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Renal Replacement Therapy (General Dialysis Complications (Infection…

- - - - Blood flows on one side of semipermeable membrane
      - Dialysate flows in the opposite direction on the other side.
      - Solute transfer by diffusion
    - - Fluid removal by creation of –ve transmembrane
        pressure by decreasing the hydrostatic pressure of the dialysate.
  - - - Rapid changes in plasma osmolarity → cerebral
        oedema
      - n/v, headache and ↓GCS
- - - - Body image
      - Anorexia
      - Inconvenience
  - - - ~3L 4x /day w/ ~4h dwell times
- - - - Carpal tunnel, arthralgia
- - - - Swelling w/ surgical scar over distal forearm or @ elbow
      - Evidence of use: needle marks
      - Evidence of infection
    - - Check if painful
      - Temperature
      - Palpable thrill
  - - - Surgically created connection between artery and vein
        
        Radio-cephalic @ wrist = Cimino-Brescia
        
        Brachio-cephalic @ the elbow
        
        Venous limb (from machine) is proximal
      - Side-to-side anastomosis w/ ligation of the distal vein
    - - High flow rates, low recirculation (<10%)
      - Low infection rates
      - Less chance of stenosis cf. grafts
    - - Take ~6 weeks to arterialise
      - Affect pts. body image
      - Must take care: avoid shaving, don’t take BP/blood here
    - - Thrombosis and stenosis
      - Infection
      - Bleeding
      - Aneurysm
      - Steal syndrome
        
        Distal tissue ischaemia
        
        Pallor, pain, ↓ pulses
        
        May → necrosis
        
        ↓ wrist:brachial pressure index
        
        Rx: banding (plication)