Dialysis.

During hemodialysis, how many pints of blood are outside of the body at a time?

1 pint.

What are the three access types for hemodialysis?

1. Arteriovenous (AV) Fistula. 2. Arteriovenous (AV) Graft. 3. Central Venous Catheter (CVC).

What cannot be completed on the arm of an individual with an access port who receives dialysis?

1. Blood Pressures. 2. IVs. 3. Blood Draws.

What is the simplified step-by-step process of hemodialysis?

1. Blood flows to the dialyzer. 2. Hemodialyzer filters the blood. 3. Blood flows back into the body.

What two sounds should you hear or feel over a fistula or graft of a person on hemodialysis?

1. Bruit. 2. Thrill.

What two things should you check the client for prior to undergoing dialysis?

1. Bruit. 2. Thrill.

What are some foods that are high in phosphates?

1. Dark Colas. 2. Whole Grains. 3. Meat. 4. Dairy. 5. Nuts. 6. Beans.

What are the causes of end stage renal disease?

1. Diabetes. 2. Hypertension. 3. Glomerulonephritis 4. Other causes: infection, stones, inherited disease, autoimmune disorders, and birth defects.

What is another name for dialysate?

1. Dialysis fluid. 2. Bath.

What are the functions/purposes of hemodialysis?

1. Filters waste. 2. Removes extra fluid. 3. Balances electrolytes.

What are some common medications given during hemodialysis?

1. Heparin. 2. Venofer. 3. Epogen. 4. Hectorol. 5. ABX.

Where can peritoneal dialysis treatments be performed?

1. Home. 2. Work. 3. While on vacation. *Can be completed really anywhere.

What are some of the potential complications of hemodialysis?

1. Hypotension. 2. Syncope. 3. Vomiting. 4. Headaches. 5. Muscle Cramping. 6. Cardiac Arrest. 7. Air Embolism. 8. DDS (dialysis disequilibrium syndrome).

What are examples of some of the other, less common, causes of end stage renal disease (ESRD)?

1. Infections. 2. Stones. 3. Inherited Diseases. 4. Autoimmune Disorders. 5. Birth Defects.

What are the signs and symptoms of DDS?

1. Irritability. 2. Confusion. 3. Blurred Vision. 4. Seizures. 5. Death.

What are the benefits of peritoneal dialysis?

1. Needle free. 2. Flexible. 3. Treatments can be performed anywhere. 4. Can help to preserve remaining kidney function. 5. Has a more liberal diet. 6. Less fluid restrictions.

What occurs after hemodialysis treatment?

1. Needles are removed and most patients hold their sites for 10-15 minutes. 2. Bandages are applied. 3. Vital signs are taken post hemodialysis. 4. A physical assessment is completed. 5. Weight is taken in order to determine whether the dry weight was achieved.

What are the two types of dialysis?

1. Peritoneal Dialysis (PD). 2. Hemodialysis.

What are the two types of dialysis?

1. Peritoneal Dialysis. 2. Hemodialysis.

What is in dialysate?

1. Pure water. 2. Electrolytes. 3. Salts.

What are the two vital functions that dialysis replaces?

1. Removal of fluid. 2. Filtering of bodily toxins.

What are the disadvantages of peritoneal dialysis?

1. Requires a permanent abdominal catheter; the catheter can cause some body image/appearance issues. 2. No swimming in public pools or lakes (ocean is okay). 3. Has to be performed daily. 4. Having had a previous abdominal surgery can cause adhesions from forming and peritoneal dialysis is not an option.

What electrolytes does hemodialysis balance?

1. Sodium. 2. Potassium. 3. Bicarbonate. 4. Chloride. 5. Calcium. 6.Magnesium. 7. Phosphate.

Which antibiotics are normally administered during hemodialysis?

1. Vanco. 2. Ancef. 3. Gentamycin.

What assessments are completed each tie prior to hemodialysis being completed?

1. Weight. 2. Blood Pressure. 3. Temperature. 4. Heart and Lung Sounds. 5. Inspection for edema. 6. Check for bruit and thrill (make sure is present).

How many pints of blood does the average person have?

10-12 pints.

How long should patients hold their sites for after the needles from hemodialysis are removed?

10-15 minutes.

How long is the average hemodialysis treatment?

3-4 hours.

When is a CVC usually placed?

A CVC is usually placed emergently and temporarily.

What type of feeling does a thrill cause?

A buzzing sensation that is felt with the fingers over the fistula/graft.

What could occur if you position a patient on their access port?

A clot.

What should be placed on the limb of a client who receives dialysis?

A limb alert.

What is a dialyzer?

A man-made membrane; AKA artificial kidney; filters the blood in hemodialysis.

Someone on peritoneal dialysis cannot swim in what types of water?

A pool or lake.

What is DDS?

A rare problem that can occur in new patients and children that consists of irritability, confusion, blurred vision, seizures, and even death.

What does an AVF create?

A super vein.

What is the peritoneal membrane?

A thin membrane that lines the abdomen.

What is hemodialysis?

A treatment that replaces kidney function; a therapy that filters waste, removes extra fluid, and balances electrolytes.

Why is Hectorol administered during hemodialysis?

A type of synthetic vitamin D that helps to control high levels of parathyroid hormone (PTH).

What is ultrafiltration?

A variety of membrane filtration in which hydrostatic pressure forces a liquid against a semipermeable membrane; a solution moves by pressure gradient.

What is a CVC?

A vascular access device that is placed emergently and temporarily into a large vessel in the neck or chest when a patient falls ill.

What kind of sound does a bruit make?

A whooshing sound that is heard with a stethoscope over the fistula/graft.

What does the absence of a thrill over a fistula or graft indicate?

Absence means that the access is clotted.

What is the dialyzer also called?

Also called the artificial kidney.

What is an AVG?

An Arteriovenous graft; a piece of man-made tubing placed under the skin that connects to an artery to a vein; can also be transplanted animal (bovine) vessels.

What is necessary to perform hemodialysis?

An access needs to be created to get the blood from the body into the dialyzer and back to the body.

What is the vascular access type most recommended by the dialysis community?

Arteriovenous (AV) Fistula.

What vascular access method is considered the gold standard and preferred access site for hemodialysis?

Arteriovenous Fistula (AVF).

What is an AVF?

Arteriovenous Fistula.

What is an AVF?

Arteriovenous Fistula; a direct connection between an artery and a vein, essentially creating a super vein; considered the gold standard and preferred access.

What is an AVG?

Arteriovenous Graft.

Why is the dialyzer called the artificial kidney?

Because it filters the blood, which is a job that the kidneys used to do before they began improperly working.

Why would I&O's be off for individuals who are on dialysis?

Because many of them no longer make urine.

At what percentage of kidney function would dialysis be started?

Below 15th.

What is blood monitored for during hemodialysis?

Blood is monitored for air in order to prevent embolism.

How does hemodialysis work?

Blood is removed from the body and filtered through the dialyzer. Filtered blood is then returned to the body.

What does CVC stand for?

Central Venous Catheter.

What could changes in the pitch of a bruit indicate?

Changes in the pitch of a bruit could represent narrowing or stenosis.

What should you always do before and after you use your stethoscope?

Clean it.

If you have a client on dialysis who received new prescriptions, what should you do prior to administering them?

Contact the pharmacist or the nephrologist in order to determine that they are safe to administer and not nephrotoxic.

What is the name of the dialysis solution used in peritoneal dialysis?

Dialysate.

What does DDS stand for?

Dialysis disequilibrium syndrome?

Why is dialysis required in end stage renal disease?

Dialysis is required to sustain life.

When is dialysis required in end stage renal disease?

Dialysis is required when more than 90% of kidney function has been lost.

What is peritoneal dialysis?

Diaylsis performed within the body; the peritoneal cavity holds the dialysate and the peritoneum acts as a filter.

What is diffusion?

Diffusion is when a solvent moves by concentration gradient to an area of higher concentration to an area of lower concentration.

By what mechanism is the waste removed from the body in dialysis?

Diffusion.

By which mechanism does dialysate work?

Diffusion.

What principle allows peritoneal dialysis to work?

Diffusion.

What should you not be in a rush to do after the client is finished with dialysis?

Don't be in a risk to feed them; there is glucose in the dialysate solution.

What is the dry weight?

Dry weight is a target weight prescribed by he nephrologist where at the end of a hemodialysis treatment, the BP is within normal limits, the lungs are clear, and there is no peripheral edema.

What does ESRD stand for?

End Stage Renal Disease (ESRD).

What is Epogen?

Eryhthropoietin hormone.

How often is peritoneal dialysis performed?

Everyday; daily.

What can be heard prior to starting dialysis when listening tot he heart and lungs?

Extra fluid in the lungs/around the heart.

Where are fluid and waste from hemodialysis drained into?

Fluid and waste are emptied into a drain behind the hemodialysis machine.

What type of restriction will many clients on dialysis be on?

Fluid restriction.

What types of food should you avoid giving to an individual on dialysis?

Foods high in phosphorus.

Which food groups are generally high in potassium?

Fruits and vegetables.

Why is Heparin administered during hemodialysis?

Given to prevent clotting in the extra corporeal circuit (aka the lines and the tubing)

What is the ingredient in peritoneal dialysate?

Glucose.

What is the solution used in peritoneal dialysis?

High glucose solution, which dwells in the peritoneal cavity and gathers toxins to later be flushed out.

What assessment will be off in individuals on dialysis?

I&Os.

Where does peritoneal dialysis take place?

In the client's peritoneal cavity.

What is Venofer?

Iron.

Why is Venofer administered during hemodialysis?

Is iron so that Epogen is able to work adequately.

What does the peritoneal membrane allow to pass?

It allows waste and excess fluid to pass.

Why should bandages be removed from the vascular access sites by the following day at the latest?

It can promote bacteria growth and cause infection.

Why is kidney dialysis necessary?

It is necessary to clean the blood and remove toxins from the body.

How long is a CVC used for?

It is usually temporary.

What shouldn't dialysis be called and what should it be called instead?

It shouldn't be called dialysis; it should be called life-alysis.

Why is Epogen administered during hemodialysis?

It stimulates the bone marrow to produce red blood cells.

How is kidney function affected by peritoneal dialysis?

Kidney function doesn't cease.

What does hemodialysis treatment replace?

Kidney function.

What does the semipermeable membrane contain?

Microscopic holes that allow only some substances to cross the membrane.

Can you get a CVC wet?

No. You are unable to get a CVC wet, even in the shower.

Do AVGs need time to mature?

No; they do not need time to mature.

Someone on peritoneal dialysis can swim in what types of water?

Ocean.

What symptom will patients exhibit after receiving dialysis?

Patient will be sleepy.

What does PD stand for?

Peritoneal Dialysis.

Which type of dialysis involves the kidney function not ceasing?

Peritoneal Dialysis.

How does peritoneal dialysis work?

Peritoneal dialysis uses the peritoneal membrane to filter the waste and fluid from the bloodstream.

In which type of dialysis does the kidney function not cease?

Peritoneal dialysis.

What medication must clients on dialysis take?

Phosphate binders.

What does glucose in peritoneal dialysate do?

Pulls/gathers/attracts the toxins within the body so that they can be later flushed out.

What can peritoneal dialysis help preserve?

Remaining kidney function.

What type of diet is an individual place on who is on dialysis?

Renal Diet; could possibly by on a cardiac and/or diabetic diet as well.

What do most patients do during hemodialysis treatments?

Sleep or watch TV.

What is ultrafiltration like?

Soaking up fluid with a sponge and then squeezing it under pressure to remove the fluid from it.

At what GFR are children placed on the kidney transplant list?

Stage 3 or a GFR of <30.

At what GFR is an adult listed on a kidney transplant list?

Stage 5 or a GFR of <15.

What does the blue needle do in cannulation?

The blue needle returns cleaned blood back to the patient.

Once the concentration in the peritoneal cavity is equal, what happens?

The dialysate is drained externally and fresh dialysate is added to keep attracting the toxins.

What does the dialyzer look like?

The dialyzer is a long hollow plastic tube that is about a foot long and three inches in diameter; it contains many tiny fibers that filter out the blood; there are two sections-the section for the dialysate and the section for the blood; the two sections are divided by a semipermeable membrane so that the contents for the two sections don't mix together; the semipermeable membrane between the two sections allows only some substances to cross the membrane; the membrane allows water and water to pass though, but doesn't allow blood cells to pass through.

What is the key to dialysis?

The dialyzer.

How does the diet of peritoneal dialysis differ from that of the diet guidelines of hemodialysis?

The diet of peritoneal dialysis patients is much more liberal; there are also less fluid restrictions.

How is an estimated dry weight calculated?

The estimated dry weight is the client's current weight prior to hemodialysis compared to the dry weight that the nephrologist determines; the difference between the two is the goal of fluid reduction of the dialysis treatment.

What occurs when dialysate is placed in the abdomen in peritoneal dialysis?

The glucose in the dialysate pulls waste and fluid from the blood vessels that pass through the peritoneum.

What does the glucose in peritoneal dialysis do?

The glucose in the dialysate pulls waste and fluid from the blood vessels that pass through the peritoneum; prevents the waste and fluid from passing back through the peritoneum.

What is another name for the extra corporeal circuit?

The lines and tubing.

What is diffusion?

The movement of molecules from an area of higher concentration to an area of lower concentration.

Who determines the dry weight?

The nephrologist.

How long after placement should the bandages be removed after hemodialysis?

The next day at the latest, but ideally removed within a few hours.

Where does the dialysate in peritoneal dialysis go into?

The peritoneal cavity.

How permeable is the peritoneal membrane?

The peritoneal membrane is semipermeable.

What is used as the filter in peritoneal dialysis?

The peritoneal membrane.

What acts as a filter in peritoneal dialysis?

The peritoneum.

What else should be monitored every 30 minutes in addition to the vital signs?

The pressure reading from inside the vascular access point.

What is cannulation?

The process by which two needles are inserted into the vascular access for hemodialysis to remove the blood to be cleaned and return cleaned blood back into the body.

What is the purpose of dialysate?

The purpose of dialysate is to pull toxins from the blood into the dialysate to remove waste from the blood.

What does the red needle do in cannulation?

The red needle removes the dirty blood and takes it to the machine to be cleaned.

What must remain visible at all times during hemodialysis?

The vascular access point.

How does dialysate work?

There is a high concentration of waste in the blood of the client and there is a low concentration of waste in the dialysate. Using the principle of diffusion, the waste moves through the semipermeable membrane to create an equal amount of both sides.

What is the risk of infection with a CVC?

There is a high rate of infection.

What limitation does an individual undergoing peritoneal dialysis have to adhere to?

They cannot swim in a pool or a lake, however, they can swim in the ocean.

What does an AVF require?

Time to mature.

Why must the vascular access remain visible during hemodialysis?

To be assessed for bleeding.

How many needles are used in cannulation?

Two needles.

By which mechanism is waste removed in dialysis?

Ultrafiltration.

What is required in order for Epogen to work properly?

Venofer (iron).

How often are vital signs monitored during hemodialysis treatments?

Vital signs should be monitored every 30 minutes.

When would peritoneal dialysis not be an option?

When the client had a previous abdominal surgery and adhesions can form, making peritoneal dialysis not an option.

When/how should phosphate binders be taken?

With the first bite of food.

Where is peritoneal dialysis performed?

Within the body; in the peritoneal cavity.

Should you hear or feel a thrill?

You should feel a thrill.

Should you hear or feel a bruit?

You should hear a bruit.

What should you not do to a patient right before dialysis?

You shouldn't feed them; there is glucose in the dialysate solution.