Dialysis Basics

Posted by e-Medical PPT Saturday, August 18, 2012
Indications
Pericarditis or pleuritis
Progressive uremic encephalopathy or neuropathy (AMS, asterixis, myoclonus, seizures)
Bleeding diathesis
Fluid overload unresponsive to diuretics
Metabolic disturbances refractory to medical therapy (hyperkalemia, metabolic acidosis, hyper- or hypocalcemia, hyperphosphatemia)
Persistent nausea/vomiting, weight loss, or malnutrition
Toxic overdose of a dialyzable drug

Modalities
Peritoneal dialysis
Intermittent hemodialysis
Hemofiltration
Continuous renal replacement therapy

Decision of modality determined by catabolic rate, hemodynamic stability, and whether primary goal is fluid or solute removal

Hemodialysis Apparatus
Dialyzer (cellulose, substituted cellulose, synthetic noncellulose membranes)
Dialysis solution (dialysate – water must remain free of Al, Cu, chloramine, bacteria, and endotoxin)
Tubing for transport of blood and dialysis solution
Machine to power and mechanically monitor the procedure (includes air monitor, proportioning system, temperature sensor, urea sensor to calculate clearance)

Hemodialysis Access
Acute dialysis catheter (vascular catheter, i.e. Quentin catheter)
Cuffed, tunneled dialysis catheter (Permcath)
Arteriovenous graft(AVG)
Arteriovenous fistula (AVF)

Complications of AVF and AVG
Thrombosis
Infection (10% for AVG, 5% for transposed AVF, 2% for non-transposed AVF)
Seromas
Steal (6% of B-C AVF, 1% of R-C AVF)
Aneurysms and pseudoaneurysms (3% of AVF, 5% of AVG)
Venous hypertension (usually 2/2 central venous stenosis)
Heart failure (Avoid AVFs in pts with severely depressed LVEF)
Local bleeding
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