Hemodialysis and Peritoneal Dialysis

When is dialysis indicated for AKI or ESRD

1. Presence of severe fluid/electrolyte imbalance

2. Elevate serum Cr

3. Elevated serum K+

4. Acidosis

5. Uremic manifestations

6. GFR <10mL

What are uremic manifestations?

Neuro and GI

Mechanism of dialysis

Diffusion of solutes and water across the semipermeable membrane (movement from high to low solute concentration)

Three types of vascular access

1. CVC in subclavian or internal jugular vein (short term, AKI/waiting for fistula)

2. AV fistula

3. AV graft

Assessment of functional AV fistula

Palpable pulsation

Feel the THRILL

Auscultate the BRUIT

Why is heparin added to the circut?

To prevent clotting

What medications are held before dialysis?

1. BP meds

2. Antibiotics

3. Anticonvulsants

4. Water-solube vitamins

Complications of HD

1. HYPOtension (fluid removal)

2. Disequilibrium syndrome

3. Bleeding (heparin)

4. Infection

5. Clotting/Thrombosis of AV Fistula

Signs of Dialysis disequilibrium syndrome

1. Confusion

2. NAUSEA/VOMITING

3. Head ache

4. Restlessness

What causes the symptoms of dialysis disequilibrium syndrome?

Rapid shift of fluid and substances into the brain → CEREBRAL EDEMA

Treatment for dialysis disequilibrium syndrome

1. Slow/decrease rate of dialysis

2. Infuse hypertonic saline, albumin, or mannitol

When is CCRT indicated?

ACUTELY ill patient with AKI with severe fluid overload who are HEMODYNAMICALLY UNSTABLE!!

• More gentle option, slow and continuous

• Can be adjusted hourly

Benefits of PD

Increased Pt control and flexibility ith the option of home tx

Shorter training period

can be performed independently by pt or a family member

Greater mobility for patient

Fill phase of PD

Room-temp, sterile dialysate is instilled into the peritoneal cavity

Warm dialysate to body temp

Dwell time

The fluid remains in the abdomen and waste products/electrolytes diffuse into dialysate

Controlled using DEXTROSE (hyperglycemia)

Gravity drains into a sterile bag

Continuous ambulatory PD

Patients can be ambulatory during the dwell time

Contraindications for PD

1. Hx of multiple abdominal sx or chronic abdominal conditions

2. Recurrent abdominal wall or inguinal hernias

3. Obesity with large abdominal wall

4. Pre-existing back problems/vertebral disease

5. COPD

Major Complications of PD

1. Peritonitis (infection)

2. Abdominal pain/distention

   1. change the catheter’s position

3. Hyperglycemia and increased triglyceride (glucose in dialysate)

4. Outflow problems

   1. Kinks → reposition catheter → constipation

5. Respiratory Compromise

   1. Frequent reposition, deep breathe, Elevate HOB

6. Protein loss

   1. Adequate intake

Signs of Peritonitis

Cloudy peritoneal effluent with an increased WBC

Dialysis nutrition

Sodium and water restriction

Increased protein due to loss during dialysis

Interventions for decreased outflow in PD

Reposition catheter, turn the patient to the side, gentle abdominal massage