NCM 112: Care for the Patient Undergoing Dialysis and Central Venous Catheter

Comprehensive practice flashcards covering the history of dialysis, comparison of normal kidney vs. dialyzer function, permanent and temporary vascular access types, access complications, central venous catheter management, intradialytic clinical emergencies, and dialysis machine alarms.

How did ancient Romans first utilize principles related to dialysis therapy?

They provided hot baths to patients to induce profuse sweating, thereby temporarily relieving symptoms and removing urea.

What contribution did Thomas Graham make to dialysis in 1854?

He coined the term "dialysis" to describe the transport of solutes through an ox bladder, shifting scientific focus toward semipermeable membranes.

What was the earliest anticoagulant used during early experimental animal dialysis?

Hirudin, an extract obtained from crushed leech heads.

When and by whom was the first successful human dialysis treatment performed?

On August 31, 1945, by Dr. Willem Kolff in Groningen, Nazi-occupied Holland.

How does a dialyzer differ from a normal kidney regarding endocrine function?

A normal kidney produces erythropoietin, whereas a dialyzer cannot produce erythropoietin.

How long does an arteriovenous (AV) fistula take to heal, and when should it be surgically placed prior to initiating dialysis?

It takes $6\text{--}8\text{ weeks}$ to heal and should ideally be placed at least $2\text{--}3\text{ months}$ before starting dialysis to mature.

What type of permanent hemodialysis access is illustrated in this diagram?

An arteriovenous (AV) graft placement, which connects an artery and a vein in the arm using a soft synthetic tube.

How long does an arteriovenous (AV) graft take to heal before it can be used?

It takes $2\text{--}3\text{ weeks}$ to heal.

What is intimal hyperplasia, and how does it contribute to vascular access dysfunction?

It is the thickening of the innermost layer of the vein in response to vessel trauma (e.g., surgery), serving as a primary cause of access stenosis.

What vascular access complication accounts for $80\%\text{--}85\%$ of all access loss?

Thrombosis.

What vascular access complication is shown in this ultrasound of an AVF draining vein?

Thrombosis (demonstrating complete thrombosis and partial thrombosis).

What is the structural difference between a true aneurysm and a pseudoaneurysm?

A true aneurysm is a dilation of the vessel wall in response to increased blood flow, whereas a pseudoaneurysm ("false aneurysm") results from an injured vessel or graft wall where escaping blood is contained solely by surrounding tissues.

What vascular complication resulting from repeated cannulation without adequate site rotation is shown in this image?

Aneurysm / pseudoaneurysm formation at the arterial and venous needle puncture sites.

What are the clinical warning signs that an access aneurysm is at risk of rupture?

Rapid increase in size, pain, thinning of the overlying skin, shiny and pulsating appearance, and localized infection.

What vascular access complication causing distal extremity ischemia is displayed in this photograph?

Steal syndrome (dialysis access-associated hand ischemia).

Which two bacterial species are most commonly responsible for biofilm formation in central venous catheter (CVC) infections?

Staphylococcus aureus and Staphylococcus epidermidis.

What type of dialyzer is shown, and what criterion must be met for it to be reprocessed and reused for the same patient?

A hollow-fiber dialyzer; it may only be reprocessed if explicitly labeled for multiple use by the manufacturer.

What are the immediate nursing actions for intradialytic hypotension?

Place the patient in Trendelenburg position, activate minimum UF or bypass mode, infuse $100\text{--}200\,\text{cc}$ of normal saline solution (NSS), administer oxygen via nasal cannula, and reduce blood flow rate to $150\text{--}200\,\text{ml/min}$.

What physical intervention and pharmacological agent are indicated for intradialytic calf muscle cramps?

Perform passive dorsiflexion of the foot to stretch the calf muscle, and administer hypertonic solutions such as $50\%$ glucose as ordered to dilate muscle bed vessels.

What physiological mechanism causes dialysis disequilibrium syndrome?

An acute increase in brain water content (cerebral edema) resulting from the rapid diffusive clearance of osmolytes from the circulation during aggressive dialysis.

What causes dialyzer syndrome ("first use syndrome"), and when do symptoms typically manifest?

An IgE-mediated hypersensitivity reaction to ethylene oxide (ETO); onset is typically within the first $20\text{--}30\text{ minutes}$ (frequently within the first $5\text{ minutes}$).

What critical rule must be followed regarding blood return if a patient experiences severe dialyzer syndrome?

Stop dialysis immediately, clamp the bloodlines, and discard both the dialyzer and bloodlines without returning the contained blood to the patient.

What is the hallmark visual sign of acute hemolysis occurring in the extracorporeal circuit?

A port-wine or lacquer red appearance of the blood in the venous line.

Why is it strictly prohibited to return blood to the patient if hemolysis occurs during hemodialysis?

Because hemolyzed blood contains dangerously high concentrations of potassium, which can cause life-threatening hyperkalemia and cardiac arrest.

What medication and maximum dosage are specified for managing persistent intradialytic hypertension?

Catapres $75\,\mu\text{g}$ up to a maximum of $3\text{ doses}$.

What immediate action is required when an Air Detector Alarm sounds on a hemodialysis machine?

Stop treatment immediately, clamp lines to prevent air entry, aspirate air using clamps or syringes, and monitor the patient before resuming treatment.