Fresenius Hemodialysis Study Guide – Flashcards
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Gown, gloves, face shield
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Three pieces of personal protective equipment that are mandatory for use in the patient care area are:
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Stimulate production of RBC's, tells bone marrow to make RBC's
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The function of Erythropoietin is
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most commonly a viral infection
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Hepatitis is an inflammation of the liver caused by
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0.09 ppm
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Max Chlorine level in H2O room
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a protein that helps fight infections and aids in healing and tissue formation. Gets fluid back into the blood, an osmotic agent.
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Albumin is
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≥ 4.0
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HD patient range for Albumin
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an electrolyte that regulates cardiac action
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Potassium is
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3.5-6.0
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HD patient range for Potassium
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what carries oxygen and iron from the lungs to vital organs
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Hemoglobin is
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10-11
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HD patient range for Hemoglobin
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what keeps bones and heart healthy if in balance, has an inverse relationship with Ca
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Phosphorus is
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3-5.5
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HD patient range for Phosphorus
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what tells if the patient is receiving adequate dialysis, clearance times time of tx in minutes divided by volume in (L) of urea distribution
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spKT/V is
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≥1.4
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HD patient range for spKT/V
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what balances Ca and Phos, elevated Phos causes elevated PTH, leads to bone and heart damage
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iPTH is
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150-600
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HD patient range for iPTH
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a mineral that keeps bones and muscles healthy
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Calcium (corrected) is
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200-300
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HD patient range for Calcium (corrected)
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blood
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Hep B may be transmitted in a dialysis unit because it is transmitted via
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PPE use, hand washing, decontamination, disposal of supplies
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There are specific procedures to control the spread of Hepatitis in the dialysis unit. What are they?
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Kidney, ureter, bladder, urethra (this is the flow path order as well)
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The four organs of the urinary tract are
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Movement of FLUID through a semi-permeable membrane from and area of LOW SOLUTE to an area of HIGH SOLUTE concentration
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Osmosis is
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bleach 1:100
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Machines and chairs are cleaned with ____________ routinely.
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10 mL
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1:10 bleach solution is used for spills of blood greater than
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pH, conductivity and temperature
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The dialysate should be checked for what 3 things prior to starting each treatment?
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Erythropoeitin
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The kidneys inability to secrete what is the primary reason dialysis patients are anemic?
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Calcium, magnesium, ion exchange
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Water softener exchanges _____________ and _____________ for sodium by _________________.
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RBC's (hemoglobin)
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Anemia is a condition characterized by unusually low levels of
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handcrank (6-10 rotations per min)
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During a power failure you would return the patients blood via
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10-15 minutes
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Max time to handcrank in power failure
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NO
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Is dialysate sterile?
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short, large
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Heparin is a ___________ acting, _________ molecule.
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3,5
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Heparin is given _________ to __________ minutes prior to the initiation of treatment.
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In order for it to become systemic throughout the body
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Why is heparin given to minutes prior to the initiation of treatment?
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resistance of blood return
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Venous pressure measures
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ability of a substance to conduct heat, electricity or sound
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Conductivity measures
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Air detector
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What protects patients from receiving air?
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bacteria and endotoxins can be in the dialysate which may cause pyrogenic reactions
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If the dialysate delivery system has been improperly disinfected what might occur?
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Hemolysis, from too high dialysis temperature
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What does the temperature monitor prevent?
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High
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Hemolysis occurs if the temperature is too
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Air embolism and Hemolysis
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What are the two most life threatening conditions that can happen during treatment?
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when 1/2 ful
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When should sharps containers be changed?
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SST first, Lavender last, Post BUN after TX
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Order in which lab tubes should be drawn?
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Redness, swelling, pain, discharge, crust, fever, chills
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Observable S/S of an infected access site
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the movement of PARTICLES through a semipermeable membrane from and are of HIGH SOLUTE to an area of LOW SOLUTE concentration
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Diffusion is
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removal of additional fluid through a semipermeable membrane with the use of of added pressure (tea bag)
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Ultrafiltration is
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Normal Saline
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The blood lines and dialyzer are primed with what before dialysis is initiated?
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Pre and Post BUN
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What blood test is done before and after hemodialysis treatment to determine adequacy of the treatment?
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to keep their access visible
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To ensure safety during treatment, a key point to remind the patient is
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Look, Listen, Feel
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Three assessments that must be completed on a fistula or graft:
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a catheter
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External access refers to
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a fistula or a graft
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Internal access refers to
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Bruit
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Listen for the
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Thrill
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Feel for the
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Bruit and thrill
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What do you do to assess if there is good blood flow through an internal access?
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Carbon tanks
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What part of the water treatment system should NEVER be bypassed
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0.09 ppm
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Chlorine/Chloramines max level?
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Blood loss, shock, toxicity, injury, dehydration
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Causes of Acute renal failure
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Diabetes, Hypertension, Lupus, Polycystic Kidney Disease, Glomerulonephritis, Goodpasture's syndrome
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Causes of Chronic renal failure
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10 ppm
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Water Hardness max level
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...
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Steps on changing a contaminated transducer
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6.8-7.4
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pH range:
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13.5-14.5
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Conductivity range:
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Remove total chlorine
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What do Carbon tanks/GAC filters do?
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the reverse osmosis, Removes all dissolved solids
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What is the R/O?
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by reverse osmosis, it relies on the application of pressure and the natural process of osmosis to remove contaminants from water
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How does the R/O work?
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Fluid loss, eating while on dialysis, blood loss, hemolysis, low albumin, temp too hot, Heart Failure, BP meds, disinfectants
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All of the following are possible causes of hypotension
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Feeling of impending doom, N/V, feeling hot, dizziness, restlessness, fatigue, decreased LOC, yawning, seizures, cool clammy skin, feeling need to have BM, SOB, blurred vision
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All of the following are s/s of hypotension
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Machine and ECC, safety, access and V/S every 30 minutes
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The following tasks are included in routine checks
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in isolation
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According to the CDC, Hepatitis B positive patients should be dialized
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in the clinic unless active TB then in the hospital in a negative pressure isolation room
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TB patients need to dialyze where?
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2.2
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1 kilogram = ________ pounds
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Calcium and Potassium (Ca and K)
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The two electrolytes in the acid bath to pay close attention to when checking the physicians orders are
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↑ Phosphorus, ↓ Calcium, can not convert Vitamin D to Calcitriol, Secondary Hyperparathyroidism
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Renal bone disease is caused by
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Phosphorus
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Most foods contain
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uses lining of abdomen (peritoneal membrane) to filter blood, catheter in abdomen surgically placed, dialysate is instilled in the abdomen, it dwells and then is drained using gravity
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What is peritoneal dialysis
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...
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Some factors that may contribute to delivering an adequate hemodialysis treatment
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Yes, frequently
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Does Estimated Dry Weight ever change?
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No, it prevents
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Does Heparin dissolve clots?
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antegrade - up, with the blood flow
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Which direction do you place the venous needle?
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antegrade or retrograde
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Which direction do you place the arterial needle?
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AV Fistula
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What vascular access is the access of choice?
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2
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The tips of the arterial and venous fistula needles must be at least ________ inches apart
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Clamp lines, off pump, left side, trendelenburg
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How do you treat an air embolism in the correct order?
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Clamp lines, off pump, left side, trendelenberg, for treatment of an air embolism
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What does COLT stand for and what is it used for?
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where the vein and artery are connected
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What is the anastomosis?
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25-30 degrees
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The angle an AV fistula needle should be inserted
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1500-150-15
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The following solutions are used to calibrate the TDS meter
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the sum of all ions in the water or the total dissolved solids
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What does the TDS meter measure?
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Switch to the 2nd tank (never bypass) then test for chlorine every 2 hours, notify technical, the clinic manager and the MD
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What should you do if your post carbon chlorine test is positive?
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45 degrees
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The angle an AV graft needle should be inserted
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above the infiltration
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After an infiltration of the venous needle the second venous needle should be stuck
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Rope ladder technique
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What technique should be used to prolong graft life?
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Confusion, uremic "frost", sleep problems, urine breath, itching
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Symptoms of uremia may include
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Use hemastick to test for blood, if blood present pull tubing, don't give blood back
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What do you do for a minor blood leak?
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Stop treatment, pull tubing, don't give blood back
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What do you do for a major blood leak?
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Edema, SOB, Hypertension, itchy, can't sleep
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S/S of fluid overload
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Dialysate or bath
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Dialyzing fluid is also known as
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Acid, bicarbonate, RO water
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The three components of dialysate are
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no white out, black pen, sign, time, date entry
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Correct way to correct charting errors
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infection
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Catheters are associated with increased risk of
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dropping BP, clots system, allergy can develop over time (back pain, flushing, chest pain, SOB)
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RN or LPN only: Adverse reactions of Venofer
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The ESRD patient can not convert Vitamin D to Calcitriol, treatment for hyperparathyroidism
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RN or LPN only: Why are we giving patients Hectoral/Zemplar?
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Treats anemia, mimics erythropoeitin
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RN or LPN only: Why are we giving patients Epogen?
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Venous
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RN or LPN only: Antibiotics should be given via what chamber?
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Nephron
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Major functional unit of the kidney is the
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CRF worsens overtime, can only slow progression, permanent, requires transplant or dialysis for survival, has stages I-V. ARF is sudden (from blood loss, drug use, toxicity), may be reversed
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Differences between Chronic and Acute Renal Failure
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Pericardia, neuropathy, itching, carpal tunnel, , sleep problems, decreased libido
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Complications of Uremia
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Transmembrane pressure
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What does TMP stand for?
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Total amount of pressure (positive and negative) exerted on the dialyzer to remove fluid from the patient
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What does TMP or transmembrane pressure mean?
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Too high of a UF goal, Kink in ECC, wet tranducers
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What should you think of when there are a lot of TMP alarms?
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Turn off UF, Turn off DFR, ↓ BFR to 100 x 15 seconds, Turn off Blood pump, Clamp A & V needle tubing, Collect from Arterial side, Invert tube 5-6 times
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Post BUN collection order
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It is short acting, 2-4 hours is its action, effects are gone by the end of the treatment, large molecule so it isn't dialyzed
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Why do we use Heparin?
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Anticoagulant, bleeding
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If patient falls, what should we think first?
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Sodium, Na
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Which molecule is used as a "surrogate" marker for urea during OLC?
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how well blood is cleared of waste products, how well the filter is working, think dialyzer
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Define Clearance
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losing dialyzer space, clotting, look at dialyzer
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If KECN is decreasing what is happening?
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135
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If conductivity is 13.5 what is the sodium?
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Dialysis machine traffic lights, green light if spKT/V ≥ 1.4, if yellow spKT/V < 1.4
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What are AMPS?
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6
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How many tests per treatment are done for OLC?
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OLC-V
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What must be programmed for AMPs to work/run accurately?
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pressure damages the small vessels, damaged vessels can't filter waste products from the blood as they should
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Why does hypertension cause kidneys to fail?
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Maintain fluid, electrolyte, pH/base balance; remove waste, covert Vitamin D to calcitriol, excrete Phosporus, secrete epoeitin, regulate BP
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What do kidneys do?
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Phosphorus
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Dialysate will never have?
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ADH - regulates Renin Angiotensin system - regulates blood pressure
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How does the kidney regulate BP?
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hormone stuff which is treated with medications
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Dialysis does everything kidneys do besides
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reducing fluid removal rate (↓ UF goal), administer meds, administer saline bolus, albumin
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Correct fluid balance by
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we are trying to remove fluid that isn't there, cramping, BP lowering, sick, pt. may have gained body weight, needs adjusted up
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If EDW is too low
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Not removing enough, leaving with crackles, SOB, swelling, pt. has lost body weight, needs adjusted down
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If EDW is too high
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pull it out of other compartments, water follows Na
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↑ Na will do what with fluid?
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thirsty
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↑ Na will make a person
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review EDW frequently, keep pt from eating on dialysis, keep feet elevated
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How to prevent hypotension
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bleeding out
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Define exsanguination
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Venous
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Most severe infiltration
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blood is pushing through
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Why is venous inflitration the most severe?
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Cherry pop, bright red, don't give this blood back
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What does hemolysized blood look like?
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pre - last
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Gain
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pre - EDW
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AW
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avail + saline
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TW
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TW x 1000
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Goal
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osmosis and diffusion
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What happens naturally and at the same time across a semipermeable membrane?
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there is something wrong with the solutions
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If the conductivity is not in normal range what is wrong?
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to remove air, wet the fibers and rinse the ECC to reduce adverse reactions to the tubing
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Why are the blood lines and dialyzer are primed before dialysis is initiated?
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Temp, conductivity ONLY
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What is a dialysate alarm?
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Patient, tubing, system. Blood is not moving, needs fixed quickly
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What is a blood alarm?
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Body has only 4-5 units of blood, the dialyzer pumps 400-500 mL or 1 unit of blood/minute. After 3 minutes of an access being dislodged, a person is dead.
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Why is a visible access important?
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out of the body
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Dislodgement
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disconnection
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Separation
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-240
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Arterial pressure should not exceed
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resistance within the blood lines between the patients access and the blood pump
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What is arterial pressure?
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machine on home screen, NS line double clamped, arterial chamber 85-95 % full, tranducers dry & unclamped, pressures w/in range, BFR correct, DFR correct, Blood pump speed set, heparin pump on, venous chamber full & in air detector, venous line is threaded through venous clamp, acid bath correct, dialyzer size correct, saline bag with at least 300 mLs, Hansens connected, red end up, UF on
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Safety checks include
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rinse back
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Never walk away from a patient during
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confirmation of placement
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Before using an external access what must you have on file?
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never get it wet, don't remove dressing (we will change the dressing or replace if it falls off)
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Reminders for external access for patient
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8-12 weeks
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How long does it take for an AV fistula to mature?
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3-6 weeks
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How long does it take for an AV graft to mature?
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clot (keep stable to control access flow)
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A low BP can make an access ...
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the arterial needle
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What needle do you pull first when terminating treatment?
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10 minutes (you peek you leak)
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How long do you allow a site to achieve hemostatis?
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4-6 hours
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How long should bandages be left on after hemostatis is achieved?
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Used on AV Fistulas only for easy painless access to fistula, cannulate in same site and same angle over 8-12 treatments
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What is a buttonhole and how is it created?
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Venous infiltration
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Which infiltration is the worst?
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Pushing blood into it, if venous pressure goes ↑ immediately, think infiltrate, stop pump - always flush venous with either heparin or saline if heparin isn't ordered
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Why is venous infiltration the worst?
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either above or below the infiltration
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If infiltration, a new arterial needle may be inserted ....
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above the infiltration
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If infiltration, a new venous needle must be inserted ...
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>600
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Good access flow reading for a graft is?
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>400
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Good access flow reading for a fistula is?
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Epogen, Iron, Folic acid and B vitamin
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What is needed for proper Anemia management (if one piece is missing anemia isn't managed)?
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Interdialytic weight gains
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What does IDWG stand for?
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losing Potassium - heart issues
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What should you be thinking about if a patient has diarrhea?
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An EKG is needed when manipulating the K
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Why don't we use a 0 K bath in the clinic?
