Nephrology Nursing Journal最新文献

Tunneled central venous hemodialysis catheters have higher infection rates compared to other access devices. Recommendations for dressing changes of these catheters are to apply povidone iodine (PI) or a triple antibiotic ointment during catheter dressing changes. Growing evidence supports using chlorhexidine gluconate (CHG) dressings to prevent catheter-related bloodstream infections in patients with short-term central venous catheters. This quality improvement project studied whether dressing changes with PI ointment in tunneled dialysis catheters was equivalent to CHG-impregnated dressings in preventing vascular access infections (VAIs). Standardized education was required for all nurses and dialysis technicians working at four dialysis centers. VAIs were measured before and after the change. Results showed that CHG is equivalent to PI ointment in preventing VAI in tunneled dialysis catheters.

Implementing evidence-based practice in nursing is essential for connecting theoretical knowledge with practical patient care. The spirit of inquiry serves as the foundational step in the evidence-based practice process. Nephrology nurses are positioned to improve patient and system outcomes through an evidence-based practice process, highlighting its transformative impact on nursing practice and patient care. This article provides an overview of evidence-based practice and explores the essential elements for the development of a spirit of inquiry.

Patients requiring hemodialysis would benefit from evidence-based strategies that improve adherence to fluid restrictions while concurrently improving quality of life (QOL). This pilot study examined the effect of a four-week mindful drinking and eating intervention on interdialytic weight gain and QOL in patients on hemodialysis. Using paired t tests, no significant differences from pre- to post-test were found in interdialytic weight gain, a measure of fluid restriction adherence, or QOL in either the intervention (n = 18) or wait list control (n = 19) group. However, there was positive qualitative feedback from participants in exit interviews, and there were other indications of feasibility (low drop out, engagement in at-home practice according to weekly checklists). Lessons learned from this pilot study about conducting research regarding fluid restrictions for patients on hemodialysis are presented.

Tunneled dialysis catheters (TDCs) serve as vascular access for hemodialysis (HD) or plasmapheresis. This study examines the frequency and indications for TDC placement and removal by an interventional radiology service over a 5-year period. Indications for catheter placement (n = 289) included HD for patients with end stage kidney disease (65%) or acute kidney injury (AKI, 24%), and plasmapheresis (11%). Indications for catheter removal included infection (20%), dysfunction (33%), no longer needed (40%), and patient issues (7%). TDCs provide access for HD when a functioning arteriovenous access does not exist. Using a TDC in patients with AKI reduces catheter complications, such as mechanical dysfunction and infection, and provides better dialysis delivery. TDC placement in patients with AKI, despite its time and resource intensity, provides medical and financial benefits.

Patients with chronic kidney disease undergoing hemodialysis generally have a significant symptom burden, which may interfere with their quality of life. The aim of this study was to identify the prevalence of fatigue, pain, anxiety, and depression in patients on hemodialysis and analyze their co-occurrence. A cross-sectional study used self-reported measures. A total of 242 patients aged 18 years or older were initially screened; 141 were included in the study; 129 answered the questionnaires (response rate 91%). Preva lences were 24.8% had moderate to severe fatigue, 38.0% had pain, 32.6% had anxiety, and 29.5% had depression. The prevalence of coexistent moderate to severe symptoms ranged from 15.5% to 25.6%. Further research is needed to better understand the symptom burden and their co-occurrence in patients receiving hemodialysis.

Sleep disturbances are serious issues in individuals with end stage kidney disease because they are associated with worsening kidney function and other negative health outcomes, especially in older adults. Our analysis aimed to provide clinicians with the conceptual clarity required for managing sleep disturbances in older patients who are receiving dialysis. A literature review revealed three attributes that define this population's sleep disturbances: sleep initiation and maintenance difficulties, restless sleep and short sleep, and abnormal breathing during sleep. Con sidering the serious consequences and correlates of sleep disturbances in older patients who are receiving dialysis, tailored interventions are needed to improve their sleep. Our literature review, concept analysis, and case studies provide key information for designing future mechanistic, clinical-translational, and interventional research.

Many patients with kidney disease are taking proton pump inhibitors (PPIs) for various gastrointestinal conditions. There are concerns about inappropriate usage of PPIs with unknown consequences, which include worsening kidney function. PPI use has been associated with kidney damage; however, a clear etiology of the association is uncertain. Potential mechanisms theorized for PPI-induced kidney damage include hypersensitivity, hypomagnesemia, gut microbiota alterations, uremic toxins, gastrointestinal hormones, and oxidative stress. Patients with kidney disease who are taking long-term PPI therapy require close monitoring for any signs and symptoms of kidney disease. Improper use of PPIs should also be reassessed and de-prescribed as indicated.

Patients with end stage kidney disease (ESKD) face challenges in comprehending and pursuing available treatment options, particularly with the rising interest in home-based dialysis. Providers struggle to deliver effective, individualized, and cost-efficient training, leading to lower adoption and retention rates. Cannulation, machine use, and safety training remain significant barriers. Using learning science - the marriage of psychology and the neuroscience of learning - we show that interactive virtual reality (IVR) can address these barriers to home dialysis success by providing the experiential learning necessary for deeper understanding and increased competence. We show that IVR broadly engages multiple learning centers in the brain, thus spreading the wealth of knowledge while reducing cognitive load. We conclude by presenting a practical example of the potential of IVR in objective assessment of home dialysis equipment use and cannulation skills training.