Dialysis


Dialysis Criteria
  1. Intractable hypErkalemia (If refractory to Tx with D5W & HCO3)
  2. HypErvolemia (progressive fluid overload)
  3. Acidosis
  4. Marked Uremic Symptoms (hemodialysis in this case)
EMERGENT DIALYSIS INDICATIONS IN ESRD:
  1. Refractory hyperkalemia
  2. Uremic pericarditis
  3. Volume overload
  4. Altered mental status
COMPLICATIONS OF HEMODIALYSIS
  • Hypotension
  • Bleeding
    • Direct pressure or tourniquet
    • Correct coagulopathy (protamine, DDAVP)
  • Clotting
    • No thrill or bruit
    • Vascular intervention with fibrinolytics or surgery within 24 hours
  • Infection
    • Most commonly S. aureus and gram negatives
    • Treat with vancomycin +/- gentamicin
  • High Output Heart Failure
    • Left-to-right shunt
  • Altered Mental Status
    • Hypotension
    • Hypoglycemia
    • Hypercalcemia
    • Subdural Hematoma
    • Dysequilibrium syndrome
      • Increased ICP from osmotic shifts
      • Diagnosis of exclusion
      • Supportive treatment
  • Gastrointestinal
    • GI bleeding
    • Bowel obstruction

 

NOTE: Dialysis Port
  • Blood draw/picc line from dominant arm (need non-dominant arm for dialysis port later on)