listen, and Feel
Look: Look at entire access from inflow to heart and outflow to access. Check for healing at sites, observe for bruising/cleanliness/intactness/drainage/ and maturation for fistulas
Listen: Listening to the bruit for a whooshing sound. If there’s whistling (outflow stenosis) or water hammer pulse (inflow stenosis) notify RN.
Feel: Feel for the thrill (vibration) in both AVF and AVG. Should be soft and compressible, not hard and raised.
Define a newly mature AVF? Who can cannulate a patient with this?
Newly mature AVF is a fistula that was recently created and has been deemed ready for cannulation by a nephrologist/surgeon.
Only cannulated by an Expert Cannulator
Define a mature AVF? Who can cannulate a patient with this?
A mature fistula is one that has successfully tolerated it’s prescribed needle gauge and BFR for at least 6 treatments.
A Proficient and Expert Cannulator can cannulate this patient
Define an established AVF? Who can cannulate a patient with this?
An established fistula is one that has been cannulated with both arterial and venous needles for at least 2 months w/o signs or symptoms of dysfunction.
A Beginner, Proficient, and Expert Cannulator can cannulate this patient.
What are the needle gauges and their corresponding BFR?
17 gauge = 200 -250 mL/min
16 gauge = 250-350 mL/min
15 gauge = 350-450 mL/min
14 gauge= 450 mL/min; do not exceed over 450 w/o physician orders
What is a tourniquet with a AVF?
Used to help engorge fistula and stabilize vessel for cannulation
What is a beginner cannulator level?
Less than 6 months of experience AND less than 10 successful cannulations on an established vascular access
What is a proficient cannulator level?
Greater than 6 months experience and cannulation of greater than 10 successful cannulations
What is an expert cannulator level?
Experience and skilled teammate. Has completed all the expert cannulation program training, expert cannulation skills documented.
What are 6 cannulation rules?
- Evaluate blood flow: thrill/bruit; look/listen/feel
- site rotation/healing time: Use rope ladder method; 2 weeks minimum for healing time
- Needle insertion: AVF - 25 degrees; AVG - 45 degrees
- Flipping the needle complications: Do not flip the needle unless necessary due to it coring the access and leading to increase bleeding/damage
- Distance from anastomosis: 1.5 inches
- Distance between the needle tips: 1.5 inches
What are the steps for needle removal? (4)
- remove needle at the same angle of insertion
- Apply pressure to wound when needle is completely removed
- Use clamps only if ordered by physician. Clamp one wound at a time and do not leave on longer than 20 minutes
- Use hemostatic sponge only if ordered by physician and must be removed prior to patient discharge.
