renal replacement therapy – Flashcards
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what is the goal of renal replacement therapy
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to replace renal function- provide a machine to do what the kidney should be doing
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what are the 3 requirements of renal replacement therapy
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bloodflow aka access filter machine pump
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which requirement of the renal replacement therapy is used to provide pressure and bloodflow
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machine pump
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which requirement of renal replacement therapy involves a membrane that functions like a kidney
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filter
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what is the role of the air detector in renal replacement therapy
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make sure that no air bubbles are going back into the bod
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what are the 2 types of renal replacement therapy
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convection diffusion
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which type of dialysis involves molecules moving across a concentration gradient
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diffusion
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in diffusion dialysis between dialysis and blood where is the higher concentration?
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blood
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in diffusion dialysis between dialysis and blood where is the lower concentration?
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dialysis solution
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in diffusion dialysis why is it important for the blood and diasylate to go in oppsite directions
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need countercurrent flow so there will be moevement from high concnentration to low
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what controls the flow in diffusion dialyis
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chemical makeup of solution electrolytes
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which form of dialysis involves pulling fluid from one side to the next
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convection
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what electrolyte has high concentration in convection dialysis
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gluclose
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what is the direction of the fluid shift in convection dialysis
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from blood to diasylate
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in convection dialsys where is the higher osmolarity blood or diaslate?
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dialysis solution
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in convection dialsys where is the lower osmolarity blood or diaslate?
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blood
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what is the primary component used in the dialysi in convection dialaysis
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dextrose
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what type of osmolarity solution is used in convetion dialysis
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hypertonic
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which indication for renal replacement therapy involves no response to bicarb and compensation
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acidosis
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which indication for renal replacement therapy involves hyperkalemia, hyperphosphatemia
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electrolyte abnormality
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which indication for renal replacement therapy involves lithium, methanol, salicylate
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intoxication
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which indication for renal replacement therapy involves left ventricular problems, edema
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fluid overload
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which indication for renal replacement therapy involves pericarditis, clotting, and bleeding disorders
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uremia
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what speed of flow rate increases the concentration gradient in diffusoin dialysis
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faster
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which electrolyte has a speed that has to be monitored so be careful in dialysis
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sodium
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where does the type of dialysis get its name from
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access site
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what is the preferred access site in dialysis
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arteriovenous fistula- av fistula
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how long does it take for a av fistula to develop
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weeks to months
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where is the connection in a av fistula
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artery to vein
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which access dialysis involves synthetic teflon
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arteriovenous graft- av graft
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which access dialysis is better in low blood blow or vascular disease
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av graft
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what is the last resort access for dialysis
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catheter
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which access for dialysis has the highert rate of clotting and infection
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catheter
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why does the catheter access have the most likely to clot
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lower overall blood flow
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name in order the preference of access in dialisis
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av fistula av graft catheter
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what are the 2 types of membranes in dialysis
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convectional hi flux
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which dialysis membrane is the historical membrane with smaller pores
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conventional
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which dialysis membrane has larger pores and removes previosly unremovable particles
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hi flux
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which dialysi membrane can release vancomycin
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hi flux
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which term represents pulling flid without touching electrolytes
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ultrafiltrate
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what is the goal of adequacy in dialysis
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over 1.2
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does low flow increase or decrease adequcy
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decrease
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what is the goal in urr- urea reduction ratio
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over 65%
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which dialysis membrane has the most accuracy
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hi flux
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how does flow rate effect efficacy
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more flow rate= more efficacy
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explain why the first hour of dialysis is more effective than the last
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protein buildup reduces efficacy
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how much fluid is dialys removing
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6L in 3 hours 10%
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the rapid shift in fluid and removal can cause what complication
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hypotension
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which population is at risk of hypotension in dialysis
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diabetes elderly
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how can you prevent hypotension in dialysis
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set accurate dry weight consistent filtration rate dont eat before
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if you dont set a correct dry weight what can happen in dialysis
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dehydration
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what is an alpha agonist used to treat hypotension in dialysis
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midodrine
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what is the controversial treatment of hypotension in dialysis
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ssri
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the great fluid loss can result in what dialysis complication
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cramping
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which vitamines help prevent cramping in dialysis
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c e
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what is the drug used to prevent cramping in dialysis that is avoided
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quinine
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what is the most common complication in dialysis with cathter access
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vascular complications
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what is a common bacvteria infection in dialysis
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staph aureus
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what is used as an anticoagulant in dialysis
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heparin
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what is a reversible anticoagulant in crt but not hemodialysis
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citrate
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what dialysis medication increases the risk of bleeding
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heparin
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which type of dialysis has improved chemodynamics, with less fluid ***** and removes larger molecules as it is done over 24 hours
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continuous renal replacment therapy ccrt
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is there any outpatient setting for ccrt
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no
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what are the disadvntages of ccrt
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costly,time consuming, clotting risk
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which form of dialysis uses hther persons own membrane
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peritoneal dialysis
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how much dialysis fluid is held in peritoneal dialysis
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1.5-3L
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What kind of peritoneal dialysis involves filling the cavity having a normal day, emptying cavity and reflling
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continuos ambulatory
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which type of peritoneal dialysis invovles hooking up to a pump with frequent exchanges over time
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automated
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what is the only patient population used for peritoneal dialysis
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chronic kidney disease
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can peritoneal dialysis be used for electrlyte replacement or overdose
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no
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in peritonela dialsys the longer the dialyste is in the _____filtratoin occures
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less
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what is the common issue in peritoneal dialysis
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peritonitis- infection of peritoneal cavity
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what electrolyte may run high in peritneal dialysis
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high gluclose, blood sugar
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what term describes the fluid distrubtuion on dialysis
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volume of distribution
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where is the only place dialysis removes drug from
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vasculaure
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large vd means___dialysis removed
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less
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what vd represents high dialsyis clearance
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less than 1l/kg
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what vd represents moderate dialysis clearance
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1-2L/kg
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what vd represents low dialysis clearance
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over 2L/kg
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how does molecular weight affect dialysis
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higher mw is less dialysis
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what value represents small molecules mw in dialysis
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under 500 daltons
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what value represents mid sized molecules mw in dialysis
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500-1000 daltons
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what value represnts large molecules mw in dialysis
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over 100 daltons
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what are examples of small mw molecules in dialysis
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urea creatinine
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what are examples of mid sized molecules in dialyisis
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gentamycin
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what are examples of large sized molecules in dialysis
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vancommycin
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explain how protein binding affects dialysis
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only free drug is removed
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intrinsic dialysis+ dialysis elimination=
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total clearance/elimination
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in dialysis how long of a reequilibration period need to be
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6 hours
