Dialysis

What is dialysis 

a process in which waste products and excess water move from the blood through a semipermeable membrane into dialysis solution 

When is end stage renal disease dialysis initiated

when the GFR is less than 15

What are the complications of AKI

fluid volume excess

hyperkalemia

uncompensated metabolic acidosis

uremic complications

types of dialysis

hemodialysis

peritoneal dialysis

continuous renal replacement therapy

what are advantages of in-center hemodialysis 

trained staff, friendwship with others 

what are disadvantages of in-center hemodialysis

treatment times are scheduled, travel, others doing it at the same time

What are advantages of home hemodialysis

dialysis at home can lead to longer life and better survival, convenient time, greater sense of control

What are disadvantages of home hemodialysis 

space in home, no medical professionals, 

What are advantages to peritoneal dialysis

no machine, fewer fluid/diet restrictions, no needles, can be a good bridge to a kidney transplant

What are disadvantages to peritoneal dialysis

done everyday, no days off, blood glucose can be more difficult to control in diabetes, potential for weight gain, potential for infection

what are types of vascular access 

AV fistula, AV graft, central lines 

nursing considerations for AV fistula and AV graft

assess for patency

monitor for signs of infection

never take a BP, draw blood or use a wrist restraint on an extremity with a graft or a fistula

short term vs long term central line 

short term = non tunneled double lumen 

long term = tunneled dialysis catheter inserted into the subclavian vein 

What meds should be held before dialysis

antihypertensive

potential complications of hemodialysis

hypotension, muscle cramps, bleeding/loss of blood, bloodborne infectious diseases, disequilibrium syndrome

peritoneal dialysis 

treatment for acute and chronic renal failure where dialysate is infused into the peritoneal space allowed to dwell and then drained 

nursing care peritoneal dialysis 

monitor for infection - prevent peritonitis by maintaining sterile technique

care for catheter site

daily weights

What is dialysate and when is it used

fluid used to pull out excess fluid and waste products

used in peritoneal dialysis (available conc 1.5, 2.5, 4)

continuous vs automated peritoneal dialysis

continuous = over 24hr 4-5 exchanges with dwell times of 4-8hrs each exchange (manual)

automated = automated cycler machine is used to deliver and drain the dialysate, exchanges at night

complications of peritoneal dialysis 

exit site infection 

peritonitis (cloudy drainage, WBC, high temp, abdominal pain, N/V)

respiratory distress 

obstruction to inflow/outflow 

protein loss