1. Causes of hemolysis
    • Hypotonic sol
    • sterilant in system
    • transfusion reaction
    • blood pump mal fx
    • chloramines in h2o
    • k,o in lines
  2. Define URR
    Urea reduction Ratio-how well pt blood cleaned (>70%)
  3. Common c/o of excessive fluid removal during tx
  4. Causes of hypotension during tx
    • Big meal during tx
    • Htn meds b4 tx
    • Too much fluid removed
  5. Define ultrafiltration
    Removing fluid under pressure
  6. What is fx of TEST button on H mach
    • To chk dialysate/blood comp
    • Chk PHT/PIT
    • Ensure pt safety
  7. Ph is checked pre tx for what reason
    To ensure safe dialysate
  8. S/s of fluid overload
    • Htn
    • SOB
    • Edema
    • MBS
  9. The process of hemo is accomplished by what three things
    • Ultrafiltration
    • Diffusion
    • Counter current flow
  10. Indredients of dialysate
    • Ro h20
    • Elect: na+, ca++, k+, HCO3-, mg+, cl, dextros, acetate
  11. What can be done to incr "cleaning" efficency of tx
    • incr BFR
    • incr tx time
    • larger dialyzer
    • incr dialysate flow rate
    • counter current flow
  12. When mach alarming what is 1st thing you chk
    mach response w/correct alarm
  13. Would waste products incr or decr during tx
  14. purpose of priming procedure
    remove air fr lines & dialyzer, to coat fibers, & remove sterilant
  15. Define Orthostatic hypotension
    drop in bp related to changes in positions
  16. Define Wheezing/crackles
    abnl breath sounds
  17. Bradycardia
    heart rate <60
  18. Tachycardia
    heart rate >100
  19. Systolic pressure
    top # of bp when heart pumps blood out
  20. Diastolic pressure
    Bottom # of bp when heart relaxes and fills back up
  21. Peri orbital edema
    fluid around the eyes
  22. Pitting edema
    fluid accumulated that leave indintation when presses on
  23. apical pulse
    sound heard w/stetascope @ top of heart
  24. Hypertension
    incr in bp
  25. Thrill
    feeling blood in access
  26. Bruit
    sound of blood thru access
  27. Bicarbonate
    maintain acid base bal
  28. Mg+
    assist with metabolism fx
  29. PO4-
    not in dialysate-cellular & energy production
  30. ca++
    • bone/teeth development
    • muscle contracting
    • energy production
    • cardiac fx
    • blood clotting
  31. Na+
    maintains fluid bal
  32. K+
    regulate muscle (heart)
  33. Internal AVF
    Surgical connection between native artery and vein
  34. Internal AVG
    access using synthetic material att 2 vein & artery
  35. External Access
    Savclavin & Jugular
  36. Heparin
    1:1000 short acting blood thinner (IVP/IC)
  37. Lidocaine
    1% anesthetic (ID)
  38. Infed, ferrlecit, venofer
    Iron supplement 4 iron difficency (IVP)
  39. Epogen
    for anemia stimulates bone marrow 2 produce RBC (IVP/SQ)
  40. Calcijex, zemplar, hectoral
    ca++ absorbtion, incr ca++ level (IVP)
  41. Benadryl
    antihestamine 4 all reaction/itching (IVP/PO)
  42. Tums
    prevents absorbtion of PO4- taken with meals (PO)
  43. Causes of high v-pressure
    clotted v-drip cham, incr BFR, v-needle infiltrate, v-needle against wall, v-needle stenosis, low TMP, spasm @ v-needle, clotted v-needle, clotted v-line below v-drip cham, k/c/o on v-line below v-drip cham
  44. Causes of low v-pressure
    a-needle infiltrate, clotted dialyzer, k/c on a-line, a-needle out of access, NSS administration, clotted a-needle, k blood pump segment, high TMP, decr BFR, NSS not clamped, v-needle out of access, a-needle against wall
  45. Purpose of 160 NVL/100 Asymmetric
    bring the lower v-level closer to the LED so that it will alarm sooner & prevent blood loss
  46. C/o caused by wet/bloody transducer
    cross contamination & inaccurate a/v pressures
  47. SVS programs & tx time
    Step profile: moderate 2 large fluid gainers: return 2 na+ base 30min b4 tx ends

    ***Linear program: small 2 moderate fluid gainers: entire tx time: return 2 na+ base 5min b4 tx ends
  48. Max na+ setting
    150 (p)

    152 (ami)
  49. Max/Min UFR

  50. Safe Conductivity range
    13.5-14.5 (p)

    13.5-14.3 (ami)
  51. Safe Ph range
    6.8-7.8 (p)

    7.0 or 7.5 (ami)
  52. What is "bypass"
    dialysate bypassed dialyzer & goes dwn the drain
  53. S/s of too much fluid removed
    • Dizzy
    • cramps
    • n/v
    • hypotensive
  54. S/s of not enough fluid removed
    • SOB
    • Htn
    • Edema
    • MBS
  55. S/s of hypotension
    • N/v
    • Dizzy
    • Clammy
    • Yawning
    • Urg BM
    • Pale
    • blank stare
  56. Tx of hypotensive episode
    • T-burg position
    • NSS 100-200cc
    • UF off max 5min (p), 15min (ami) or decr UF min 300cc/hr
    • bp q5min til pt stable
  57. Where would u look for high v-pressure alarms
    V-needle to top of v-drip cham
  58. Where would u look for low v-pressure alarms
    A-needle to v-needle
  59. Blood Alarms
    high/low a-pressure, high/low v-pressure, high/low TMP, air/foam in blood, blood in dialysate, no power
  60. Blood responses
    uf stops, blood pump stops, a/v alarms, rtd stops, v-line clamps, all fx cease, unmutable alarm
  61. Dialysate Alarms
    high/low temp, high/low conductivity, no h2o
  62. Dialysate responses
    a/v alarm, bypass, rtd stops
  63. Draw pic of loop graft with direction of blood flow & needle placement
    see att
  64. Draw pic of fistula with direction of blood flow & needle placement
    see att
  65. Wat safety measures do we have in place 2 prevent blood loss during tx
    access visable, needles secure, trandsducers clean/intact, hemosafe on catheters, 160NVL/100 asymetrical
  66. What must b done b4 hand cranking & how long can we hand crank:
    remove v-line from occlusion clamp; can crank max 15min
  67. Food with K+
    melons, bananas, salt subs, avocados
  68. Foods with Na+
    processed foods, beacon, pickles, lunch meats, chips
  69. fluids
    ice, soups, jellow, ice cream
  70. Foods with PO4-
    diary products, nuts, peanut butter, beans
  71. How far in advanced can meds b drawn
    1 hr (p), 8hrs (ami)
  72. If meds are pre drawn what must b on label
    pt name, rx name, rx route, rx dose, date/time, initials of who drew it
  73. S/s of infxn on AV access
    reddness, swelling, pn, tender 2 touch, warm
  74. ** What is expose incident & examples
    Exposure to PIM like dirty needle stick, blood splash
  75. Wat are NL fx of kidneys & if can b done by dialysis
    • fluid/elec bal done w/hemo
    • waste/toxin removal done w/hemo
    • Acid base bal done w/hemo
    • Bp regulation done w/hemo
    • RBC production not done w/hemo given EPO
    • Vit d conversion not done w/hemo given synthetic form
  76. 3 things needed 2 b taken outside w/pt's during emergency evacuation
    emergency box, staff schd, and pt schd
  77. How often do we do safety chk
    Min q 30min
  78. **Wat is infiltration
    leakage of blood into sourrounding tissue
  79. Wat is anastomosis
    surgical connection of artery 2 vein on access
  80. Wat do we chk during 30min chk
    • transducers clean/intact; a-header up
    • drip cham 85-95%; access visable
    • pt alert; blood lines in guards
    • tape intact/secure
    • nss double clamped; counter current flow
    • needles secure; min 300cc NSS
  81. How long do we wait after giving heparin b4 call 4 double
  82. **Which pt needs to dialyze in isolation room
    pt (+) hep b
  83. S/s of Uremia
    htn, anemia, poor apetitie
  84. S/s of anemia
    • SOB
    • hypotension
    • pale
    • weakness
  85. know why TMP <0 (+) is a concern
    due to back filtration, dialysate in blood
  86. Calculations
    See att
  87. Wat 2 mach steps you done if pt c/o chpn
    turn uf off, decr BFR 200cc/hr (p) or 150cc/hr (ami)
  88. Most common cuase of high more (-) a-pressure
    A-access prob
  89. When is UFR turned on @ initiation
    when rx'd BFR is reached
  90. ** Max BFR @ termination
    200cc/hr (ami)-100cc/hr (p)
  91. Position you would put pt on ASAP if has air embolism
    lt side t-burg
  92. Why pt take tums with meals
    to prevent absorbtion of PO4-
  93. why dont we let pt put feet dwn b4 termination
    bp can drop (orthostatic bp)
  94. What is done with mach after a major c/o
    left as is for TECH to chk
  95. **Know e & c's you would not return blood to pt
    hemolysis, blood leaks, air embolism
  96. **know how 2 determine direction of blood flow on loop graft
    press side of loop, side with strongest thrill is a-side
  97. Know task that requ full PPE
    priming bucket disinfxn, blood spill, cannulation, initiation/termination, blood draw, bio haz, chk cond/ph
  98. 4 tx options
    hemodialysis, Peritoneal dialysis, transplant, no tx
  99. 3 blood borne pathogens we r concerned with
  100. **Know wat TMP is
    Trans membrane pressure: (+) pushing press of blood pump & (-) pulling press of dialysate comp
  101. How far aprt the tips of needles need 2 b in a AV access & why
    2 in apart; 2 prevent recirculation
  102. Causes of high a-pressure
    • hypotension
    • a-needle against wall
    • infiltration of a-needle
    • k/c/o bloodline between pt & a-monitor
    • high BFR thru small needle
    • high hbg/hct
    • clotted fibers in dialyzer
    • dialysate fiber screen dirty
  103. Causes of Low a-pressure
    • NSS administration
    • wet transducers
    • UF rate too low
    • clampped monitoring line
  104. Formaldehyde reaction s/s, causes, tx
    - S/S: peppery taste, chpn, numb lips, burning @ needle site, sob, anx, hemolysis, hypotension

    -causes: sterilants in system, improper priming, sterilant trapped, initiation not done after dump

    - TX: clamp v-line asap, chk bp, no blood rtn,notify RN, code cart/o2, mach 4 tech's
  105. Hypotension s/s, causes, tx
    - S/S: dizzy, HA, n/v, blank stare, sob, yawning, chg in level of consciousness

    -causes: meds, eating during tx, cardia c/o, sepsis, excessive UFR, excessive blood loss

    - TX: UFR off/down, t-berg, bp's, NSS 100-200, vs q5 min til stable, notify RN
  106. Air Embolism
    - S/S: chpn, coughing, sob, air below air detector, noise in ears, sz's, cardiac

    -causes: unarmed air detector, v-line not in clamp, empty meds/NSS bag, a- line disconnected, catheter disconnected from lines

    - TX: clamp v-line asap,lt side t-burg, chk bp, no blood rtn, inform RN, code cart/o2, aspirate v-needle 2 remove air, mach 4 tech's, inform RN
  107. CHPN s/s, causes, tx
    - S/S: chpn, pn radiates arm/neck/jaw, bkpn, sob, heartburn, dizzy

    -causes: excessive UFR, hypotension, anx, pericarditis, anemia, air embolism

    - TX: UFR off, decr BFR 200, chk bp, no blood rtn, inform RN, code cart/o2, pn level/hx of chpn, inform RN
  108. Dialyzer reaction s/s, causes, tx
    - S/S: tightness throat/chest, hives, itching, rash, flushed, swelling face/extremites, sob, bp's fluctuate

    -causes: sensitivity to dialyzer/sterilant,gases, 1st use syndrom

    - TX: clamp v-line asap, BFR off, chk bp, notify RN, code cart, o2, 911 prn, inform RN
  109. Pyrogen Reaction s/s, causes, tx
    - S/S: chills, fever, n/v, flu like symptoms, incr temp, bp chg

    -causes: endotoxins, sterilant in dialyzer >30d, cannulated infected access, contaminated supplies, bicarb >24hrs, mach not disinfected

    - TX: blood pump off, clamp v-line, chk vs, blood may b rtn if reaction not violent, meds tylenol/benadryl, blood cultures, mach 4 tech's, inform RN
  110. HTN s/s, causes, tx
    - S/S: HA, edema, n/v, sz

    -causes: fluid overload, bp meds removed during tx, incr na+ intake,

    - TX: dialyze to remove fluid, meds, pt educ/diet/fluid intake, inform RN
  111. SZ's s/s, causes, tx
    - S/S: blank stare, convulsions of extremities, pt c/p floaties

    -causes: extreme hypotension, cerebral hypoxia, electrolyte imbal, sz disorder, uremia, DES-dialysis disicolibrium syndrom, 1st tx syndrom

    - TX: monitor bp, protect access, maintain airway, o2, cart, 911, inform RN
  112. Cramping s/s, causes, tx
    -s/s: pn/tightness in extremities, RLS, grabs leg, streching of legs

    -Causes: fluid shifts, elec imbal, hypotension, pt below TW, poor circulation, Ph changes

    -tx: NSS 100-200cc, hypertonic sol, na+ variation, streching/standing, DO NOT MASSAGE CRAMPS, vit E 400u 30min b4 tx, inform RN
  113. Hemolysis s/s, causes, tx
    -s/s: cranberry colored blood, burning @ v-site, abd/bck/chpn, feeling of warmth, hypotension, SOB, arrhythmias

    -Causes: hypotonic sol, sterilant in system, k/o in lines, blood pump mal fx, chloramines in h2o, dialystate temp >41c, a-pressure >-250

    -tx: clamp v-line ASAP, blood pump & UF off, vs, DNT RTN BLOOD, aspirate 10cc fr v-needle, o2, code cart, 911 prn, leave mach for tech, inform RN
  114. Bloos loss s/s, causes, tx
    -s/s: blood on floor, blood on pt, s/s hypotension, snoring, sz, cardiac arrest, low v-pressure,

    -causes: disconnected needles/lines, access covered, wet transducer, clamped monitor line, hemosave not on

    -tx: clamp lines ASAP, chk vs, t-berg if hypotension, o2, code cart, 911, inform RN
  115. Pericarditis/pericardial s/s, causes, tx
    -s/s: chpn, fever, tachycardia, hypotension, heart sounds more distant

    -causes: uremia, bacteria, TB, collagen disease, cancer, MI, trauma

    -tx: notify RN, monitor vs, gentle dialy tx, decr or no heparin, 02, code cart, 911
  116. Blook leak s/s, causes, tx
    -s/s: blood leak detector alarm, blood in a-dialysate hose, hypotension

    -causes: defect of dialyzer, dropping dialyzer, too much (+ or -) pressure

    -tx: chk a-dialysate hose w/hemastix, DNT RTN BLOOD, aspirate & flush needles, get new set up, tag dialyzer to tech
  117. No power s/s, causes, tx
    -s/s: unmutable alarm, all fx cease

    -causes: power cord unplugged, circuit breaker mal fx, natural disaster

    -tx: press power button on mach, remove v-line fr line clamp, open blood pump & extend handle, v-drip cham 85-95% full during craking, crank clockwise @ 6-10 rotation/min, cnt til power on or max 15min
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