Based on the information provided:
- Mr. Jackson was admitted for hypotension during dialysis and now has a fever
- This raises concern for possible infection, such as line infection
- As the intern on call, I would:
1. Review the admission note and labs/cultures drawn so far
2. Perform a focused exam looking for signs of infection
3. Draw blood cultures and consider changing the line
4. Start empiric antibiotics for line infection
5. Notify the nephrology team and discuss management
The key issues are evaluating for possible infection as the cause of fever, reviewing previous workup, examining the patient, and involving the nephrology team for guidance on next steps.
Dialysis is used to treat kidney failure and manage its complications. There are different modalities including peritoneal dialysis, hemodialysis, and continuous renal replacement therapy. Hemodialysis uses a dialyzer, tubing, and machine to remove waste and fluid by diffusion and ultrafiltration as blood and dialysate flow countercurrently. Vascular access includes catheters, arteriovenous grafts, and arteriovenous fistulas. Complications can include infections, thrombosis, and fluid overload.
This document discusses hemodialysis for acute kidney injury (AKI). It provides information on:
1. Hemodialysis is a form of renal replacement therapy that uses a dialyzer and extracorporeal circuit to partially replace kidney functions like fluid balance and waste removal when kidney function is insufficient.
2. The decision to start renal replacement therapy like hemodialysis for AKI is based on clinical signs of issues like volume overload or biochemical abnormalities rather than single thresholds, though emergencies require immediate dialysis.
3. The optimal timing of dialysis initiation for AKI is unclear, but observational studies suggest earlier initiation may improve outcomes compared to waiting for more severe clinical indications.
Dialysis various modalities and indices usedAbhay Mange
Dialysis is a process used to remove waste and excess water from the blood of patients with kidney failure. There are various modalities of dialysis including intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and ultrafiltration across a semi-permeable membrane in a dialyzer to clean the blood. Proper vascular access and anticoagulation are also important aspects of hemodialysis treatment.
Dialysis is a process that removes waste and excess fluid from the body when the kidneys are not functioning properly. It usually requires a team including a doctor, nurse, and the patient. There are different types of dialysis including peritoneal dialysis which uses the peritoneum and exchanges fluid through a catheter, and hemodialysis which pumps blood out of the body to a machine that filters it before returning it. Hemodialysis is often needed when kidney function drops below 10-15% and usually occurs 3 times a week for 3-4 hours each time. Complications can include low blood pressure, infection, bleeding, and heart problems.
Indications of renal replacement therapyBimal khadka
1. The document discusses the history of hemodialysis and kidney transplantation, beginning with the first hemodialysis treatment in 1924 and the first documented kidney transplant in 1950 in the US.
2. It then covers the development of dialysis therapy and renal replacement therapy, including the first successful kidney transplant between identical twins in 1954.
3. Key aspects of dialysis therapy methods like hemodialysis and peritoneal dialysis are described, along with indications for starting renal replacement therapy and complications of transplantation.
This document summarizes renal replacement therapy modalities. It discusses that acute kidney injury affects 5% of hospitalized patients and increases mortality. The main renal replacement therapies are hemodialysis, peritoneal dialysis, and continuous renal replacement therapies. Hemodialysis removes water and solutes across a semipermeable membrane via diffusion and convection. Peritoneal dialysis utilizes the peritoneal membrane for solute and fluid removal. Choice of modality depends on patient factors and available resources. The goal of renal replacement therapy is to control fluid, electrolyte, and acid-base disturbances while providing adequate solute clearance.
Dialysis is a treatment that replaces kidney function by removing waste and excess fluid from the blood. It is commonly prescribed for those with temporary or permanent kidney failure, as their kidneys cannot remove fluids from the body. There are two main types of dialysis - hemodialysis, which circulates blood outside the body through a machine, and peritoneal dialysis, which uses the lining of the abdomen as a filter through a surgically implanted catheter. Dialysis is the primary treatment option for end stage renal disease besides kidney transplantation.
The document provides historical background on the development of peritoneal dialysis (PD) and outlines its use in acute kidney injury (AKI). It discusses:
1. The first experiments using the peritoneal cavity for uremia removal in the 1920s.
2. The development of intermittent PD in the 1960s and continuous ambulatory PD in the 1970s.
3. Evidence that high doses of continuous PD can provide appropriate metabolic control in AKI, with survival and renal recovery rates similar to other renal replacement therapies.
4. Indications for acute PD include hemodynamic instability and bleeding risks, while contraindications include recent abdominal surgery and severe peritonitis.
Dialysis is used to treat kidney failure and manage its complications. There are different modalities including peritoneal dialysis, hemodialysis, and continuous renal replacement therapy. Hemodialysis uses a dialyzer, tubing, and machine to remove waste and fluid by diffusion and ultrafiltration as blood and dialysate flow countercurrently. Vascular access includes catheters, arteriovenous grafts, and arteriovenous fistulas. Complications can include infections, thrombosis, and fluid overload.
This document discusses hemodialysis for acute kidney injury (AKI). It provides information on:
1. Hemodialysis is a form of renal replacement therapy that uses a dialyzer and extracorporeal circuit to partially replace kidney functions like fluid balance and waste removal when kidney function is insufficient.
2. The decision to start renal replacement therapy like hemodialysis for AKI is based on clinical signs of issues like volume overload or biochemical abnormalities rather than single thresholds, though emergencies require immediate dialysis.
3. The optimal timing of dialysis initiation for AKI is unclear, but observational studies suggest earlier initiation may improve outcomes compared to waiting for more severe clinical indications.
Dialysis various modalities and indices usedAbhay Mange
Dialysis is a process used to remove waste and excess water from the blood of patients with kidney failure. There are various modalities of dialysis including intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and ultrafiltration across a semi-permeable membrane in a dialyzer to clean the blood. Proper vascular access and anticoagulation are also important aspects of hemodialysis treatment.
Dialysis is a process that removes waste and excess fluid from the body when the kidneys are not functioning properly. It usually requires a team including a doctor, nurse, and the patient. There are different types of dialysis including peritoneal dialysis which uses the peritoneum and exchanges fluid through a catheter, and hemodialysis which pumps blood out of the body to a machine that filters it before returning it. Hemodialysis is often needed when kidney function drops below 10-15% and usually occurs 3 times a week for 3-4 hours each time. Complications can include low blood pressure, infection, bleeding, and heart problems.
Indications of renal replacement therapyBimal khadka
1. The document discusses the history of hemodialysis and kidney transplantation, beginning with the first hemodialysis treatment in 1924 and the first documented kidney transplant in 1950 in the US.
2. It then covers the development of dialysis therapy and renal replacement therapy, including the first successful kidney transplant between identical twins in 1954.
3. Key aspects of dialysis therapy methods like hemodialysis and peritoneal dialysis are described, along with indications for starting renal replacement therapy and complications of transplantation.
This document summarizes renal replacement therapy modalities. It discusses that acute kidney injury affects 5% of hospitalized patients and increases mortality. The main renal replacement therapies are hemodialysis, peritoneal dialysis, and continuous renal replacement therapies. Hemodialysis removes water and solutes across a semipermeable membrane via diffusion and convection. Peritoneal dialysis utilizes the peritoneal membrane for solute and fluid removal. Choice of modality depends on patient factors and available resources. The goal of renal replacement therapy is to control fluid, electrolyte, and acid-base disturbances while providing adequate solute clearance.
Dialysis is a treatment that replaces kidney function by removing waste and excess fluid from the blood. It is commonly prescribed for those with temporary or permanent kidney failure, as their kidneys cannot remove fluids from the body. There are two main types of dialysis - hemodialysis, which circulates blood outside the body through a machine, and peritoneal dialysis, which uses the lining of the abdomen as a filter through a surgically implanted catheter. Dialysis is the primary treatment option for end stage renal disease besides kidney transplantation.
The document provides historical background on the development of peritoneal dialysis (PD) and outlines its use in acute kidney injury (AKI). It discusses:
1. The first experiments using the peritoneal cavity for uremia removal in the 1920s.
2. The development of intermittent PD in the 1960s and continuous ambulatory PD in the 1970s.
3. Evidence that high doses of continuous PD can provide appropriate metabolic control in AKI, with survival and renal recovery rates similar to other renal replacement therapies.
4. Indications for acute PD include hemodynamic instability and bleeding risks, while contraindications include recent abdominal surgery and severe peritonitis.
This seminar presentation provides an overview of continuous renal replacement therapy (CRRT). CRRT is a slow, continuous blood purification therapy that mimics kidney function for patients with kidney failure who are hemodynamically unstable. The presentation defines CRRT and discusses its principles, indications, features, types including CVVH, CVVHD and CVVHDF, vascular access requirements, dialysate fluids, the CRRT process, nursing management, complications and conclusions. A research study is also summarized that found comparable survival outcomes between acute peritoneal dialysis and CRRT for hemodynamically unstable patients requiring renal replacement therapy.
The document discusses continuous renal replacement therapy (CRRT) in critical care units. It begins with definitions and history of renal replacement therapy. It then covers principles, techniques, applications, results and complications of CRRT. The techniques discussed include continuous venovenous hemofiltration (CVVH), hemodialysis (CVVHD) and hemodiafiltration (CVVHDF). Advantages include hemodynamic stability, precise volume control and removal of toxins and cytokines. Complications can include bleeding, infection and electrolyte imbalances. CRRT remains the preferred technique for critically ill patients with acute kidney injury in many intensive care settings.
Acute renal replacement therapy (RRT) is indicated for acute kidney injury (AKI) with severe complications such as hyperkalemia, acidosis, or fluid overload. Other indications include toxic ingestions that can be cleared by RRT like toxic alcohols, lithium, and salicylates. RRT may also be used to manage severe electrolyte imbalances other than from AKI, including sodium levels less than 110 or greater than 160 mmol/L, and hyperthermia over 40°C.
Complications & troubleshooting in continuous renal replacement therapymansoor masjedi
Acute kidney injury is a common and important issue in critical care patients . Among different extra corporeal supporting modalities , continuous renal replacement therapy is a common selection especially in unstable conditions . As any other intervention , there are some related complications that should be diagnosed and treated as early as possible .
Renal replacement therapy encompasses life-supporting treatments for renal failure such as hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and filtration across a semi-permeable membrane to remove waste and fluid. Peritoneal dialysis infuses dialysate into the peritoneal cavity. Continuous renal replacement therapy provides 24-hour treatment through diffusion, convection, or a combination. These therapies aim to replace normal kidney functions of waste removal and fluid balance.
The document discusses several potential complications of hemodialysis, including intradialytic hypotension, dialyzer reactions, disequilibrium syndrome, cramping, air embolism, hemolysis, cardiac arrhythmias, hemorrhage, pruritus, febrile reactions, and hypokalemia. For each complication, the document outlines the etiology, diagnosis, treatment, and prevention strategies.
Process where the solute composition of a solution A is altered by exposing solution A to a second solution(B) through a semi-permeable membrane. Solute transport occurs primarily via diffusion down a concentration gradient or ultrafiltration where water is pushed through the membrane by hydrostatic or osmotic pressure. Dialysis disequilibrium syndrome is a neurological complication that can occur when urea is removed too rapidly from the blood during dialysis, creating a reverse osmotic gradient that draws water into the brain and causes swelling.
Hemodialysis is a process used to remove waste and excess fluid from the blood of patients with kidney failure. During hemodialysis, blood is pumped out of the body and into a dialyzer, where it passes through a semi-permeable membrane that removes toxins and fluid before returning clean blood to the body. Key aspects of hemodialysis include diffusion of wastes out of the blood, osmosis which removes excess water, and ultrafiltration of water under pressure. Patients typically require hemodialysis treatments lasting 4 hours, 3 times per week, either at a dialysis center or at home. Lifestyle management and monitoring for complications are important for patients on chronic hemodialysis
Kidneys normally remove waste and regulate fluids and chemicals in the body. Kidney failure occurs when the kidneys fail to function properly. Dialysis is a treatment that artificially performs the kidneys' functions through diffusion and filtration across a semipermeable membrane. There are two main types of dialysis - hemodialysis which uses an external machine to filter blood, and peritoneal dialysis which uses the peritoneal membrane in the abdomen. Both treatments require vascular access or catheter placement and frequent sessions to sustain life for those with kidney failure.
Peritoneal dialysis by Dr. Basil TumainiBasil Tumaini
Peritoneal dialysis by Dr. Basil Tumaini, prepared for nephrology lecture during the residency in Internal medicine at Muhimbili University of Health and Allied Sciences
Haemodialysis is a medical procedure that removes waste and fluid from the blood using an artificial kidney machine and dialyzer. It was pioneered by Dr. Willem Kolff in 1943. Conditions like acute renal failure and chronic renal failure can necessitate haemodialysis when they lead to acid-base imbalances, electrolyte abnormalities, fluid overload, or uremia. The goals of haemodialysis are solute clearance and fluid removal through diffusion and ultrafiltration across a semi-permeable membrane. It requires a dialyzer, dialysis solution, blood tubing, and a machine. Access points like arteriovenous fistulas and catheters are used to connect the patient's blood to the
This document provides an overview of sustained low-efficiency extended dialysis (SLED). SLED uses a hemodialysis machine with slower blood and dialysate flow rates and a smaller filter over 8-12 hours, often overnight. This allows for less rapid fluid and electrolyte shifts compared to conventional hemodialysis. SLED has similar outcomes to continuous renal replacement therapy but is simpler, cheaper, and easier on nurses. It also allows more time for patient rehabilitation compared to other acute renal replacement therapies.
Continuous renal replacement therapy (CRRT) involves slow, continuous blood filtration and fluid removal to manage fluid overload and provide medication delivery in critically ill patients. It utilizes hemofiltration, hemodialysis, or hemodiafiltration via a semipermeable membrane. Key advantages include hemodynamic stability, precise fluid control, and ability to customize replacement solutions. Clearance depends on filter properties, blood and dialysate flow rates, and drug characteristics like molecular weight and protein binding.
Dialysis dose prescription (the basics) dr ujjawalUjjawal Roy
The document discusses key aspects of dialysis dose prescription, including:
1) Components of the dialysis prescription include dialyzer choice, time, blood and dialysate flow rates, ultrafiltration rate, dialysate composition, temperature, and anticoagulation.
2) Prescription goals are to restore the body's fluid and electrolyte balance and remove waste and excess water from patients with end-stage renal disease.
3) Important considerations for dialysis prescription include a patient's dry weight and risk of intradialytic hypotension.
This document discusses renal replacement therapy (RRT) including the stages of kidney disease, types of dialysis, and access methods. It covers the primary functions of the kidney and consequences of kidney failure. The two main types of RRT are peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the peritoneal membrane as a filter through a catheter, while hemodialysis uses an artificial kidney external to the body with vascular access.
The document discusses factors to consider for a patient's first dialysis session for end-stage renal disease including using heparin-free anticoagulation, limiting fluid removal to 2 liters, using a bicarbonate dialysate, and having skilled medical staff present. It also provides guidelines for initial settings for a first session such as a blood flow rate of 150-200 ml/min, a dialysis time of 60-90 minutes, and a dialysate potassium level of 4-4.5 mmol/L. Precautions are recommended when initiating and terminating dialysis to ensure patient safety.
Osmosis and diffusion play key roles in the kidneys by facilitating the movement of substances like water, nutrients, and waste products. Through osmosis, water and nutrients are transferred from blood in the kidneys into urine for excretion or delivery to cells. Diffusion allows for the movement of toxins, drugs, and other harmful substances out of the blood and into urine. If osmosis and diffusion failed, the kidneys would be unable to filter wastes and regulate water levels, leading to a buildup of toxins in the blood and improper fluid balance in the body.
1. Gene expression can be regulated positively or negatively at the levels of transcription, RNA processing, translation and protein activity through the actions of regulatory proteins and hormones.
2. Hormones like steroids enter cells and bind nuclear receptors to activate transcription, while peptide hormones signal through cell surface receptors and secondary messengers.
3. Key mechanisms of transcriptional control include chromatin remodeling, DNA methylation, and the binding of transcription factors to regulatory sequences which can either promote or block transcription initiation.
This seminar presentation provides an overview of continuous renal replacement therapy (CRRT). CRRT is a slow, continuous blood purification therapy that mimics kidney function for patients with kidney failure who are hemodynamically unstable. The presentation defines CRRT and discusses its principles, indications, features, types including CVVH, CVVHD and CVVHDF, vascular access requirements, dialysate fluids, the CRRT process, nursing management, complications and conclusions. A research study is also summarized that found comparable survival outcomes between acute peritoneal dialysis and CRRT for hemodynamically unstable patients requiring renal replacement therapy.
The document discusses continuous renal replacement therapy (CRRT) in critical care units. It begins with definitions and history of renal replacement therapy. It then covers principles, techniques, applications, results and complications of CRRT. The techniques discussed include continuous venovenous hemofiltration (CVVH), hemodialysis (CVVHD) and hemodiafiltration (CVVHDF). Advantages include hemodynamic stability, precise volume control and removal of toxins and cytokines. Complications can include bleeding, infection and electrolyte imbalances. CRRT remains the preferred technique for critically ill patients with acute kidney injury in many intensive care settings.
Acute renal replacement therapy (RRT) is indicated for acute kidney injury (AKI) with severe complications such as hyperkalemia, acidosis, or fluid overload. Other indications include toxic ingestions that can be cleared by RRT like toxic alcohols, lithium, and salicylates. RRT may also be used to manage severe electrolyte imbalances other than from AKI, including sodium levels less than 110 or greater than 160 mmol/L, and hyperthermia over 40°C.
Complications & troubleshooting in continuous renal replacement therapymansoor masjedi
Acute kidney injury is a common and important issue in critical care patients . Among different extra corporeal supporting modalities , continuous renal replacement therapy is a common selection especially in unstable conditions . As any other intervention , there are some related complications that should be diagnosed and treated as early as possible .
Renal replacement therapy encompasses life-supporting treatments for renal failure such as hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Hemodialysis uses diffusion and filtration across a semi-permeable membrane to remove waste and fluid. Peritoneal dialysis infuses dialysate into the peritoneal cavity. Continuous renal replacement therapy provides 24-hour treatment through diffusion, convection, or a combination. These therapies aim to replace normal kidney functions of waste removal and fluid balance.
The document discusses several potential complications of hemodialysis, including intradialytic hypotension, dialyzer reactions, disequilibrium syndrome, cramping, air embolism, hemolysis, cardiac arrhythmias, hemorrhage, pruritus, febrile reactions, and hypokalemia. For each complication, the document outlines the etiology, diagnosis, treatment, and prevention strategies.
Process where the solute composition of a solution A is altered by exposing solution A to a second solution(B) through a semi-permeable membrane. Solute transport occurs primarily via diffusion down a concentration gradient or ultrafiltration where water is pushed through the membrane by hydrostatic or osmotic pressure. Dialysis disequilibrium syndrome is a neurological complication that can occur when urea is removed too rapidly from the blood during dialysis, creating a reverse osmotic gradient that draws water into the brain and causes swelling.
Hemodialysis is a process used to remove waste and excess fluid from the blood of patients with kidney failure. During hemodialysis, blood is pumped out of the body and into a dialyzer, where it passes through a semi-permeable membrane that removes toxins and fluid before returning clean blood to the body. Key aspects of hemodialysis include diffusion of wastes out of the blood, osmosis which removes excess water, and ultrafiltration of water under pressure. Patients typically require hemodialysis treatments lasting 4 hours, 3 times per week, either at a dialysis center or at home. Lifestyle management and monitoring for complications are important for patients on chronic hemodialysis
Kidneys normally remove waste and regulate fluids and chemicals in the body. Kidney failure occurs when the kidneys fail to function properly. Dialysis is a treatment that artificially performs the kidneys' functions through diffusion and filtration across a semipermeable membrane. There are two main types of dialysis - hemodialysis which uses an external machine to filter blood, and peritoneal dialysis which uses the peritoneal membrane in the abdomen. Both treatments require vascular access or catheter placement and frequent sessions to sustain life for those with kidney failure.
Peritoneal dialysis by Dr. Basil TumainiBasil Tumaini
Peritoneal dialysis by Dr. Basil Tumaini, prepared for nephrology lecture during the residency in Internal medicine at Muhimbili University of Health and Allied Sciences
Haemodialysis is a medical procedure that removes waste and fluid from the blood using an artificial kidney machine and dialyzer. It was pioneered by Dr. Willem Kolff in 1943. Conditions like acute renal failure and chronic renal failure can necessitate haemodialysis when they lead to acid-base imbalances, electrolyte abnormalities, fluid overload, or uremia. The goals of haemodialysis are solute clearance and fluid removal through diffusion and ultrafiltration across a semi-permeable membrane. It requires a dialyzer, dialysis solution, blood tubing, and a machine. Access points like arteriovenous fistulas and catheters are used to connect the patient's blood to the
This document provides an overview of sustained low-efficiency extended dialysis (SLED). SLED uses a hemodialysis machine with slower blood and dialysate flow rates and a smaller filter over 8-12 hours, often overnight. This allows for less rapid fluid and electrolyte shifts compared to conventional hemodialysis. SLED has similar outcomes to continuous renal replacement therapy but is simpler, cheaper, and easier on nurses. It also allows more time for patient rehabilitation compared to other acute renal replacement therapies.
Continuous renal replacement therapy (CRRT) involves slow, continuous blood filtration and fluid removal to manage fluid overload and provide medication delivery in critically ill patients. It utilizes hemofiltration, hemodialysis, or hemodiafiltration via a semipermeable membrane. Key advantages include hemodynamic stability, precise fluid control, and ability to customize replacement solutions. Clearance depends on filter properties, blood and dialysate flow rates, and drug characteristics like molecular weight and protein binding.
Dialysis dose prescription (the basics) dr ujjawalUjjawal Roy
The document discusses key aspects of dialysis dose prescription, including:
1) Components of the dialysis prescription include dialyzer choice, time, blood and dialysate flow rates, ultrafiltration rate, dialysate composition, temperature, and anticoagulation.
2) Prescription goals are to restore the body's fluid and electrolyte balance and remove waste and excess water from patients with end-stage renal disease.
3) Important considerations for dialysis prescription include a patient's dry weight and risk of intradialytic hypotension.
This document discusses renal replacement therapy (RRT) including the stages of kidney disease, types of dialysis, and access methods. It covers the primary functions of the kidney and consequences of kidney failure. The two main types of RRT are peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the peritoneal membrane as a filter through a catheter, while hemodialysis uses an artificial kidney external to the body with vascular access.
The document discusses factors to consider for a patient's first dialysis session for end-stage renal disease including using heparin-free anticoagulation, limiting fluid removal to 2 liters, using a bicarbonate dialysate, and having skilled medical staff present. It also provides guidelines for initial settings for a first session such as a blood flow rate of 150-200 ml/min, a dialysis time of 60-90 minutes, and a dialysate potassium level of 4-4.5 mmol/L. Precautions are recommended when initiating and terminating dialysis to ensure patient safety.
Osmosis and diffusion play key roles in the kidneys by facilitating the movement of substances like water, nutrients, and waste products. Through osmosis, water and nutrients are transferred from blood in the kidneys into urine for excretion or delivery to cells. Diffusion allows for the movement of toxins, drugs, and other harmful substances out of the blood and into urine. If osmosis and diffusion failed, the kidneys would be unable to filter wastes and regulate water levels, leading to a buildup of toxins in the blood and improper fluid balance in the body.
1. Gene expression can be regulated positively or negatively at the levels of transcription, RNA processing, translation and protein activity through the actions of regulatory proteins and hormones.
2. Hormones like steroids enter cells and bind nuclear receptors to activate transcription, while peptide hormones signal through cell surface receptors and secondary messengers.
3. Key mechanisms of transcriptional control include chromatin remodeling, DNA methylation, and the binding of transcription factors to regulatory sequences which can either promote or block transcription initiation.
18 Use Of Peritoneal Dialysis For The Treatment Of Acute Renal FailureDang Thanh Tuan
1) Acute peritoneal dialysis (PD) is an option for treating selected acute renal failure patients, especially those who are hemodynamically unstable or have coagulation abnormalities.
2) A study compared PD to hemofiltration for acute renal failure patients with malaria or sepsis in Vietnam and found that hemofiltration corrected metabolic abnormalities faster and had lower mortality.
3) The poorer outcomes with PD may have been due to its less optimal technique in this setting, with slower solute removal compared to hemofiltration.
Dialysis is a process that removes waste and excess water from the blood when the kidneys fail. It uses the peritoneum as a natural membrane to remove wastes and water from the blood into a dialysate solution in the abdominal cavity. There are two main types of peritoneal dialysis - continuous ambulatory peritoneal dialysis (CAPD) which is done manually throughout the day, and automated peritoneal dialysis (APD) which uses a machine at night. The peritoneal dialysis procedure involves infusing dialysate into the abdominal cavity, allowing it to dwell to enable diffusion and osmosis, then draining the used fluid and repeating the cycles. Nursing care focuses on infection prevention, assessing
This document discusses continuous renal replacement therapy (CRRT). It begins by defining CRRT as any extracorporeal blood purification therapy intended to substitute for impaired renal function over an extended period of 24 hours per day. The document then discusses the reasons for CRRT, including removal of waste products, fluid, regulation of electrolytes and acid-base balance, prevention of further kidney damage, and hemodynamic stability. It provides examples of how CRRT can help in conditions like acute renal failure, congestive heart failure, sepsis, rhabdomyolysis, and intoxications by closely mimicking the functions of the native kidney over a continuous period of time.
Khaled El Masry, is an assistant Lecturer of Human Anatomy & Embryology, Mansoura University, Egypt. Great thanks to Prof. Dr Salwa Gawish, professor of Cytology & Histology, Mansoura University, for her great effort in explaining Genetics course.
This document provides an overview of chronic kidney failure (CKF), including its definition, classification, incidence, etiology, clinical presentation, investigations, management, complications, and references. Some key points include:
CKF is a progressive decrease in renal function over 3 months or more, leading to accumulation of waste and electrolyte abnormalities. Diabetes and hypertension are the leading causes of CKF. Treatment options for CKF include dialysis, renal transplant, or conservative management. Dialysis can be done through hemodialysis or peritoneal dialysis. Renal transplant provides the best outcomes for patients compared to long-term dialysis.
Dialysis refers to the diffusion of molecules through a semipermeable membrane from an area of higher concentration to lower concentration. It serves to maintain fluid, electrolyte, and acid-base balance and remove toxins as a substitute for some kidney functions. The two main types are hemodialysis, which cleans the blood using an external dialysis machine, and peritoneal dialysis, which uses the peritoneal membrane. Hemodialysis requires vascular access via an arteriovenous fistula, graft, or catheter and involves passing blood through a dialyzer to remove waste using countercurrent dialysate flow. Nursing care focuses on monitoring patients during and after treatment and educating on access care.
This document provides information about dialysis including hemodialysis and peritoneal dialysis. It defines dialysis as a procedure that substitutes for kidney function by filtering and cleaning the blood. It discusses the types of dialysis as well as the principles, indications, equipment, procedures, complications, nursing management and lifestyle considerations for patients undergoing hemodialysis or peritoneal dialysis.
Hemodialysis is a medical procedure that uses a machine to filter waste and excess fluid from the blood of patients with kidney failure or injury. During hemodialysis, the patient's blood is pumped through a dialyzer filter to remove toxins and regulate electrolyte and mineral levels before being returned. It helps control symptoms but is not a cure for kidney disease. Vascular access is required, either through an arteriovenous fistula, graft, or temporary catheter placed in the subclavian, jugular, or femoral vein. Precise regulation of dialysate solutions, blood flow rates, and treatment time is needed to safely remove waste while avoiding complications.
The document discusses dialysis as a renal replacement therapy for patients with kidney failure or injury. It describes the process of diffusion and ultrafiltration that occurs during hemodialysis and peritoneal dialysis to remove waste and excess fluid. Complications related to each type of dialysis are also outlined. Nursing considerations are provided for pre-dialysis assessment, monitoring patients during treatment, and post-dialysis care.
ARTIFICIAL KIDNEY , DIALYSIS AND RENAL TRANSPLANT.pptPandian M
This document discusses dialysis, artificial kidneys, and renal transplantation. It begins by outlining the objectives and providing definitions of dialysis and indications for when it is needed, both acutely and chronically. It then describes the two main types of dialysis - hemodialysis, which uses an artificial kidney machine, and peritoneal dialysis, which uses the peritoneum. The principles, procedures, requirements, compositions and potential complications of each type of dialysis are explained in detail. Finally, the document covers renal transplantation as the treatment of choice for end-stage renal disease, outlining the benefits, risks, types of donors, compatibility testing, immunosuppressant drugs used, and the transplantation procedure and potential
Hemodialysis is a medical procedure that removes waste and excess fluid from the blood. It involves filtering the patient's blood through a dialyzer, which acts as a semipermeable membrane. Wastes and fluid move from the blood to a dialysate solution through diffusion, osmosis, and ultrafiltration. Proper nursing management is needed to minimize complications and infections from the procedure, which is often needed long-term or permanently for patients with kidney disease.
This document provides an overview of peritoneal dialysis and hemodialysis. It discusses the definition and indications for dialysis, as well as complications. Nursing care is described for patients undergoing hemodialysis, including pre-dialysis assessment and preparation, care during dialysis to monitor for common complications like hypotension, and post-dialysis care after the treatment has ended. The role of nurses is emphasized in properly caring for patients throughout the hemodialysis process.
The document provides guidance on fluid management for emergency laparotomy patients. It emphasizes the importance of aggressive preoperative resuscitation to correct dehydration, hypovolaemia, hypoxia and acidosis in order to reduce high peri-operative mortality rates. The protocol involves structured clinical assessment, measurement of vital signs and urine output, and administration of IV fluids and electrolytes to optimize the patient's condition prior to anesthesia and surgery. Goals of preoperative resuscitation are to provide adequate tissue perfusion without harming the patient.
IV or intravenous (in-trah-VEE-nus) therapy is a way to give fluids, medicine, nutrition, or blood directly into the blood stream through a vein. IV therapy uses a type of tiny plastic tubing (cannula) that goes into the vein, a needle, and plastic tubing that connects the set-up to a bag of fluid. All together, the pieces are called an “IV.” Intravenous (IV) therapy is administering fluids directly into a vein. It benefits treatment by enabling water, medication, blood, or nutrients to access the body faster through the circulatory system.
This document discusses the management of acute renal failure. It covers various modalities for managing ARF requiring dialysis including peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapies. It describes the indications, contraindications, procedures and complications of peritoneal dialysis. It also discusses hemodialysis, continuous renal replacement therapies like CVVH, and SLEDD. The outcome of ARF depends on the underlying cause and severity of renal injury. Special considerations for managing ARF in newborns are also provided.
Dialysis types, procedure advantage and disadvantageJanviPatel106
This document discusses different types of dialysis, including hemodialysis and peritoneal dialysis. It outlines the procedures for each type and their advantages and disadvantages. Hemodialysis involves using a machine to filter blood outside the body through a semipermeable membrane, while peritoneal dialysis uses the peritoneum as a membrane. Both have benefits like improved quality of life but also risks like infection. The choice depends on factors like independence, lifestyle, and a patient's medical situation.
Dialysis is a procedure that substitutes for kidney function by cleaning and filtering the blood. There are different types of dialysis used to treat both acute and chronic kidney failure. Hemodialysis is the most common method and involves using an artificial kidney machine to remove waste through diffusion, osmosis, and ultrafiltration across a semipermeable membrane. A vascular access such as a catheter, arteriovenous fistula, or graft is required to access the bloodstream during hemodialysis treatments. Complications can include infections, stenosis, thrombosis, and aneurysm formation if not properly cared for.
Portal hypertension results from increased resistance to blood flow through the liver and can cause dangerous complications like variceal bleeding and ascites. The most common cause is cirrhosis which scars and narrows vessels in the liver. Initial presentations may be asymptomatic but can include gastroesophageal varices, ascites, and splenomegaly. Prevention and treatment of variceal bleeding involves beta blockers, band ligation, and as a last resort transjugular intrahepatic portosystemic shunt placement. Ascites is treated through dietary sodium restriction, diuretics, and paracentesis while spontaneous bacterial peritonitis requires antibiotics.
Portal hypertension results from increased resistance to blood flow through the liver and can cause dangerous complications like variceal bleeding and ascites. Variceal bleeding is a major cause of mortality in cirrhosis and requires rapid fluid resuscitation and treatment to stop bleeding, often through vasoactive drugs, endoscopic variceal ligation or transjugular intrahepatic portosystemic shunt placement. Ascites develops due to fluid leakage from blood vessels and impaired fluid regulation, and is treated through dietary sodium restriction, diuretics and paracentesis.
haemodialysis.pptx Best Education Ppt For Use Study502poojan
Haemodialysis is a therapy that filters waste and balances electrolytes from the body through a semipermeable membrane. During haemodialysis, blood is pumped from the body through an artificial kidney called a dialyzer which cleans the blood before returning it. The average treatment lasts 3-4 hours and occurs weekly. The dialyzer contains thousands of tiny hollow fibers that act as semipermeable membranes, allowing waste to pass through into the dialysate solution which is then flushed out while balancing electrolytes in the blood. Preparing vascular access through an arteriovenous fistula or graft is important for efficient blood flow during haemodialysis treatments.
2. Why the boot camp lecture?
Most do not get ample exposure to
patients on hemodialysis during medical
school
Patients on hemodialysis have a different
set of medical problems that are unique to
them.
We’ll try to make this short and simple.
3. Objectives
- Types of Dialysis
- Access
- Acute Indications for Dialysis
- What do I need to know to survive Eckel
- Cases of common admissions and
overnight issues
4. Types of Dialysis That You Should
Be Aware of
1. Hemodialysis
2. Peritoneal dialysis – just be aware of it’s
existence
3. CVVH / CVVHD / CVVHDF – mostly
seen in the ICU setting and can be
grouped into one entity
5. Hemodialysis
Hemodialysis -Dialysis works on the principles of the
diffusion of solutes and ultrafiltration of fluid across a
semi-permeable membrane.
Hemodialysis removes wastes and water by circulating
blood outside the body through an external filter that
contains a semipermeable membrane. The blood flows
in one direction and the dialysate flows in the opposite.
This maximizes the concentration gradient of solutes
between the blood and dialysate
Ultrafiltration occurs by increasing the hydrostatic
pressure across the dialyzer membrane. This usually is
done by applying a negative pressure to the dialysate
compartment of the dialyzer. This pressure gradient
causes water and dissolved solutes to move from blood
to dialysate, and allows the removal of several liters of
fluid
7. Peritoneal Dialysis
Peritoneal dialysis - uses the same principles as before however
rather than extracorpeal membranes, uses patients own peritoneal
membrane to move solutes across. Place dialysate bath into
patient’s abdomen. May have a few patients on this on the Eckel
service
8. CVVH / CVVHD / CVVHDF
WHY SO MANY ACRONYMS????
Continuous veno veno hemofiltration, continuous veno veno hemodialysis,
Continuous veno veno hemodiafiltration
You’ll see this in the ICU setting in patients who have acute renal failure and
volume overload. This basically allows for fluid removal through
ultrafiltration and convection (high to low pressure system) as well as
dialysis for solute removal in patient’s who may not be able to tolerate
intermittent dialysis. Allows for less drastic fluid shifts and hypotension.
Goes on for 24 hours a day. Do to the high volume of ultrafiltrate that is
produced, know that fluid replacement is needed to to restore ideal fluid
balance.
You can either just have
- hemofiltration (no dialysate, replacement fluid, moderate solute removal and
large fluid removal)
- hemodialysis (dialysate, no replacement fluid, large solute removal, less
fluid removal
- combination of both with dialysate and replacement fluid
9. An Attempted diagram to Make you
Understand
Dialysate
Replacement
Fluid
Ultrafiltrate
Pump
Dialysate Pump
Fluid Pump
Hemofilter
Blood Pump
From the Air Detector
Patient
To The Patient
10. One slide on access.
This includes AV fistulas, grafts, temporary lines or permanent central access
lines that are tunneled.
Fistulas are the preferred access type but take 3-6 months to mature. Grafts
are used when you don’t have good veins/arteries next to each other and
they don’t take as long after insertion to use. Complications of these include
thrombosis, infections and aneurisms, and outlet obstruction.
Lines are common with our patients in the hospital because the most common
admission on the eckel service is line infection or probable line infection.
KNOW THEIR ACCESS.
FYI – When you try to order a picc line on a patient who is on dialysis, the
picc line nurse will likely say no and that you need nephrology approval.
This is because picc lines use potential areas for future access so we prefer
not putting them in. If access is really needed for a long period of time, you
can order a tunneled picc line to be put in by IR.
11. Eckel Admissions – Must Know
Mr/Ms ________ is a ____ y/o with a hx of esrd or not (CKD stage __) 2/2 ______ on
hemodialysis _______via ______ at __________
- also know dry weight
- inter-dialysis weight gains
- last dialysis session
- full session or not
- their nephrologist’s name
- nutritional status
- code status
Gold Star - If their admission pertains to missed dialysis session, hypotension during
dialysis, anything to do with dialysis, you can get the flow sheets from the dialysis
center by calling them. They will fax that last few sessions to you and will document
vitals and bp during session, febrile or not, medications that were given during
dialysis.
Know if they get any medications during dialysis such as antibiotics, epogen etc.
12. Now this is getting good. What else?
Give me more, give me more!!
- Dosing of meds - always check renal dosing on medications or HD
dosing. These are not the same as what you usually have to
prescribe. This is important because HD patients do not clear meds
the same way as others might, must check dosing of medications.
- ABX dosing - many abx are given as loading doses and then
dosed after dialysis. Remember common ones such as vanc and
gent which are given as loading doses and then dosed during/after
dialysis depending on vanc or gent levels. (Vanc dosing is usually
20 mg/kg loading and then 500 mg after dialysis, gent is 1.5 - 2
mg/kg loading dose, then 1 mg/kg maintenance)
- Medications not to give to HD patients - fleet enemas, mri gad,
magnesium and phosphate, morphine!
CHECK DOSING, CHECK DOSING, CHECK DOSING
13. Case 1
62 y/o female with pmh of esrd (not initiated on
dialysis yet who is on the transplant list,
(baseline creatinine 7) htn, dm presents from an
osh with complaints of chest pain x 5 days,
generalized fatigue and malaise. Patient on
arrival to UH MICU was unstable with
temperature of 39.0, tachycardia into 140’s,
blood pressure into systolics of 70’s, with
respirations 24. On exam, patient is alert and
oriented, conversive, has flat neck veins, slightly
decreased breath sounds over left base, cv
exam remarkable for tachycardia and no
pericardial rub, no abdominal pain, trace pedal
edema, foley catheter with dark urine.
14. Laboratory evaluation as below.
131 / 104 / 126 /
--------------------- < 117
WBC 10, HGB/ HCT 11.4 / 35.9, PLT 195
5.5 / 7 / 10.9
What more would you like?
- if you asked for a blood gas, ph was 7.07
- Coagulation panel showed inr of 10.2 as patient was on coumadin
What abnormalities do you see on hx, exam, and labs?
- Decreased breath sounds suggesting possible pna
- Vitals signs
- Anion Gap Metabolic Acidosis (as well as a non anion gap metabolic
acidosis)
- Upper limit of normal potassium
- Acute on Chronic Renal Failure
- Hyponatremia (likely hypovolemic hyponatremia)
- Uremia
Does this patient need Dialysis?
15. ACUTE INDICATIONS FOR
DIALYSIS
Creatinine level is not an indication for dialysis
Remember your vowels
- A – Acidosis (metabolic acidosis)
- E - Electrolyte Abnormalities (hyperkalemia)
- I - Ingestants/Toxins (lithium)
- O – Overload (volume overload causing respiratory
distress)
- U – uremia (systemic effects – uremic encephalopathy,
uremic pericarditis)
16. Case 2
Patient is a 42 y/o female with esrd 2/2 lupus nephritis
on HD mwf via left radial av fistula who presents to ED
with compalints of muscle cramps. Vitals signs are
T 36.3 / hr 97 / bp 109/68 / r 20
Exam is significant for 1+ edema b/l in lower extremities.
Laboratory evaluation shows a renal function panel as
below.
132 / 109 / 36
-------------------- 142
6.3 / 22 / 7.3
- What is your next step?
17.
18. Common Admissions
HYPERKALEMIA
Questions to ask
- did they miss a dialysis session
- was their dialysis session cut short - inadequate
dialysis session
- did they eat an extra banana for breakfast - dietary
indiscretion
- any new medications
Follow C a BIG K Drop (Calcium, B-agonist/Bicarbonate,
Insulin, Glucose, Kayexalate, Dialysis)
19. Case 3
Mr. Jackson is a 55 y/o female with esrd 2/2
hypertensive nephrosclerosis on hd t/t/s via right
tunneled ij line who presents from his HD
session with hypotension. Patient’s session was
cut short 2/2 to blood pressure systolic drop into
70 systolic. Currently patient is without
complaints.
- What are the different causes of hypotension
during dialysis?
20. Case 3 Continued
HYPOTENSION during dialysis
- too rapid or excessive fluid removal
removal
- acetate in dialysate
- heat-related vasodilation
- underlying conditions (eg, autonomic
neuropathy, myocardial ischemia,
arrhythmias)
- sepsis
21. Case 3 continued
Mr. Jackson was admitted to the hospital for low
blood pressures. Overnight, Odessa the
secretary on LK40 calls you stating the nurse
just took his temperature and it is 38.4.
You look at your signout and realize you don’t
have a signout on Mr. Jackson. Now what?
You now head over to LK40 to read the admission
note which states that the patient was admitted
for hypotension during dialysis, is usually
hypertensive and now has spiked a temperature.
Patient had a temperature during dialysis of
38.0 based on dialysis flowsheets in the chart.
What are you thinking?
- Could this patient be septic?
- Next steps?
22. Case 3 Continued
You go an examine the patient and notice
vital signs of 38.3 / 110 / 90/60 / 22
On exam of the right tunneled ij, you
noticed some erythema and tenderness at
the line site, no active drainage from the
catheter site?
Now what?
Labs?
Meds?
23. Things that go bump in the
night……
FEVER
- common things common (pneumonia, uti
(make sure they are not anuric), line infections,
diarrhea, osteomyelitis
- Line infection – Make sure you look at the line -
exit site infection, tunnel infection, catheter
related bacteremia.
Treatment options include catheter removal,
change catheter over guide wire, antibiotic locks
and catheter salvage. This depends on the
speciation of the organism.
24. Things that go bump in the
night……
SHORTNESS OF BREATH
Questions to ask
- did they miss a dialysis session
- was their dialysis session cut short - inadequate
dialysis session
If they make urine, you can give trial of diuretic (high
dose lasix or bumex if blood pressure allows)
If they don’t make urine, will they make it to their next
dialysis session
- remember those things that pertain to all patients – PE,
pleural effusions, pna, pericardial effusions (htn
medications)
25. Things that go bump in the
night……
Hypertension – Stuck between a rock and a hard place.
- Treat the hypertension with prn antihypertensives,
increasing the next doses of medications that are
already given.
- Do not want the patient to go into hypertensive
emergency and flash pulmonary edema however the
patient needs adequate blood pressure for perfusion
(normal at higher blood pressures, need to perfuse
access site as well as need adequate blood pressure for
next dialysis session.)
26. Things that go bump in the
night……
Bleeding Post Dialysis
- Not much you can do about this as most
ESRD patients have thrombocytopenia
and platelet dysfunction.
- PRESSURE, PRESSURE, PRESSURE
- In the ICU setting, can consider DDAVP
however not used very often.
27. Things that go bump in the
night……
Low Blood Counts
- You will likely get called on a patient’s morning
CBC by a nurse. This is likely not acute and if it
is, pay attention to next week’s boot camp
lecture by Dr. Tannous on GI bleed.
- Remember in most cases, DO NOT give blood
overnight. Give blood with dialysis. (general rule,
give abx during or after dialysis, give blood
during or after dialysis, get labs during or after
dialysis.
28. Questions?
Remember
- ALWAYS GO ASSESS THE PATIENT
- YOU ARE NEVER ALONE, IF YOU NEED
HELP, CALL YOUR SENIOR
Diffusion describes a property of substances in water. Substances in water tend to move from an area of high concentration to an area of low concentration.[5] special dialysis fluid, flows by the opposite side. A semipermeable membrane is a thin layer of material that contains various sized holes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances (for example, red blood cells, large proteins).[5] The concentrations of solutes (for example potassium, phosphorus, and urea) are undesirably high in the blood, but low or absent in the dialysis solution and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of minerals like potassium and calcium that are similar to their natural concentration in healthy blood. For another solute, bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of bicarbonate into the blood, to act as a pH buffer to neutralize the metabolic acidosis that is often present in these patients.
Tunneled is better because it uses less area of the actual vein which provides less risk for stenosis in the future and loss of access in the future.