Please enable JavaScript.
Coggle requires JavaScript to display documents.
Dialysis: Special Considerations (Psychotropics (Accumulation (Meperidine…
Dialysis: Special Considerations
Psychotropics
Accumulation
Meperidine (seizures); morphine, neuromuscular blockers
Increased sensitivity to central opioids
Caution
TCA
Lithium
Easily removable but requires longer HD (rebound)
Antibiotics
Dose adjustment necessary
Absorption inhibited by antacids
Longer T for Maintenance, same method for LD
Mostly given intraperitoneally
Antihypertensive
Need supplementation
ACE - all except fosinopril
ARB- none
atenolol and metoprolol
Amlodipine
Anticoagulants
Heparin accumulates
Follow anti-factor Xa
Reduce T
Endocrine
Caution for renally excreted OHA (sulfonylurea); insulin given IP
RA
Allopurinol accumulation (metabolite)
Colchicine
Myopathy, polyneuropathy
Phenytoin
Increased Vd but decreased protein binding
Low plasma levels do not equal subtherapeutic range
Monitor free and bound phenytoin
Adverse events
Peritonitis
Contamination in exchange or infection at site
Loss of access site due to fibrosis and infection
Death if sepsis occurs
Due to failure in using aseptic techniques - must counsel patient
Catheter related bacteremia
Requires blood sample from peripheral vein and catheter
Catheter should have at least 5x higher counts and growth at 2 hours earlier than peripheral vein
Challenges
Cannot use peripheral vein due to reservation for further injections/exhaustion
Majority of peripheral vein samples are taken from central catheter during hemodialysis - unknown correlation significance
Non-standardised handling procedures
OPD dialysis units are remote from hospitals under a national dialysis provider
Shipped via express mail to laboratory
Transport conditions and variable period before placement in incubator
No quantitative colony counts, less precise time for bacterial growth; accuracy of differential time growth only up to 6 hours
Antibiotics
Administered after each dialysis
Gram positive
Vancomycin
Gram negative
ceftazidime, ceftarolin