Frequently asked questions

1. How is water contaminated?
Absorbed gas from the atmosphere, dissolved minerals from the ground, pesticide residue, industrial discharge, and chemicals added in water treatment (ie. Flouride)
2. What is the importance of pure water?
the average patient is exposed to more water than the average person WITHOUT the ability of selective absorption.
3. What is an endotoxin?
An endotoxin is a chemical component of a cell wall of gram negative bacteria that causes a pyrogen reaction.
4. Why are endotoxins bad?
Endotoxins are “bad” because they cause pyrogen reactions.
5. What is the acceptable CFU for water cultures?
An acceptable CFU is below 50.
6. Where are chlorine and chloramine levels checked?
The chlorine and chloramine levels are checked in the carbon tanks.
7. Why is water pretreated?
Water is pretreated to reduce the spread of disease.
8. What is Kt/V?
Kt/v is fractional urea clearance. Kt/v describes the percent of total body water cleared of urea in a single dialysis treatment.
9. What does K in Kt/v mean?
K is the clearance of plasma urea.
10. What is the t in Kt/v?
T is the treatment time.
11. What does v stand for in Kt/v?
V is the urea distribution volume.
12. When are chlorine and Chloramine levels checked?
The chlorine/chloramine levels are checked every patient shift or four hours whichever comes first.
13. What is the acceptable level for chlorine?
The acceptable level for chlorine is less than 0.1
14. What lab values are used to calculate Kt/v?
The lab values used to calculated Kt/v are Pre-BUN and Post-BUN.
15. What are the signs and symptoms of inadequate dialysis?
Decreased interdialytic weight gain, low serum albumin levels, and decreased food intake are signs of inadequate dialysis.
16. Why is a recirculation study done?
A recirculation study is done when there is a low Kt/v in a seemingly adequate dialysis prescription.
17. What can be changed in the dialysis prescription to improve dialysis?
An increase in time may be prescribed for inadequate dialysis.
18. What is the diabetic Kt/v?
A diabetic Kt/v is 1.4.
19. What is the non-diabetic Kt/v?
A non-diabetic Kt/v is 1.2.
20. What is First Use Syndrome?
First use syndrome is a cluster of symptoms associated with the use of new dialyzers.
21. What three chemicals are used for reprocessing?
Renalin, Formaldehyde, and bleach.
22. What sterilants are used in dry dialyzers and lines?
Gamma Irradiation and Ethel Oxide.
23. Who may not be allowed to participate in reuse?
Patients may not participate in reuse if they have refused, if they are HIV positive, Hepatitis B positive, or have Hepatitis C with elevated enzymes.
24. Why are dialyzers preprocessed?
Dialyzers are preprocessed to establish original fiber bundle.
25. What test is done during and after priming?
A test for residual Renalin is done during and after priming.
26. Why is a presence test done?
A presence test is done to check for the presence of Renalin.
27. What are the risks associated with reuse?
Pyrogen reaction, inadequate dialysis, and getting the wrong dialyzer are all risks associated with reuse.
28. What two things need to be signed and checked in reuse?
The presence of Renalin in the dialyzer and acceptable levels of residual Renalin need to be checked and verified.
29. What is the most common cause of dialyzer reaction?
The most common cause of dialyzer reaction is a pyrogen reaction.
30. What are three ways to prevent air embolism?
Secure all connections , have 300cc of NS ready at all times, and don’t intentionally introduce air into the circuit.
31. What are the first two steps in treating air embolism?
Clamp the venous line/turn off the blood pump and put the patient in the recovery position.
32. Name three ways to prevent exsanguination.
Tape and bridge all connections without a leur lock, have good needle placement, and check the access frequently.
33. List four causes of hemolysis.
A pyrogenic contamination, a chemical injury, a mechanical injury, or a thermal injury.
34. What are the signs and symptoms of hemolysis?
Signs and symptoms include cherry pop plasma, abdominal pain, burning at the venous needle site, SOB, mental confusion, low bp, and lab tests that reveal a drop in hemoglobin and hematocrit.
35. What is the treatment for an anaphylactic reaction?
Administer an antihistamine.
36. What is a minor blood leak?
A minor blood leak has a positive hemastix and the dialysate lines are clear.
37. What is a major blood leak?
A major blood leak has occurred when the hemastix is positive and there is blood in the dialysate line.
38. What is the purpose of a transducer?
A transducer regulates the pressure in both the venous and arterial lines.
39. What tests are performed in an SST?
Pre-BUN and chemistry.
40. What lab tests are done in a lavender tube?
CBC and HNH.
41. What tests are done in a light blue tube?
INR and PT.
42. Describe a recirculation study procedure.
Wait 5 min. but no longer than 1 hour, simultaneously draw samples from the arterial port, venous port, and peripheral vein, place in tubes, clot for 45 min., and then spin for 20 min.
43. Describe the method for drawing post BUN.
Reduce the blood pump to 50, wait 30 seconds, take 4cc from the arterial port and put it red tube, clot for 45 min., then spin for 20 min.
44. What effect will heat have on blood samples?
Hemolysis.
45. What type of dialysate system do we use?
We use three stream proportioning with bicarbonate, acid solution, and purified water.
46. What are the components of dialysate?
Sodium, Potassium, Calcium, Magnesium, Chloride, Bicarbonate, Acetate, and Glucose.
47. What is a biocompatible dialyzer?
A synthetic dialyzer that has less of an immune respone.
48. What is dry dialysis?
Dry Dialysis is pure ultra filtration with no dialysate flowing and dialysis in bypass. The removal of fluid is enhanced but there is no waste clearance.
49. What are the signs and symptoms of hypovolemia?
Low bp, nausea/vomiting, poor skin turgor, and weakness.
50. What are the signs and symptoms of hypervolemia?
Elevated bp, edema, SOB, difficulty breathing while laying down.
51. What is the number one reason for reuse?
Cost containment.
52. What MUST be on a reuse dialyzer?
Name, date and time reprocessed, number of reuses, and volume.
53. What is the most common cause of hypothermia in dialysis patients?
Elevated BUN.
54. When should patient assessment begin?
A patient assessment should begin the moment a patient enters the unit.
55. What is a general survey?
A general survey includes the level of awareness/consciousness, mobility, visible signs of distress, and recent history/verbalization of concerns.
56. What is a systems survey?
A systems survey is an assessment of the skin, vascular system, and edema.
57. What is the normal BP ?
120/80
58. What is the normal range for pulse rates?
60-100 beats per minute.
59. What is the normal range for temperatures?
97-98° F.
60. What is the range for normal respiratory rate?
12-20 breaths per minute.
61. Which direction should the arterial needle point?
Down away from the heart but may be placed either direction.
62. Which direction should the venous needle point?
Up towards the heart in the direction of flow.
63. What is the cannulation angle for a graft?
45°
64. What is the cannulation angle for a fistula?
25° -30°
65. Describe osmosis.
Osmosis is the movement of a solvent through a semipermiable membrane from an area of low concentration to an area of higher concentration.
66. What is ultrafiltration?
Ultrafiltration is the movement of solutes and water across a semipermiable membrane as a result of pressure applied to the membrane.
67. What is diffusion?
Diffusion is the movement of particles from an area of high concentration to an area of low concentration through a semipermiable membrane.
68. Why is dry dialysis typically prescribed?
To treat fluid overload.
69. List three types of dialyzers.
Parallel Plate, hollow fiber, and biocompatible.
70. What is equilibrium?
Equilibrium is when the concentration of solutes is equal on both sides of the semipermiable membrane.
71. Define hydrostatic pressure.
Hydrostatic pressure is the pressure exerted by a sloution on the cell walls of its container.
72. What is colloidal oncotic pressure?
Colloidal Oncotic Pressure is the pressure exerted by solutes too big to diffuse across a semipermiable membrane.
73. Delta pressure should not exceed ______ per square inch.
15 lbs psi.
74. The normal dialysate temperature should be in what range?
36-37° C