Renal Replacement Therapies

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Renal Replacement Therapies by Mind Map: Renal Replacement Therapies

1. Hemodialysis

1.1. Benefits

1.1.1. Most effective

1.1.2. filters blood of toxins

1.2. Down Falls

1.2.1. 3-4 times per week

1.2.2. requires vascular access

1.3. Complications

1.3.1. hypotension: d/t rapid removal of fluid

1.3.1.1. S/S include muscle cramps, dizziness, HA, low BP, increased HR and respirations

1.3.2. Bleeding: d/t heparin use, altered platelet function, and uremia

1.3.3. Infection: r/t vascular access

1.3.3.1. can be local or systemic

1.3.3.2. S/S include:high fever, chills, shaking, tachycardia, tachypnea

1.4. Vascular Access Devices

1.4.1. Acute/Temporary

1.4.1.1. insertion of double lumen catheter

1.4.1.1.1. femoral can be in for 1 week

1.4.1.1.2. PREFERRED: jugular/subclavian can be in for 1-3 weeks

1.4.2. Longer Term

1.4.2.1. AV Fistula

1.4.2.1.1. between the artery and vein

1.4.2.1.2. usually takes 4-6 weeks to mature: often times a short term port is used in the mean time

1.4.3. Chronic Renal Failure Devices

1.4.3.1. AV Graft/ Shunt

1.4.3.1.1. peripheral vein with peripheral artery

1.4.3.1.2. takes 2-4 weeks to heal

1.4.3.1.3. clot and infection are very high

2. Peritoneal Dialysis

2.1. Benefits

2.1.1. continuous

2.1.2. client able to be at home, not come to hospital for Tx.

2.1.3. most widely used

2.1.4. self-managing

2.1.5. can eat what they want to

2.1.6. less fluid restriction

2.1.7. avoid heparinization and vascular complications

2.1.8. clearance of metabolic wastes is more continuous

2.2. Downfalls

2.2.1. much slower rate

2.2.2. at risk for peritonitis

2.2.3. access into the abdominal wall ( Tenckhoff )

2.3. Complcations

2.3.1. Perforation of the bowl during surgery

2.3.2. bacterial infection

2.3.3. peritonitis

2.3.3.1. S/S: cloudy diaslyate

2.3.4. pulmonary issues

2.3.4.1. this is related to increase pressure on the diaphragm

2.3.5. abdominal pain (referred shoulder pain)

2.3.6. hypoglycemia

2.3.7. sclerosis peritonitis

2.3.8. protein loss

2.4. Cycles of Peritoneal Dialysis

2.4.1. Inflow

2.4.1.1. 10min/2L

2.4.2. Dwell

2.4.2.1. Solution remains in peritoneal cavity for prescribed "dwell" time

2.4.2.2. During dwell time is when the filtering occurs 20-30min could be as long as 8hrs

2.4.3. Drain

2.4.3.1. Output should be > input It should include all of the waste materials in addition to the solution

2.5. Contraindications

2.5.1. Hx of multiple abdominal surgeries

2.5.2. pancreatitis

2.5.3. hernias

2.5.4. obesity

2.5.5. chronic back pain

2.5.6. COPD

3. Kidney Transplant

3.1. Benefits

3.1.1. after first year it is actually cheaper than dialysis

3.1.2. lifestyle is much better, no need for dialysis if everything goes according to plan

3.2. Downfalls

3.2.1. absolute last resort

3.2.2. Wait time is usually 2 years for a cadaver kidney

3.3. Contraindications

3.3.1. non-compliance -drugs and alcohol dependencies

3.3.2. heart failure

3.3.3. cancer

3.3.4. cardiovascular problems

3.3.5. diabetes

3.4. Rules for Cadaver Kidney Donor

3.4.1. brain death

3.4.2. age <65

3.4.3. free of disease

3.4.4. preservation

3.4.4.1. 24-48 for hypothermia

3.4.4.2. 3 days for continuous pulsation

3.5. Complications

3.5.1. Acute rejection

3.5.1.1. within months: reversible with immunosuppressive therapy

3.5.1.1.1. S/S: oliguria

3.5.2. Chronic rejection

3.5.2.1. major cause of graft loss, irreversible

3.5.3. infection

3.5.4. tumors

3.5.5. congenital anomalies

3.5.6. bone problems

3.5.6.1. d/t: body stealing calcium from bones

3.5.7. GI disorders

3.5.8. cataract formation