bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality monitoring of care: Ask the patient
Authors: De Vos J‐Y. , Leleu L. , Geenens M. , Hombrouckx R.
Published: July 2012

In 1998 and 1999, we organised a questionnaire to be filled out by chronic haemodialysis patients. The first part dealt with general information data on the specific patient and the second part dealt with quality assessment data given as experienced by the individual patient. This second part included a ranking of preference by the patients and aspects patients wanted to see improved in the future.

As we implemented the EDTNA/ERCA Clinical Standards and Core Curriculum, the monitoring tool, as described in this paper, was developed in order to monitor the effect of implementation.

As a result of this two‐year monitoring process of quality of care, we can follow up the care provided by our multidisciplinary team.

It has proven a very useful tool to find out what is to stay as it is and what is to be improved. Simply closing the loop!
Improving care and efficiency: Appointment times in a haemodialysis unit
Authors: Lunts P.
Published: July 2012

Shortage of nurses and dialysis spaces and the desire to improve patient care are the two main driving forces in the dialysis field today. This paper suggests that these issues can be addressed by organisational change. We describe a simple, dramatically effective but rarely used example — the effect on a haemodialysis unit of the introduction of patient appointment times.

This paper will demonstrate that appointment times can be highly effective in reducing waiting times for patients and in utilizing staff and resources more efficiently, as long as there is commitment from key staff to implement and maintain them effectively.
Chronic Renal Failure, nursing diagnoses and interventions
Authors: Yürügen B.
Published: July 2012

Chronic renal failure (CRF) is a clinical condition resulting from a multitude of pathologic processes which lead to derangement and insufficiency of renal excretory and regulatory functions (uraemia). There are normally two million glomeruli in both the kidneys of an adult, which filter an average amount of 120 ml of blood per minute. This filtration is called glomerular filtration rate (GFR). In the case of damaged parenchyma tissues due to renal disease, the filtration rate goes down to 20–30 ml per minute. This is when findings and symptoms of renal failure come about. In the case of a filtration rate less than 10 ml (GFR< 10 ml/min), a patient is understood to have reached the final stage of renal failure. At this stage, fluid and electrolyte balance is disturbed, azotemia increases and systemic manifestations (uraemia) occur (1,2).

Renal failure is a condition in which the kidneys cannot fulfil their function of discharging metabolic waste and of maintaining the fluid and electrolyte balance. It can be divided into two groups: acute and chronic.

This paper discusses the etiology, pathophysiology and signs and symptoms. of CRF as well as the diagnosis and interventions required by nurses. Deficit, nursing priority and intervention are discussed in relation to patient problems.
Daily use of the physio dialysis system: Long‐term experience
Authors: Pastore C. , Ruggieri G. , Pastore A. , Siliberto P. , Cristofaro V.
Published: July 2012

Background: Hypovolaemia has been implicated as a major causal factor of morbidity during haemodialysis (HD). In order to avoid the appearance of destabilising hypovolaemia a biofeedback control system for intra‐HD blood volume (BV) change modelling has been developed (Hemocontrol™, Hospal Italy). It is based on an adaptive controller incorporated into a HD machine (Integra™, Hospal Italy). The Hemocontrol™ biofeedback system (HBS) monitors BV contraction during HD with an optical device; furthermore, HBS modulates BV contraction rates (by adjusting the ultrafiltration rate — UFR) and the refilling rate (by adjusting dialysate conductivity — DC) in order to obtain the desired pre‐determined BV trajectories.

Methods: Nineteen patients prone to hypotension (7 males, 12 females, mean age 64.5 ± 3.0 SEM years, on maintenance HD for 80.5 ± 13.2 months) volunteered for the prospective study which aimed to compare the efficacy and safety of bicarbonate HD treatment equipped with HBS, as a whole (HBS), with the gold standard, bicarbonate treatment, equipped with a constant UFR and DC (BD). The study included one period of 6 months of BD always preceding a follow‐up period of HBS treatment ranging from 14 to 30 months (mean 24.0 ± 1.6).

Results: The overall occurrence of symptomatic hypotension and muscle cramps was significantly less in HBS treatment. Self‐evaluation of intra‐ and inter‐HD symptoms (the worst score was 0 and the best one 10) did reveal a statistically significant difference, as far as post‐HD fatigue is concerned (6.2 ± 0.2 in HBS vs. 4.3 ± 0.1 in BD treatment, p < 0.0001). No difference between the two treatments was observed when comparing pre‐ and post‐HD lying blood pressure, heart rate, body weights and body weight changes.

Conclusions: HBS is an effective treatment. Hypovolaemia‐associated morbidity occurs less in BD treatment than HBS. Furthermore, HBS is a safe treatment in the medium‐term because these results are achieved without potentially harmful changes in blood pressure, body weight and serum sodium concentration.
Personality dimensions of haemodialysis patients related to initial renal disease
Authors: Koutsopoulou V. , Theodosopoulou E. , Vantsi E. , Kotrotsiou E. , Kostandinou V. , Dounousi E.
Published: July 2012

Objective: The aim of the study was to investigate personality dimensions in uraemic patients undergoing haemodialysis (HD. The relationship between the disease that led to renal failure (and the subsequent need for haemodialysis) and the personality of the haemodialysis patients in question were investigated.

Methods: In the present study, which was conducted in three Greek hospitals, 103 patients were analysed and compared to 138 control patients matching the groups according to their age, sex and place of residence. The investigation was conducted using the Eysenck Personality Questionnaire (EPQ), a reliable method for clinical studies that measures three dimensions of personality: neuroticism, psychoticism and introverted/extroverted.

Results: The results from the EPQ were compared to the three disease categories that cause renal failure: glomerulonephritis, polycystic disease, and vascular disease. It was concluded that haemodialysis systematically affected all three scales of personality disorders in the patients. Male patients scored higher in neuroticism, while female patients appeared to score higher in psychoticism. Renal disease, the responsible factor for renal failure and the need for haemodialysis, significantly affected personality disorders.

Conclusion: The findings show that dialysis modality influences the personalities of patients, and that initial renal disease must be strongly considered in the psychosocial evaluation and care of these patients.
Effect of integrated education on nurses' knowledge of haemodialysis vascular access
Authors: Gelmez M. , Akçaoglu T. , Utkucu Ü.
Published: July 2012

The success of haemodialysis depends on access to the circulation. Preservation of the access site should be a primary goal of patient care. Little research on nursing interventions related to vascular access exists. Access care varies from centre to centre and there are often no written protocols for guidance. The aim of the study was to determine the effect of integrated education on nurses' knowledge.

The fundamental principles of vascular access should be used to help train future dialysis staff members in order to improve quality of care. We must continue to gain knowledge in this important area through nursing research and education.

This research demonstrates that integrated education improves the knowledge of nurses working in a renal unit.
Home training experience in peritoneal dialysis patients
Authors: José Castro M. , Celadilla O. , Muñoz I. , Martínez V. , Mínguez M. , Bajo M. Auxiliadora , del Peso G.
Published: July 2012

The objective of nursing is to increase health and well being, prevent morbidity and obtain the best physical and social rehabilitation. The nurse's role in Peritoneal Dialysis (PD) consists of promoting and supporting patients to perform self‐care.

In the ‘Text Book of Peritoneal Dialysis’, published in 2000, the chapter dedicated to the nurses' role says: “Regular home visits are an important part of follow‐up care, as the family and patient need to realize that continuing support is available… It is advisable that the first exchange after discharge from hospital is in the presence of a nurse… Early recognition and management of problems will assist in keeping the patient healthy and well rehabilitated, and will hopefully reduce hospital visits and inpatient stays” (1).

Home care in Hospital Universitario La Paz has been developed with varying dedication over the years. Firstly, it was offered if significant problems appeared (1979–1990), later, home visits were started for some new PD patients (1990–1994) and follow up visits then ensued (1995–1996). In 1997, a project was undertaken which included home training for the first time in our unit, as well as periodic follow up visits. This project was shown to the Hospital Nurse Direction, and approved immediately. It started during the first term of 1997.

There were several reasons which led us to undertake this project including the importance of providing PD at home and making it lifelong and it was felt that the hospital was an unfriendly environment in which to learn PD. The main objective was to establish early on, the patient's social environment and psychological status, and to assess how these influenced aspects of learning and adapting to PD.

Most patients expressed a very good opinion about the home training. Only one patient rejected the presence of the nurse at home. The nursing team was very satisfied because early knowledge about the patient's psychosocial conditions and family environment was established. The incidence of peritonitis decreased.
Compliance with automated peritoneal dialysis
Authors: Rivetti M. , Battú S. , Barrile P. , Benotto S. , Berruto L. , Bosio A. , d'Auria L. , Tortone C.
Published: July 2012

Compliance in peritoneal dialysis is reported as being a significant problem. In CAPD, the percentage of non‐compliant patients varies between 10 and 40%. In APD the phenomenon seems to be more limited, at 15% −20%. We considered 23 patients who had been on APD for more than 3 months. The dialytic treatment was performed using the Home Choice Pro device to record all the parameters of the dialysis session.

The last 30 days of treatment were considered in the assessment of compliance, evaluating differences in daytime and night‐time volumes between the prescription and the actual treatment, the length of the night‐time session, and the days of treatment. As regards volume and duration, no differences were found compared to the dialytic prescriptions. For the days of treatment, a difference was only found in 3 patients:2 self‐administered patients missed 1 day of therapy out of 30, and in both cases the missed tretment was ageed with the Centre; non‐compliance was only found in 1 patient (4,3%), whose treatment was performed by the family, and who missed 4 days out of 30.
Organ donation: Attitude and knowledge of nurses in South Africa
Authors: Naude A. , Nel E. , Uys H.
Published: July 2012

Various factors influence the process of organ donation. As a result, there is a shortage of organs for transplant. Poor communication and cooperation between transplant coordinators and intensive care nursing staff can lead to the non‐referral of potential organ donors, which is detrimental to the process. The purpose of this research was to ascertain the attitude and knowledge of the transplant coordinators and intensive care nursing staff that work in intensive care units during organ donation. Contextual descriptive research was carried out by compiling literature‐based questionnaires, one each for the transplant coordinators and intensive care nursing staff, and then analysing responses. The indications are that problem areas exist between the role players in the organ transplant process. Guidelines were drawn up for the improvement of communication and cooperation between them in order to promote organ donation.
Information and counselling for patients approaching end‐stage renal failure in selected centres across Europe
Authors:   For the EDTNA/ERCA Collaborative Research Programme, Da Silva‐Gane Maria , Goovaerts Tony , M. Elseviers Monique , J. Lindley Elizabeth
Published: July 2012

The EDTNA/ERCA survey of the provision of pre‐ESRF information, education and counselling in renal care was the third project organised through the Collaborative Research Programme (CRP). Data was collected from 35 participating centres in 10 countries. The majority of participating centres had a structured pre‐ESRF programme. Advice and education received by patients in these centres was usually provided by a multidisciplinary team and was coordinated by nurses in half of the centres. Programmes in all countries had similar content in that normal kidney function, medication, diet, haemodialysis, peritoneal dialysis and transplantation were routinely discussed and that issues such as employment, importance of leisure activities, holidays and Kidney Patient Associations were also on the agenda for discussion. Educational material produced by companies was widely used.

Policy differences did emerge in attitudes to discussing the “no‐treatment” option with patients accepted for dialysis and in the treatment that would be offered to patients with specific co‐morbidities and life‐style.
Self adhesive dressing pouch for the protection of catheters
Authors: Martínez María Teresa de la Cruz , Hernández María José
Published: July 2012

This paper is about a new model of dressing, used for the protection of all types of temporary and permanent catheters. Those who developed this dressing realised the practical difficulties during the placement and removal of traditional dressings, used in haemodialysis units. They also realised that it this was unpleasant for the patients, and there was a risk to the catheters when removing the dressings because of the use of scissors and other cutting instruments.

This new dressing solves these previously mentioned problems and at the same time contributes to the comfort of the patients.

The model has been registered as a standard using model, and therefore it is protected by law and its copyright (Intellectual Property).
The SF‐36: An instrument for measuring quality of life in ESRD patients
Authors: Terada I. , Hyde C.
Published: July 2012

This paper provides a review of four studies, which use the generic Medical Outcome Study Questionnaire 36‐Item Short Form Survey (SF‐36) to investigate the quality of life of patients with end‐stage renal disease. Both English and translated versions of this instrument have been demonstrated to be valid. It is difficult however, to compare results from western and eastern populations as cultural differences may influence how people rate their quality of life.

The SF‐36 has been demonstrated to be a valid instrument when used to measure the quality of life of ESRD patients. Research findings from Europe and the United Kingdom demonstrate that patients who are treated with a successful renal transplant can experience a QOL which, is superior to that achieved with any dialysis modality and which is very close to the QOL scores of the general population.

It is acknowledged that while the studies cited in this article all used the SF‐36 the research design employed in each instance is not exactly comparable, and any conclusions drawn here require further testing.
Unstable diabetes and peritoneal dialysis — what are the challenges?
Authors: Thomas N. , Mahon A.
Published: July 2012

This case study outlines the care of a young woman undergoing peritoneal dialysis (PD) who has Type 1 diabetes mellitus as the underlying cause of her renal disease. Although she is able to manage the practical aspects of her fluid exchanges and exit‐site care, she has difficulty with managing her fluid balance. This necessitates the use of two 3.86% glucose bags per day, which in turn sometimes leads to high, unstable, blood glucose levels.

This study will outline the nursing challenges and interventions and will evaluate the nursing management.
Management of a pregnant woman dependent on haemodialysis
Authors: Walsh Anna‐Marie
Published: July 2012

This is a case study of a woman who became pregnant whilst receiving haemodialysis in a London teaching hospital. She courageously disregarded the doctors' advise to abort the fetus. The doctors advised her to wait until she had a kidney transplant to become pregnant again, rather than increase maternal and fetal risk on dialysis. She was due to have a live‐related transplant from her father in the spring.

The case study describes a practical account in detailed measure to equip nurses with the knowledge to provide specialised care to high‐risk dialysis expecting mothers. The main problems in this case study were trying to manage the mother's dialysis regime, control her anaemia, ensure good nutritional levels and gain accurate daily weights.
Endotoxin and ‘on line’ production of substitution fluid in haemodiafiltration and haemofiltration
Authors: Nystrand Rolf
Published: July 2012

In dialysis, machines intended for use in the treatment modes haemodiafiltration (HDF) and haemofiltration (HF) have been on the market about 10 years. These machines are equipped to be able to produce the substitution fluid to be used for direct infusion. In principle, this is done by using the reverse osmosis water of the clinic and mixing in concentrates as usual to form dialysis fluid. The dialysis fluid is then filtered in order to prepare it for use as substitution fluid.

The volumes used when the substitution fluid is prepared on‐line are usually 20–50 litres in HDF mode and 70–150 litres in HF mode. This means that a patient treated 3 times a week is exposed to a total volume of substitution fluid ranging from 3,000 litres to a maximum 23,000 litres a year. Where else in medicine do we see something coming close to this? Because of these large infusion volumes, the issue of endotoxin levels becomes as important as the issue of sterility.
Routine disinfection of the total dialysis fluid system
Authors: Gorke A. , Kittel J.
Published: July 2012

The importance of bacteria and endotoxin free, sterile dialysis fluid for long term, high quality haemodialysis treatment is obvious and very much demanded (1,2). Dead spaces and connections between units (segments) of fluid production and delivery in elder systems are a continuous source for bacteria growth, biofilm generation and endotoxin release (3).

After varying success with routine disinfection of system components showing partly fast recovery and growth of bacteria (i.e. < 48 hours) we changed to routine disinfection of the entire fluid production and distribution system. We call this ‘system disinfection’.

We report the methods and results from observation of practice over 28 months of disinfection. The fluid system is composed of a soft water tank, reverse osmosis (double RO), RO fluid loop, central bicarbonate production and delivery system and dialysis stations with and without ultrafilter and citric‐thermal disinfection before and after each haemodialysis.

The system disinfection is carried out bimonthly with peracetic acid 3.5% in < 0.1% solution at a mean temperature of > 15 °C and at a minimum of 60 minutes of disinfection time.

Samples for microbiological testing and endotoxin measurement were assessed 3–4 monthly at 7 measurement points. The tests were carried out 7 times on the 11th day (mean value [MV]) after routine system disinfection. The result was in 0.2 CFU/ml (MV) in 40 tests.

The endotoxin levels (IU/L) were all < 0.25 except one at 0.325 in RO water. Endotoxin was assessed 5 times in 26 tests over 28 months. Samples were taken at 10.5 (MV) days after system disinfection. The Gel Clot or turbometric method was used.

Efficient and preventive routine system disinfection of an entire dialysis fluid production and distribution system — as standard in modern equipment — can support sufficient quality in dialysis fluid produced and distributed by elder and composed systems.
Hand decontamination: What interventions improve compliance?
Authors: Hinkin J.
Published: July 2012

Background: Haemodialysis units have traditionally been classified as high‐risk areas in relation to infection control. Hand decontamination is the fundamental infection control practice, although this is not always performed optimally. Deficiencies in the technique, frequency and appropriateness of this vital practice are frequently reported in health care journals. A literature search was carried out to determine what interventions improve compliance with hand decontamination practice.

Method: A literature search was carried out of electronic databases from 1988–2000. Forty articles matched the key search words. When inclusion/exclusion criteria had been applied, seven primary research articles were found to be suitable. Appropriate tools were used to critically analyse the research. The findings were then synthesised into similar themes.

Findings: The interventions used in the seven articles utilised a combination of staff and patient education, feedback and motivational interventions to improve compliance. The evidence showed that these interventions met with different degrees of success. Multiple interventions were generally more successful than individual efforts. The improvement in hand decontamination practice often fell back to base line measurements after the intervention had ceased.

Implications for practice: The findings can cautiously be used to improve practice. A combination of continuous, innovative education and motivation should improve and maintain this important skill.
The Role of the Renal Specialist Nurse in Prevention of Renal Failure
Authors: Hurst J.
Published: July 2012

This article will investigate the care required for those with reduced renal function before renal replacement therapy (RRT) commences. Renal nurses are often involved with the technical, monitoring and evaluative aspects of RRT for those with end stage renal failure. However, many patients may experience reduced renal function many years before reaching the stage of needing RRT. Renal nurses are already involved in the preparation of patients for RRT, but are not presently exercising their specialist skills in the period before this time by contributing to the prevention of end stage renal failure (ESRF). Screening programmes carried out in various parts of the world demonstrate that many members of the population have undetected renal insufficiency, and may benefit from intervention from the nephrology team to prevent further renal dysfunction. It is for this group of patients that this article will consider the potential for the renal nurse to expand their scope of practice.
Dialysis — A family matter. A personal tribute to the relatives of kidney patients
Authors: Auer J.
Published: July 2012

The patient and his or her treatment is the main focus of the multidisciplinary team in the Renal Unit, yet the most important part of the patient's life is that spent at home, outside the hospital. It is important to recognise the contribution to care of the patient's family, especially the spouse. It is also important to understand the carer's needs. Carers experience many of the stresses associated with End Stage Renal Failure, while being relatively unsupported and unappreciated by hospital staff. This paper focuses on the need for imagination and understanding of the carer's predicament, and suggests ways in which carer's needs can be met.
Distribution of study observations
Authors: Elseviers Monique M.
Published: July 2012

Suppose that you took a sample of dialysis centres in your country and collected individual information from more than a thousand dialysis patients. Suppose you are interested in the age these patients were when they started dialysis, how can you investigate and summarize this result?
Belgian peer review experience on the Achille's Heel in haemodialysis care: Vascular access
Authors: Theelen B. , Rorive G. , Krzesinski J.M. , Collart F.
Published: July 2012

Aims: In order to improve the supervision and to evaluate the quality of care in dialysis units, a national project was promoted as a Peer Review. It consisted of systematic, continuous and critical evaluation of the care and the application of international guidelines and compared the reality of care with standards.

Method: The first chart consisted of the evaluation of infectious episodes of vascular access. This point is particularly relevant since infection represents the second cause of mortality in haemodialysis.

A questionnaire concerning each patient was designed. Questions concerned the description of vascular access and the related infectious events. Each questionnaire included 21 items. The project involved 29 dialysis centres, 1644 patients and 1775 vascular accesses. The database included 90,525 data.

Results: Among the 29 centres, the native arteriovenous fistula (AVF) is the first choice (67.5%) in vascular access, but the proportion of AVF decreases with age contrary to the catheter, which is more frequently chosen, in older patients. Independent of age, 20% of hospitalisations are among patients with catheters and only 7% among patients with AVF. The RR (relative risk) of being hospitalised (any complication of vascular access) is 1.68 for patients with catheters compared to patients with AVF. The rate of infections does not increase with age but is higher for patients with catheters (RR = 2.26). The number of infections appears to be dependent on the staphylococcus aureus carriage in the year.

Conclusions: This first step allows each centre to compare itself to others in an anonymous way. This approach should lead to specific recommendations to improve the quality of care in dialysis units.
Do demographic variables affect the timing of referral to the nephrologist?
Authors: Steel J. , Ellis P.
Published: July 2012

The consequences of late referrals for nephrological care include: increased morbidity, poorer quality of life on dialysis and probably increased mortality. Few studies look at the socio‐demographic factors which influence referral to the nephrologist. There is good evidence from studies in other areas of health care that socio‐demographic and economic factors influence access to health care. It is important that the nephrology community understand whom the individuals are who likely to be referred late so that we can address any inequality in access to services. We studied all of the patients who started renal replacement therapy in our unit over a five‐year period, 1st January 1996 to 31st December 2000 (n = 494). We collected data on gender, age at referral, ethnicity, the date that the individual started dialysis as well as the date they were first seen by a nephrologist.

We analysed the data to see if age, gender or ethnicity was associated with timing of referral. If an individual had seen a nephrologist more than three months prior to starting dialysis, they were termed ‘early referred’, if not they were termed ‘late referred’. Since this was a sociologically driven research project, we set statistical significance at the 10% (0.1) level. Our data showed that gender did not affect the timing of referral (p = ns), ethnicity affected referral in so much as whites were more likely to be referred late than blacks (p = 0.08) but no more so than non‐whites (p = ns). People under the age of 30 were statistically more likely to be referred late than people over the age of 30 years (p = 0.027) as were people under the age of 40 (p = 0.047). We interpret these finding as demonstrating that health care professionals are referring older people and people from the black community in good time and that, in contrast to other studies of inequalities in health, these findings demonstrate that the elderly and ethnic minorities are not being disadvantaged.
Effects of different doses in continuous veno‐venous haemofiltration on outcomes of acute renal failure: A prospective randomised trial
Authors: Ronco C. , Belomo R. , Homel P. , Brendolan A. , Dan M. , Piccinni P. , La Greca G.
Published: July 2012

Background: Continuous veno‐venous haemofiltration is increasingly used to treat acute renal failure in critically ill patients, but a clear definition of an adequate treatment dose has not been established. We undertook a prospective randomised study of the impact of different ultrafiltration doses in continuous renal replacement therapy on survival.

Methods: We enrolled 425 patients, with a mean age of 61 years, in intensive care who had acute renal failure. Patients were randomly assigned ultrafiltration at 20 ml/h−1/kg−1 (group 1, n = 146), 35 ml/h−1/kg−1 (group 2, n = 139), or 45 ml/h−1/kg−1 (group 3, n = 140). The primary endpoint was survival at 15 days after stopping haemofiltration. We also assessed recovery of renal function and frequency of complications during treatment. Analysis was by intention to treat.

Results: Survival in group 1 was significantly lower than in groups 2 (p = 0.0007) and 3 (p = 0.0013). Survival in groups 2 and 3 did not differ significantly (p = 0.87). Adjustment for possible confounding factors did not change the pattern of differences among the groups. Survivors in all groups had lower concentrations of blood urea nitrogen before continuous haemofiltration was started than non‐survivors. 95%, 92% and 90% of survivors in groups 1, 2 and 3, respectively, had full recovery of renal function. The frequency of complications was similarly low in all groups.

Interpretation: Mortality among these critically ill patients was high, but increase in the rate of ultrafiltration improved survival significantly. We recommend that ultrafiltration should be prescribed according to patient's bodyweight and should reach at least 35 ml/h−1/kg−1.
Importance of increased ultrafiltration volume and impact on mortality: Sepsis and cytokine story and the role for CVVH
Authors: Ronco C. , Ricci Z. , Bellomo R.
Published: July 2012

There is growing interest in extracorporeal blood purification therapies (EBPT) as adjuvants in the complex therapy of sepsis and multiple organ dysfunction syndrome (MODS). Nowadays the only routinely used purification technique is ‘renal replacement therapy’ (RRT) during acute renal failure (ARF), one of the almost inevitable and deadly components of MODS. RRT has been the first and still is the most utilised and effective type of EBPT. Evidence is growing about its ability to maintain homeostatic balance in critically ill patients, and specifically in septic patients with MODS. Clinical trials have been recently designed to modify or improve these therapies. In detail, the following issues have been currently addressed: effects on blood purification provided by different therapies, adequacy of prescription and delivery of therapy, toxins and solutes to be removed with these techniques. Based on these speculations we will briefly review the current understanding of these issues and the rationale for application of RRT in the intensive care unit (ICU). In particular, we will focus on the importance of increased ultrafiltration volume and its impact on mortality in the general ICU population and in septic patients.
Continuous Renal Replacement Therapies
Authors: Gaspar Luis Jorge Rodrigues , Moreira Nelson Martins , Moutinho Aires Ademar , Pinto Paulo Jorge Moreira , Lima Helder Brízida
Published: July 2012

Continuous Renal Replacement Therapy (CRRT) is frequently used in patients admitted to intensive care units with multiple organ failure and acute renal failure. These patients are prone to developing hypotension making it very difficult to use conventional haemodialysis for their treatment. When compared to conventional haemodialysis CRRT has obvious clinical advantages. These advantages are mostly due to slow volume and uraemic toxin removal leading to better haemodynamic tolerability for such patients.

In our unit during the year 2000, 58 patients were submitted to CRRT: 14 of the patients underwent treatment with continuous veno‐venous haemofiltration and 44 were submitted to continuous veno‐venous haemodiafiltration. The mean patient age was 61.7 years (range: 20–87), 36 male and 22 females. Twenty patients (43.1%) had sepsis, 18 (31%) were post open‐heart surgery, 7 (12%) had multiple organ failure, 4 (6.9%) were polytraumatised, 3 (5.2%) were post neurosurgery and 1 (1.8%) was a liver transplant patient.

Despite the grave prognosis of these patients, 22 (37.8%) survived and 36 (62.2%) died. Of the patients that survived, 10 (17.2%) recovered renal function and 12 (20.6%) remained on a regular haemodialysis programme. The authors conclude that CRRT seems to be an alternative to conventional haemodialysis for the treatment of those patients with acute renal failure.
Vascular access in Acute Renal Failure
Authors: Van Waeleghem J.P.
Published: July 2012

Today, central venous access catheters play an important role in the treatment and management of many dialysis patients. Their use and care may influence the patient's overall outcome. Therefore, it is critical to have a thorough knowledge of the vascular anatomy, types of catheters, placement techniques and maintenance and management of complications.

The incidence nowadays of acute renal failure in intensive care patients is reported as high as 25%. Acute renal failure is one of the few causes of organ failure in which complete recovery is possible, provided the patient survives the associated comorbid conditions. There are various extracorporeal dialysis techniques available to treat this category of patients using mostly a central dialysis catheter as vascular access.

It is important to select carefully the type of catheter and to create a specific vascular access system in order to be able to perform the selected dialysis technique in the most optimal efficient conditions. Any inadequacies of access will create dialysis insufficiency leading to more comorbid conditions and even higher mortality.

In this article, we will describe the different possibilities as well as the nursing management of that type of vascular access in patients with acute renal failure.
Who should manage continuous renal replacement in the intensive care setting? A nursing viewpoint
Authors: Martin R. K.
Published: July 2012

Since its inception, continuous renal replacement therapy (CRRT) has been performed in critical care units with or without the involvement of nephrology nursing support (1,2). It is apparent that the issue of providing care to patients requiring this therapy is not so much a debate on the nursing control of CRRT, but a focused discussion on the nursing management and delivery of care to the patient receiving CRRT in the intensive care setting.

Although the choice of a nursing care model for CRRT is dependent on many clinical and organisational factors, the use of one nursing specialty to deliver CRRT care can leave gaps in practice. The Joint or Collaborative Nephrology/critical care nursing model brings the highest level of nursing expertise to the bedside. The joint model tends to promote collaboration between two distinct nursing specialties, with opportunities for setting joint standards and promoting research.

With this in mind, this discussion will examine some of the factors affecting structuring of nursing care, describe nursing models currently in use, compare the attributes of each, and conclude which model is preferred for the delivery of nursing care for CRRT.
VASCULAR ACCESS QUALITY MONITORING
Authors: Lopot F. , Portová M. , Bednářová L. , Pilbauerová K. , Wittgrúberová M. , Nejedlý B.
Published: July 2012

Access dysfunction presents a risk for haemodialysis patients and is costly for health care providers. Regular vascular access quality (VAQ) monitoring enables the detection of adverse access conditions early allowing timely interventions, which will presumably be less invasive, more successful and cheaper. This paper reviews all currently used assessment parameters: dynamic and static pressures, recirculation and blood flow through the access — and analyses pros and cons of each of them. Based on this overview it is concluded that access flow monitoring should be the method of choice, possibly combined with monitoring of another parameter to further enlarge diagnostic possibilities of the monitoring. The VAQ monitoring system developed and used currently in the author's dialysis centre is briefly described as an example. The issue of access flow related to haemodynamics is briefly mentioned. With the introduction of any VAQ monitoring system, one has to acknowledge a change in structure of interventions and that the demand for surgical procedures decreases with a concurrent increase in percutaneous interventions.
PSYCHOLOGICAL CARE OF THE HAEMODIALYSIS PATIENT
Authors: Bath J. , Tonks S. , Edwards P.
Published: July 2012

The psychological care of patients at the haemodialysis unit is becoming an increasingly important aspect of the overall treatment of patients with end‐stage renal failure. As more is understood and reported regarding the impact of psychological factors on physical processes it becomes crucial that good quality psychological care is delivered to patients by nurses working at the haemodialysis unit. This study aimed to look at haemodialysis patients' perceptions of their treatment to discover if a dialysis centre in Southern England might benefit from a more formal system of psychological care.

The data revealed four main themes that were of particular importance to the participants of this study: The New Self, Coping, Medical Concerns and Psychological Care. Within these areas of importance, the need for good quality information, the need for a suitable dialysis environment and the importance of social and family support were evident. Although the psychological care system that was in place at the unit appeared to be working well a more formal system of care might improve the patient experience.
CITRATE ANTICOAGULATION AND ADVERSE EVENTS
Authors: De Vos J. , Hombrouckx R.
Published: July 2012

Several patients with heparin intolerance were dialysed with tri‐sodium citrate as anticoagulant without acute clinical problems
NURSING TERMINALLY SICK DIALYSIS PATIENTS
Authors: De Miguel Bienvenido
Published: July 2012

The number of terminally sick patients (TSP) in haemodialysis (HD) is rising. The personnel that assist these patients wonder if they are sufficiently qualified to help and care for them and if TSP require treatment that is different to the other chronic dialysis patients. The reason for this study was to investigate if caring for TSP psychologically affected the infirmary personnel who looked after them during HD.
BED‐SIDE BLIND INSERTION OF PERITONEAL DIALYSIS CATHETERS
Authors: Dequidt C. , Vijt D. , Veys N. , Van Biesne W.
Published: July 2012

Access to the peritoneal cavity is an essential factor for successful peritoneal dialysis. The technique of catheter insertion can influence technique success and patient satisfaction. As compared to conventional surgical laparotomy, a bedside blind insertion technique under local anaesthesia has logistical advantages for the patient, the hospital and the community. This study compares outcomes of both methods in a single centre.

A retrograde analysis of a prospectively collected database on all catheters implanted at the University hospital Ghent between 1/1/1998 and. 31/5/2002 was carried out. During this period, catheters were implanted either by conventional laparotomy (CL) or by a bedside blind insertion technique (BI) under local anaesthesia.
EVIDENCED BASED NEPHROLOGY CARE
Authors: Sedgewick JM.
Published: July 2012

This paper highlights the importance of evidenced‐based practice (EBP) and its implications to patient and health professionals working within nephrology. The need to ensure that practice is based upon best evidence should be a concern for all health care professionals. Confusion sometimes surrounds the concept of EBP and the potential impact this may have upon patient outcomes. It is the intention of this paper to firstly demystify the process of EBP highlighting the important factors to be considered in moving towards EBP in nephrology care. Secondly, the paper draws upon a number of well‐conducted research studies, which have important implications for nephrology care. These selected examples of best evidence will highlight further where ongoing work could be focused. Whilst there is much published within current literature concerning research within nephrology it is essential that practitioners are encouraged to develop the skills to critically search literature, appraise and evaluate its usefulness in developing appropriate and meaningful evidence to enhance practice and patient care.
THE EUROPEAN BASIC CORE CURRICULUM FOR NEPHROLOGY NURSING THE PROCESS OF WRITING, PUBLISHING AND DISSEMINATING
Authors: Fuchs S. , Thomas N.
Published: July 2012

In August 2002 the European Basic Core Curriculum (BCC) for Nephrology Nursing was published on the EDTNA/ERCA homepage. At the EDTNA/ERCA annual conference in The Hague in September 2002, it was presented to the delegates as an oral presentation and a poster presentation. Publicity flyers were translated into seven languages and distributed to delegates. This paper will describe the aims of the BCC, the process of writing and publishing, the use of the BCC in nursing schools and the measures that have already been taken in implementation and dissemination.
ACCREDITATION OF POST‐BASIC NEPHROLOGY COURSES WITHIN THE EDTNA/ERCA
Authors: Hurst J. , Thomas N. , Sedgewick J. , Reichardt M.
Published: July 2012

This paper will outline the development of the EDTNA/ERCA accreditation programme for post‐basic courses in nephrology. It will discuss results of the pilot project and relate the experiences of one school that has successfully gone through the accreditation process. The article will conclude with a discussion on more recent developments and evaluate the project in light of the original concepts.
A NURSE LED CENTRAL LINE INSERTION SERVICE
Authors: Casey J. , Davies J.
Published: July 2012

Advanced Nurse Practitioners (ANP) are developing their role in order to insert temporary and permanent central venous catheters to facilitate haemodialysis.

Two hundred and eighty‐nine central venous catheters (CVC) were inserted over a two‐year period. The ANP inserted 117 CVC with 172 CVC inserted by the nephrology medical team. Using non‐parametric independent two—group comparison Mann Whitney test and Chi‐Squared test, the two groups were compared for specific outcomes. When comparing both groups with respect to CVC longevity, elective and non‐elective removal along with infection (exit site and systemic) no statistical difference between the ANP and the nephrology medical staff could be found.
THE HURDLES OF MIGRANT NURSES
Authors: Funtera C. Campos
Published: July 2012

The vast disequilibrium between healthcare providers and the recipients of care creates a hazard effect to all. This is a global issue as who will look after the growing and ageing population? Some countries have decided to recruit from outside their own country.

Prior to registration, the Board of Nursing has imposed a regulation that a foreign nurse has to undergo a three‐ to six‐month adaptation programme. The main objective is to assess and evaluate and at the end of the programme it is hoped that the nurse will be deemed competent and safe to practice.

Foreign nurses face tremendous challenges but are able to integrate with the provision of support services and an adaptation programme. This programme needs to be culturally sensitive to nurses who are used to work in a different system of health care.
ON‐LINE TECHNIQUE FOR PRODUCING SUBSTITUTION FLUID IN HAEMODIAFILTRATION AND HAEMOFILTRATION
Authors: Nystrand R.
Published: July 2012

When the kidneys are not able to fulfil their task anymore the individual reaches a situation known as End‐Stage Renal Disease (ESRD). Haemodialysis may be carried out. In order to have a more efficient dialysis the treatment modes haemodiafiltration and haemofiltration are also in use. In these modes a substitution fluid is added to the bloodstream and continuously removed by the dialyser. However, these modes require large volumes of sterile fluids, 10 to 30 litres for haemodiafiltration and 70 − 100 litres for haemofiltration. This fact has made these treatment modes expensive.

The fluids have traditionally been produced by the pharmaceutical industry in five litre bags, but in bags not all solutions are stable or possible to produce, for instance when sodium bicarbonate is used as a buffer. Today sodium bicarbonate is the absolute predominant buffer. An alternative way of producing the fluids has to be found. In 1978 LW Henderson (1) described a technique using filtration to produce substitution fluid on‐line i.e. preparing the fluid directly on site and giving it to the patient. Since then work has taken place in order to construct a system that is able to both mix, sterilise and administrate the substitution fluid in haemodiafiltration and haemofiltration. This work has resulted in dialysis machines with the feature to fulfil the task of producing sterile substitution fluid. On‐line haemodiafiltration is carried out in dialysis clinics. There are approximately 65 in Sweden, 1000 in Germany, 900 in Italy, 600 in France and 2500 in the US. The number of dialysis patients is around 1.000.000 worldwide and the increase is around 7 − 9% annually.
HOW TO EVALUATE ORGAN DONATION: THE QUALITY PROGRAMME IN TUSCANY
Authors: Matesanz R. , Bozzi G. , Saviozzi A.R. , Ferrini P.L. Rossi , Cardone A. ,   Tuscany Nurse Transplant Co‐ordinators
Published: July 2012

The shortage of cadaveric organ donors imposes a severe limit on the number of patients who can benefit from transplantation. This paper describes a programme for evaluation and improvement of the organ donation process, which has been implemented in the hospitals of the Tuscany region, Italy. After analysing the first results it was found that there was great potential for growth, especially in those hospitals with neurosurgery where the weakest points of the process were detected

The development of a quality improvement programme in cadaveric organ donation is an adequate and scientific method to detect where the problems in the process of organ donation lie. Ideally, the comparison of these data with those of other Italian or European regions should be very useful to plan adequate strategies to improve cadaveric organ donation.
POST INSERTION CATHETER CARE IN PERITONEAL DIALYSIS CENTRES ACROSS EUROPE: RESULTS OF THE POST INSERTION PROJECT OF THE RESEARCH BOARD
Authors: Castro M.J. , Vijt D. , Endall G. , Elseviers M. , Lindley E. ,   EDTNA/ERCA Research Board
Published: July 2012

The EDTNA/ERCA survey of Post Insertion Catheter Care in Peritoneal Dialysis (PICC) was a project organised through the Collaborative Research Programme (CRP) of the EDTNA/ERCA. In this survey, data were collected from 54 participating centres in 20 countries.

From this survey it became clear that there is no standardised approach to immediate post‐catheter insertion treatment protocols. If we want to reduce technique failure of PD related to catheter failure, a first step will be to investigate the different policies used in Europe in order to evaluate the outcome results derived from different policies in post insertion catheter care.