Which one of hemodialysis and Peritonial dialysis is good for people with ventilator?

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Posted on Sat, 13 Jun 2015 in Kidney Conditions
Question: Hemodialysis vs peritonial dialysis
which is one better for people with vent support and waiting to wean off the vent
doctor
Answered by Dr. Rakesh Madhyastha 27 minutes later
Brief Answer:
Hemodialysis

Detailed Answer:
Hello

Thanks for the query

To wean the patient off the ventilator especially if the patient is in volume overload ( fluid in the lungs) hemodialysis is better. Hemodialysis in 'isolated ultrafiltration' mode is the best way to absorb all the excess water from the lungs. This helps in improving saturation and finally to wean off the ventilator.

I hope I was of help, if you have any further queries please get back to me

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 7 minutes later
how many different ways we can get access for hemodialysis?
doctor
Answered by Dr. Rakesh Madhyastha 22 minutes later
Brief Answer:
Access

Detailed Answer:
Hello

Here are the different types of access in order of preference

1. Right and left internal jugulars
2. left and right femorals
3. Right and left subclavian ( not recommended unless absolutely unavoidable )
4. translumbar if all access have failed

Regardd
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 45 minutes later
what is permcath
why does it get infected often and what are alternative access for hemodialysis besides permcath and fistula??


doctor
Answered by Dr. Rakesh Madhyastha 12 minutes later
Brief Answer:
Access

Detailed Answer:
Hello

Thanks for getting back

Perm XXXXXXX is similar to ijv Hd catheter but placed differently where it is subcutaneous in nature, major part of the catheter goes below the skin.

The most common reason for it to get infected is by improper handling of the catheter especially by the technicians

Besides perm XXXXXXX and fistula the other options are peritoneal dialysis, av graft and also kidney transplant in cases of end stage renal disease

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 4 minutes later
she is sill having night fever but x ray showed lungs are clear and no infection.
She has fever of 102 last night

doctor
Answered by Dr. Rakesh Madhyastha 6 minutes later
Brief Answer:
Evaluation of fever

Detailed Answer:
Hello

Thanks for updating me

In such a situation I usually send two sets of blood culture. One from the catheter line and one from the peripheral line.
I also send a urine routine and culture to rule out a urine infection.

In peristant fever not responding to antibiotics I send a pro calcitonin to rule out Bactrial sepsis.

In our hospital , patients on perm XXXXXXX with fever we presumptively treat with vancomycin or amikacin through the catheter

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 5 minutes later
she is on vancomycin and still showing fever
what is pro calcionin
speaking of av graft, what is that and what are side effects of it
doctor
Answered by Dr. Rakesh Madhyastha 3 minutes later
Brief Answer:
Follow up

Detailed Answer:
Hello

Pro calcitonin is a measure by which we can tell if the infection is severe or not. In bacterial infections it is raised.

Av Graft is usually done on patients who have weak veins where fistula can't be done. Newer type of grafts are also placed when all other access are run out. Biggest disadvantage is that it fails more frequently than fistula and also the rate of infection is very high.

If she is on Vanco and it is not responding then I put them on teicoplanin

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 12 hours later
her lungs are clean and wbc is around 14000 and how can we put her off the vent
doctor
Answered by Dr. Rakesh Madhyastha 9 hours later
Brief Answer:
Follow up

Detailed Answer:
Hello

I am sorry for the short delay in my reply. I just got back from the hospital.

What exactly do you mean by her lungs are clean? Is she on spontaneous ventilation mode or assisted?
Is it possible to get hold of her abg and chest x Ray?

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 7 minutes later
Oxygen is set to 28 on vent and she is on pressure support. There is no infect in Lungs
doctor
Answered by Dr. Rakesh Madhyastha 2 minutes later
Brief Answer:
Ventilator

Detailed Answer:
Hello

The oxygen setting is quite low, if the lung is not infected and if she is not in volume overload then the only other reason why she might continue to require ventilator is reduced sensorium.
Please find out her abg if you can. If it's not done then please send one

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4360 Questions

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