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Kidney Function and Dialysis
Technician Exam
Fresenius Clinical Hemodialysis Technician
Review Exam
The Functional Unit of the Kidney
The functional unit of the kidney, or the structure in the kidney that does the work, is the nephron.
Components of a Nephron
A nephron is made up of a glomerulus and a tubule.
Endocrine Functions of the Kidney
The endocrine functions of the kidney include making erythropoietin and the active form of Vitamin D.
Leading Cause of End-Stage Renal Disease
The leading cause of End-Stage Renal Disease for adults in the US is Diabetes.
Cause of Itching in Kidney Patients
Patients with kidney failure often complain of itching, which is likely to be caused by hyperphosphatemia.
Cause of Bone Disease in Kidney Patients
Kidney patients often have bone disease because the kidneys stop producing calcitriol.
Symptoms Indicating Need for More Dialysis Time
Symptoms that a patient may need more dialysis time include anorexia, fatigue, swelling.
Semipermeable Membrane
A semipermeable membrane is a porous barrier that allows for only certain sized particles to cross.
Diffusion
Diffusion is the movement of particles from an area of higher concentration.
Negative Pressure
Negative pressure is pressure created when fluid is pulled through a restriction.
Ultrafiltration During Dialysis
During dialysis, ultrafiltration occurs when water is removed from blood because there is a pressure gradient between blood and dialysate.
Location of Negative Pressure in Extracorporeal Circuit
At which point in the extracorporeal circuit is the blood usually under negative pressure? the arterial line section before the blood pump.
Factors Affecting Solute Diffusion
Which of the following will increase the amount of solutes that will diffuse across the semipermeable membrane? high concentration gradients.
Components Affecting Dialysis Clearance
The components of the dialysate treatment that affect clearance include dialysate flow, time of treatment, dialyzer size, blood flow rate.
Factors Affecting Dialyzer's Ability to Remove Wastes
Two things that affect the dialyzer's ability to remove wastes from the body include surface area and molecular weight cutoff.
Dialysate Composition
Dialysate is the fluid that helps remove waste products from the body. It contains a number of substances. The group that might be prescribed for a dialysate solution includes bicarbonate, sodium, potassium.
Most Important Safety Monitor During Dialysis
The most important safety monitor during a dialysis treatment is the dialysis technician.
Dialysate Conductivity
Dialysate conductivity measures the total electrical charge of a solution.
First Action for Suspected Dialyzer Clotting
The transmembrane pressure has been gradually changing during the last 1-1/2 hours of dialysis. You suspect clotting in the dialyzer. The 1st action you should take is to rinse the dialyzer with normal saline.
Factors to Consider for Decreased URR or Kt/V
If there is a decrease in the patient's URR or Kt/V, the following factors should be looked at: - increased access recirculation - diminished dialyzer performance due to reprocessing - inadequate anticoagulation of the blood - blood pump speed
First Symptom of Dialysis Disequilibrium Syndrome
Which of the following is the 1st symptom that a patient developing dialysis disequilibrium syndrome is most likely to exhibit? headache.
Symptoms of Fluid Overload
A patient who is fluid overloaded will probably have the following set of symptoms: tachycardia, hypertension, dyspnea.
Characteristics of 'First Use Syndrome'
'First use syndrome' is a hypersensitivity reaction to a dialyzer. It is characterized by back pain, anxiety, tachycardia, wheezing, circulatory collapse.
Problems Related to Dialyzer Reuse
Dialyzer performance can be affected by reuse. The set of potential problems that may be related to reuse includes reduced dialyzer performance, plugged hollow fibers, changed fiber bundle volume.
Verification of Reprocessed Dialyzer Quality Control
AAMI standards recommend quality control activities before a reprocessed dialyzer is used on a patient. The number of people who must check the dialyzer to verify quality control information is 2 people, one of whom should be the patient.
Symptoms of Chemical Reaction Due to Incomplete
Rinsing
Which of the following is NOT a symptom of chemical reaction due to incomplete rinsing of germicide from a reprocessed dialyzer? diarrhea.
Purpose of Dialyzer Processing
Dialyzers are processed before use to rinse out manufacturing residues and to establish the original fiber bundle volume of the dialyzer and check for leaks.
Criteria for Rejecting a Reprocessed Dialyzer
The following contains 2 criteria for rejecting a reprocessed dialyzer: less than 80% of original fiber bundle volume, aesthetic appearance.
AAMI's Role in Dialysis
Which of the following statements is true of AAMI (the Association for the Advancement of Medical Instrumentation)? AAMI designs water treatment systems for dialysis units.
Frequency of Bacteriologic Testing for Water and Dialysate
According to AAMI standards, bacteriologic testing for water and dialysate should take place monthly.
AAMI Standard for Total Microbial Count in Dialysis Water
According to the AAMI standards, the total microbial count of water used to prepare dialysate shall not exceed 200 CFU/mL.
Cause of Access Failure
Stenosis is a major cause of access failure which, unless corrected, can lead to thrombosis and other complications.
Stenosis and Aneurysm
Signs of Stenosis
The following are signs of stenosis:
Changes in the thrill and bruit: Stenosis can cause changes in the vibration (thrill) and buzzing/swooshing sound (bruit) associated with the dialysis vascular access. Skin discoloration over the site of stenosis: Stenosis can lead to changes in the appearance of the skin over the affected blood vessel. Increase in skin temperature at the site of stenosis: Stenosis may cause an increase in the temperature of the skin over the affected blood vessel.
Rales (crackles) on the bases of both lungs are not a sign of stenosis.
Causes of Poor Blood Flow in Catheter Patients
Poor blood flow during dialysis in patients with catheters is often due to the following factors:
A blood clot Poor placement of the catheter within the blood vessel A fibrin sheath that has formed around the catheter
Dialysis Parameters
Ultrafiltration Calculation
A dialyzer with an ultrafiltration coefficient (Kuf) of 12 and a transmembrane pressure (TMP) of 120 mmHg will remove 1440 mL of fluid per hour.
Vascular Access Cannulation
Handling Venous Needle Infiltration
If a venous needle is infiltrated, the appropriate action is to insert a second needle above the venous infiltration.
Needle Size and Blood Flow
A 17-gauge needle will only allow for a blood flow of 250-300 mL/min, as larger needle sizes are required to achieve higher blood flow rates in well- developed fistulae.
Professional Organizations
The only professional organization in the country specifically for dialysis technicians is the National Association of Nephrology Technicians.
Professional Boundaries
Addressing a patient as "sweetie" is inappropriate, as it can make the patient feel dependent on the caregiver and cross a professional boundary.
Vascular Access Complications
Steady increases in venous pressure during treatment, along with prolonged bleeding after needle removal, may indicate the presence of venous stenosis.
Buttonhole Technique
The buttonhole technique for vascular access cannulation can result in fewer infections, missed needle insertions, hematomas, and infiltrations. It involves removing the scab, cannulating the same site at the same angle by the same caregiver with sharp needles for 3-4 weeks to create a tunnel.
Maintaining Vascular Access for Hemodialysis
Removing and Cannulating the Scab
To create a tunnel for vascular access during hemodialysis, the following steps should be taken:
Remove the scab from the same site where the needle was previously inserted. Cannulate the same site at the same angle by the same caregiver. Use sharp needles for 3-4 weeks to establish the tunnel.
Factors Affecting Venous Pressure During Dialysis
If the venous pressure on a dialysis machine starts to rise but the venous needle is not infiltrated, the following factors could be responsible:
Arterial stenosis Clotting of the venous line Venospasm
Factors Affecting Peritoneal Membrane Permeability
Factors that can affect the permeability of the peritoneal membrane during peritoneal dialysis include:
Peritonitis infection Amount of residual renal function The ability of the liver to convert lactate to bicarbonate Nutritional status of the patient
Functions of the Kidney
The four main functions of the kidney are:
Excretory: The kidneys rid the body of waste products, excess fluid, and electrolytes. Regulatory: The kidneys maintain acid-base balance, fluid balance, and electrolyte balance. Filtration: The nephrons in the kidneys retain some substances and filter out and reabsorb others. Endocrine: The kidneys produce several hormones, including renin, erythropoietin, and the active form of vitamin D (calcitriol).
