Low+kt_v in a dialysis patient
demo
Published on Jul 3, 2021
A 42-year-old man with ESRD is on HD via (AVF) is on a 4-hour treatment, 400 ml/min blood flow, and 800 ml/min dialysate flow had a recent drop in single pool Kt/V decreased to 1.0. He routinely stays for his full 4-hour treatment. Examination of the left arm reveals a mature fistula with a bruit and a thrill , normal arm elevation test( no excessive collapse of the fistula on arm elevation) . there was no significant aneurysms. there have been no difficulties with cannulation. There is no history of prolonged bleeding at the end of treatment. Nursing has noticed high venous pressures , elevated filter pressure and normal arterial pressures during HD . No recent weight loss - Likely cause for decrease in KT.V -
A Venous (or outflow) stenosis
B Arterial (or inflow) stenosis
C Poor needle placement during the treatment for the last Kt/V measurement
D Clotting in the dialyzer resulting in impaired clearance.
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ANSWER IS D
1. has no post prolonged bleeding following needle removal making venous stenosis less likely.
2. he has no difficulty with cannulation, normal arterial pressures during dialysis, continuous bruit and thrill, and has normal “arm elevation test”:
3. Poor needle placement causes negative arterial pressures
4. . Clotting in the dialyzer result in high venous and filter pressures with normal arterial pressures.
