Dialysis Access Management

These flashcards cover key concepts related to dialysis access management, kidney failure stages, symptoms, and treatment options.

To remove extra fluid and waste products from the blood when the kidneys are not able to. means what

What is the main purpose of dialysis?

what type of thrombectomy is this and what types of vessels is it used on

AVG

fogarty thrombectomy

arterial plugs can be treated in two ways

performed with a fogarty balloon

mechanical thrombectomy device (only one device- Arrow Tretola PT(thrombolytic)Device)

when using a mechanical thrombectomy device to treat a AVG clot what is it best to avoid

avoid deployment at the anastomosis to prevent an embolus

Advance the **** balloon beyond the arterial anastomosis, inflate it under fluoroscopy, and pull it back through the anastomosis. Several passes may be needed due to the firm clot.

what balloon is this

fogarty balloon

What are three ways to achieve post intervention hemostasis

1. manual compression

2. manual compression with clotting agent

3. purse string stuture

pic is purse string

tunneled catheters should be on what side of the maturing AVF/AVG

opposite side

In summary, ******* catheters are for short-term use and are inserted directly into the vein, while********* catheters are for longer-term use, with the catheter portion tunneled under the skin to offer better security and lower infection risk.

In summary, non-tunneled catheters are for short-term use and are inserted directly into the vein, while tunneled catheters are for longer-term use, with the catheter portion tunneled under the skin to offer better security and lower infection risk.

what are four advantages of CVC (hemodialysis catheters)

simplicity of insertion

************

*******************

ease of replacement and removal

simplicity of insertion

immediate utility

access without needle cannulation

ease of replacement and removal

what are the three preferred access sites for CVC placement

with what caviet

R internal jugular vein

R external jugular vein

L internal jugular vein

must be placed on opposite side of the maturing AVF/AVG

when is the use or placement of a nontunneled temporary catheter appropriate

short term use and temporary. for hospitalized patients without existing function access

what AVG site or access is considered a last resort

lower extremity graft

order of AVG creation

4x

1. forearm

2. upper arm graft

3. chest wall prosthetic graft (necklace graft)

4. lower extremity AVG

order of AVG creation 4x

1. forearm

2. *****

3. *****

4. lower extremity AVG

1. forearm

2. upper arm graft

3. chest wall prosthetic graft (necklace graft)

4. lower extremity AVG

where is the inflow tract of an AVG

graft anastomosed to the arterial side

where is the outflow tract of an AVG

it is anastomosed to the vein to allow for venous return

Where should the start of diagnostic fistulogram be performed?

From the arterial inflow to the right atrium to visualize the entire circuit

what is the recommended treatment for any stenosis of 50% or greater that explains the presenting symptoms

PTA (percutaneous transluminal angioplasty)

when should a stent graft placement be considered

4x

1. graft venous anastomotic stenosis and in stent stenosis

2. *******

3. ********

4. recurrent stenoses

• Graft-venous anastomotic stenosis and in-stent stenosis, as self-expanding stent-grafts have been shown to improve patency at 6 months, and KDOQI recommends using them over angioplasty alone.

• Venous rupture that is refractory to prolonged PTA (percutaneous transluminal angioplasty).

• Elastic stenoses in locations where surgical intervention is not easily possible.

• Recurrent stenoses within 3 months or less, where no surgical options are available.

what are the three indications for AVF imaging/intervention

failing to mature (imaging)

failing AVF (intervention)

clotted AVF (intrv)

where should the diagnostic fistulogram be performed

from the arterial inflow

what is a AV anastomosis

a surgical procedure that creates a connection between two tubular structures in the body, such as blood vessels, intestines, or urinary tracts

What are the two main types of dialysis?

Hemodialysis (HD) and

Peritoneal Dialysis (PD).

What does a GFR of less than 15 indicate?

Stage 5, which is kidney failure.

what does GFR measure

kidney function, measures the amount of blood filtered by your kidneys each minute

What is Oliguria?

low urine output

often defines as less than 400 mL

What is Anuria?

complete absence of urine production or less than 100 mL

What are two common causes of kidney failure?

Diabetes and hypertension.

What are the absolute contraindications for imaging/intervention of an AVF?

2x

Uncorrectable coagulopathy,

graft infection,

What is the typical placement site for an AVF?

could be 2 sites

Usually placed in the upper arm or lower forearm.

is a medical treatment that replaces the function of the kidneys in patients with kidney failure, using techniques like hemodialysis, peritoneal dialysis, and kidney transplantation to remove waste, excess fluid, and electrolytes…. this is what kind of therapy

renal replacement therapy

What is the typical wait time before an AVF can be used?

About 6 months to allow the vein to mature.

What is the first stage of Chronic Kidney Disease (CKD)?

Kidney damage with normal kidney function (GFR of 90 or higher).

What does the abbreviation ESRD stand for?

End stage renal disease.

What is a sign of obstructive ureteral kidney stones?

Extreme flank or abdominal pain.

Utilizing a dialyzer to remove waste and extra fluid from the blood is what kind of dialysis

What does 'hemodialysis' involve?

What does AVF imaging check for?

Signs of stenosis, clotted AVF, or failures to mature.

What are the common types of vascular access sites for tunneled catheters?

RIJV, REJV, LIJV, with tunneled catheters being the preferred option.

What are the three long term dialysis conduits a graft an AV shunt may be made out of

1. native conduits

2. artificial conduits

3. hybrid conduits

A conduit made entirely from the patients own vessels (e.g. radiocephalic AV fistula, saphenous vein graft in CABG)

Native conduit

A conduit made from synthetic material like PTFE or Dacron (ex. PTFE AV graft, synthetic vascular bypass)

artificial conduit

a combination of native vessels and synthetic material

ex. saphenous vein graft reinforced with a synthetic graft

hybrid conduit

A sudden episode of kidney failure or kidney damage that happens within a few hours or days

AKI acute kidney injury

Kidneys are funcitoning at 10-15% and are no longer able to keep the patient alive without external assistance

chronic kidney/renal failure.