Journal Watch
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Vascular Access Technique Audits Can Reduce Home HD Access Infections
Self-cannulation errors can lead to infections. A retrospective study of all prevalent home HD patients at the University Health Network in Canada looked at access infections between 2006 and 2013. Among the 92 patients who completed at least one vascular access audit, those with five or more errors had significantly higher infection rates. Longer duration on home HD was associated with higher error rates. Audits give nurses a chance to retrain patients and reduce future errors and infections.
Read the abstract » | (added 2015-11-11)
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UK Identifies Ways to Boost Use of Home HD
Commissioners in the West Midlands, where home dialysis rates had been falling for 10 years, set a target for home dialysis uptake. Comparing this area’s seven hospitals with the rest of England for 3 years before and after the target found significant increases at the study hospitals. Use of financial penalities, adding funding for specialist staff and equipment, having visible champions, good systems for patient training, and ongoing healthcare support at home all helped. Lack of training for non-specialists, poorly developed patient education, and patients’ unmet emotional needs are ongoing challenges.
Read the abstract » | (added 2015-11-11)
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Case Report: Thrombocytopenia with NxStage
Two patients have developed thrombocytopenia while using NxStage dialysis machines, perhaps due to electron-beam sterilization of the dialyzers. Switching to another machine resolved the problem; but it recurred in the patient who retried NxStage.
Read the abstract » | (added 2015-11-11)
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Trial of a Virtual Home HD Ward
Transitions from hospital stays back to home can lead to gaps in care. In Toronto, a virtual ward (VW) has been tested to see if care can be made more seamless. Following hospital discharge, a procedure, an antibiotic prescription, and/or completion of home dialysis training, patients were followed in the VW for 14 days. A nurse looked for the need for an HD prescription change, coordination of follow-up care, and medication changes. Care gaps were found in 67% of the 52 VW admissions for a total of 85 gaps. The researchers concluded that using a VW is practical, feasible, and identifies gaps that can be addressed.
Read the abstract » | (added 2015-11-11)
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Pelvic Drainage + Catheter Removal May Aid Refractory Peritonitis
Complications of peritonitis can go on even after PD catheter removal. A retrospective review of 46 patients with refractory peritonitis over 12-years found that the 12 who’d had pelvic drainage with closed active suction devices had an 8% future complication rate, vs. 44% in those who did not. None of the active drainage group needed further drainage or open laparotomy, while 35% of the non-drainage group did.
Read the abstract » | (added 2015-11-11)
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For Phosphorus Removal, Dialysis Time Matters
Dialysis guru John Daugirdas, coauthor of the Handbook of Dialysis, observes that “the most practical way to increase phosphorus removal is to extend dialysis, time” in this article, recommending 18-30 hours of HD per week to eliminate the need for binders. Other suggested interventions include use of more efficient dialyzers and possibly hemodiafiltration.
Read the abstract » | (added 2015-10-15)
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Urgent Start PD: Safe and Effective
The first Canadian group to try urgent start PD followed 30 patients for a total of 3 years. They found no peritonitis or exit site infections in the first 4 weeks after catheter placements, three minor leaks that were managed conservatively, and four catheter migrations that were relocated without the need for surgery. The researchers concluded that urgent start PD is safe and effective for people who need to start dialysis and do not have an access.
Read the abstract » | (added 2015-10-15)
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PD Catheters: To Dress or Not to Dress?
Which is better for preventing exit site infections, a PD catheter dressing, or leaving a healed catheter open to the air? A prospective, randomized, controlled trial in Malaysia followed 108 patients for 2 years. All were instructed to wash the exit site daily with antibacterial soap. The dressing group (n=54) used povidone iodine, mupirocin ointment, sterile gauze, and tape. The non-dressing group did not. Of the 97 patients who completed the study, the results from both groups were similar.
Read the abstract » | (added 2015-10-15)
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Excessive Weight Gain in Year 1 of PD Predicts Poor Outcomes
In a PLoS One study, 148 incident PD patients were observed for a median of almost 2 years. Those who gained more than 3% of their body weight lost residual kidney function 4.17 times faster (p<0.001), and had higher blood pressure, more inflammation, and an increased rate of diabetes.
Read the abstract » | (added 2015-10-15)
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Simultaneous PD Catheter Removal and Replacement
A PD catheter can be replaced without interrupting PD, finds a new study in 55 patients with peritonitis, tunnel infection, or mechanical problems. Most used low-volume APD even on the day of surgery. Antibiotics were given for 2-4 weeks, and almost 90% of the procedures were done in an outpatient setting. Just one had a peritonitis recurrence, and no newly placed catheters were lost. Using the protocol allowed a median PD technique survival of 5.1 years and avoided the use of central venous catheters.
Read the abstract » | (added 2015-10-15)
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