Sensing Savvy

A vascular access is required in order to have hemodialysis. The three most common types of vascular access are: an arteriovenous fistula (AVF) created by joining a vein and an artery, usually in the arm; an arteriovenous graft (AVG) formed by connecting an artery to a vein with a tube, or a central venous catheter (CVC). Optimally, a fistula or graft will be surgically created several months before dialysis starts, in order to ensure it is ready when it is needed. 

A Central Venous Catheter (CVC) is a soft flexible tube that is placed into a large vein, usually in the chest. It has two openings or ports. During hemodialysis, the ports are connected to the hemodialysis machine; one to take blood from your body to be cleaned, and the other to return blood cleaned of its impurities back to the body. A CVC is often used while a patient is awaiting surgery to have an arteriovenous fistula or graft placed to be used as a permanent vascular access. Although not optimal, a CVC can also be used as a permanent vascular access.

As a hemodialysis nurse, you have probably performed cannulation on hundreds of hemodialysis patients. But, did you know researchers have noted that the ideal person to do the procedure is the patient? That’s because the patient is always there for his or her hemodialysis session.

Despite the fact many patients may not have had any medical training, most can quickly achieve expert-level skill with self-cannulation, which not only makes the patient more active in his or her care and reduces the risk for complications, it also frees nursing staff up to do other pre-dialysis and dialysis tasks.

The National Kidney Federation (NKF) is the largest kidney patient association in the United Kingdom. The NKF entered the United Kingdom’s renal landscape in 1979 as a national organization when renal patients realized that individual Kidney Patient Associations (KPAs) needed to band together to have their voices heard in concert. While the current 69 KPAs remain both the ears and the eyes of the NKF, end-stage renal disease (ESRD) patients or their caregivers serve as the NKF’s officers, members of its executive committee and its workforce.

Multiple Comorbidities Increases Risk of Early Dialysis Initiation
Patients who have CKD along with other comorbidities face an increased risk of early dialysis initiation, researchers found. Smoking, older age and proteinuria significantly increased the risk for  two or more comorbidities. The most common comorbidities found in these patients are diabetes, hypertension and hyperlipidemia.

A working vascular access is the lifeline for a hemodialysis patient. It is also an Achilles heel, for when it fails, another access (frequently a catheter) must be quickly placed for life preserving hemodialysis to continue. While an arteriovenous fistula (a natural conduit connecting an artery and a vein) is the preferred vascular access, expanded polytetrafluoroethylene (ePTFE) synthetic grafts are frequently used as the second choice for a vascular access, before placing a catheter.

Life-threatening bleeds (LTB) from arteriovenous fistulas or grafts are significant bleeds which are not stopped by application of a normal amount of pressure as is commonly used to stop bleeding after dialysis needle removal. In many cases they occur spontaneously at home between dialysis sessions, away from the clinic or caregiving team. Although access-related LTBs are not common, they can result in the loss of the patient’s access and even be fatal.

As a healthcare professional, you know your treatment plans are only as powerful as your patients’ commitment. Your patients’ quality of life not only depends on your expertise but also on how well they implement their care plan after they leave your office. And when it comes to patients with end-stage renal disease (ESRD), non-adherence to dialysis and supporting factors such as diet and medication can lead to severe complications and an increased risk of mortality. Unfortunately, at least 50 % of hemodialysis patients are believed to be non-adherent, according to a study by the Department of Internal Medicine at Cairo University.

In February, the Bipartisan Budget Act of 2018 was signed into law, expanding Medicare reimbursement for a small list of telehealth services, including home dialysis for end-stage renal disease (ESRD), according to the Clinical Journal of American Society of Nephrology. 

Clotting and bleeding are major causes of mortality and morbidity during high risk ECMO therapy that treats the “sickest of the sick” by infusing patients with oxygen-rich blood drawn from an ECMO circuit. One key component of an ECMO circuit is the oxygenator. As a clot develops in the oxygenator over time, the volume of oxygenated blood decreases and less oxygen-rich blood is delivered to the critically ill patient. If the clot gets large enough, the oxygenator will need to be switched out by the perfusionist as quickly as possible and replaced by one that will continue to oxygenate the blood.