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Introducción: El recambio plasmático terapéutico es una técnica extracorpórea de depuración sanguínea. El recambio plasmático terapéutico mediante el método de centrifugación (plasmacentrifugación) requiere flujos de 50 ml/min lo que permite realizar el intercambio con accesos vasculares periféricos. El principal objetivo de este estudio fué el de analizar el uso y las complicaciones del acceso vascular periférico en las sesiones de plasmacentrifugación. Material y Método: Estudio observacional descriptivo longitudinal sobre el análisis de complicaciones del acceso vascular periférico de las sesiones de plasmacentrifugación realizadas entre enero de 2017 y marzo de 2018. Resultados: Inclusión de un total de 93 sesiones de plasmacentrifugación, estas sesiones fueron llevadas a cabo en 9 pacientes con una mediana de 7 [P25:6; P75:10,5] sesiones por paciente. El 66,66% (n=6) fueron mujeres. En el 89,24% (n=83) de las sesiones se usó la centrifugación y en el 10,75% (n=10) la fotoaféresis. La etiología de enfermedad para estos pacientes fue: renal en el 55,55% (n=5) de los casos, neurológica en el 33,33% (n=3) de los casos y dermatológica en el 11,11% (n=1). De las 93 sesiones totales hubo problemas relacionados con la canalización de un acceso vascular periférico en el 52,69% de las sesiones (n=49). Conclusiones: Debido a que en más de la mitad de las sesiones se presentaron complicaciones en el abordaje del acceso vascular periférico, se concluye que es necesario el estudio vascular ambulatorio del paciente antes de la primera sesión, pudiendo ser útil el uso de la punción ecoguiada.

Background: Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety. Aims: To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients. Methods: This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used. Findings: This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment. Conclusion: Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe.

Introduction: Plastic cannulas (PC) have shown efficacy in haemodialysis (HD) and are presented as a positive innovation for patients and vascular access survival. Objective: To analyse Spanish HD nurses' experience of using PC. Design: Cross-sectional observational study. Methods: An ad hoc questionnaire was administered on nurses' experience of PC use. Results: A total of 163 Spanish HD nurses were surveyed, of whom 42.3% had PC in their workplace and 50.9% had used them. In all, 55.8% had received training and 77.9% wished to receive more training. These needles were significantly more available in public institutions than in private centres (p < 0.001). There was no significant difference between years of experience and having received training (p = 0.915). There was a moderate-strong correlation (ρ = 0.659) between greater professional satisfaction with the product and greater patient satisfaction (p < 0.001). The nurses would make a median of two [P25 , 1; P75 , 3] modifications in the product design. The characteristics of the PC were rated positively by 55.8% and negatively by 10.3%. Conclusions: A substantial proportion of the nurses surveyed did not use PC and had not received training in their use. Respondents reported that PC could be improved and a small percentage perceived them negatively.Implications for practice: Based on the evidence presented and available, if we manage to integrate this knowledge and work on the continuum of achieving excellence, we will continue to grow as a profession and provide higher quality care.

espanolIntroduccion: Se ha documentado que implementar programas de actividades recreativas durante las sesiones de dialisis es una buena alternativa para mejorar no solo la percepcion hacia el tratamiento, sino tambien otras alteraciones presentes en las personas con enfermedad renal cronica en tratamiento con hemodialisis. Objetivos: Analizar la satisfaccion de los pacientes con el Proyecto Deficit de Actividades Recreativas, asi como cuantificar el coste economico del mismo. Material y metodo: Estudio descriptivo transversal realizado en 2019. Se recogieron datos clinicos. Se valoro la satisfaccion con el proyecto de actividades propuesto. Se recogieron datos de autopercepcion sobre el estado de salud y el tratamiento. Se cuantifico el coste economico del proyecto. Resultados: Evaluados 37 pacientes. La puntuacion mediana de satisfaccion para las actividades fue: Programa Pallapupas 8/10 [P25:6; P75:10], Celebraciones mensuales 10/10 [P25:8; P75:10], Ejercicio fisico intradialisis 7/10 [P25:5; P75:10], Conciertos en directo 7/10 [P25:5,5; P75:9,5]. En la autopercepcion, un 37,84% (n=14) percibia negativamente el tratamiento y un 29,73% (n=11) no estar satisfecho con la inversion de tiempo. El 91,89% (n=34) desea continuar participando en las actividades organizadas. El coste total teorico de las 4 actividades evaluadas es de 33.715,22 euros al ano. Conclusiones: Se ha hallado una alta satisfaccion de los pacientes con el Proyecto deficit de actividades recreativas en hemodialisis, pudiendo ser el coste anual de dicho proyecto asumible. EnglishIntroduction: It has been documented that implementing leisure activity programs during dialysis sessions is a good alternative to improve not only the perception towards treatment, but also other alterations present in people with chronic kidney disease on hemodialysis. Objectives: To analyse patient satisfaction with the Lack of Leisure Activities Project, as well as quantify its economic cost. Material and Method. Descriptive cross-sectional study conducted in 2019. Clinical data were collected. Satisfaction with the proposed activity project was assessed. Self-perception data on health status and treatment were collected. The economic cost of the project was quantified. Results: 37 patients were evaluated. The median satisfaction score for the activities was: “Pallapupas” Program 8/10 [P25:6; P75:10], Monthly celebrations 10/10 [P25:8; P75:10], 7/10 intradialytic exercise [P25:5; P75:10], live concerts 7/10 [P25:5.5; P75:9.5]. Regarding to self-perception, 37.84% (n=14) perceived the treatment negatively and 29.73% (n=11) were not satisfied with the time invested. 91.89% (n=34) wish to continue participating in organized activities. The total theoretical cost of the 4 activities evaluated is 33,715.22 euros per year. Conclusions: A high satisfaction of the patients with the Lack of Leisure Activities in hemodialysis Project was found, being the annual cost of the project acceptable

El Yodo 131 es un isotopo radiactivo que se usa con fines médicos, y se ingiere en forma de líquido o cápsula. Su absorción se produce en el tracto gastrointestinal, pasa al torrente sanguíneo y se concentra finalmente en la glándula del tiroides destruyendo sus células1,2. Es un tratamiento de elección en pacientes que estén afectados por un cáncer de tiroides o sufran de un hipertiroidismo1,2,3. En el cáncer de tiroides se administran dosis muy altas de este radiofármaco (del orden de 100 mCi de actividad)1,2, por lo cual el paciente precisa de ingreso hospitalario y medidas de protección radiológicas estrictas, tales como habitación plomada, visitas controladas, etc2,4. En el tratamiento del hipertiroidismo se administran unas dosis bajas de radioyodo (aproximadamente 10 mCi de actividad) por vía oral en capsulas1,2,3. La máxima captación en la glándula tiroides se produce las primeras 48 horas y la eliminación de la actividad radioactiva remanente es por medio del propio decaimiento físico del isotopo, y a través de orina, heces, sudor y saliva. Es un tratamiento que se administra de forma ambulatoria, aunque el paciente debe seguir una serie de recomendaciones de protección radiológica ya que, debido a la incorporación del radioisótopo, pasa a ser un emisor de radiación1,4.

Hemodialysis (HD) has a significant impact on health-related quality of life (HRQoL). We performed an observational study to assess the mental and physical status of 41 patients on chronic HD treatment. We planned and launched a program of recreational and therapeutic intradialysis activities to reduce patients' boredom due to inactivity. Patients' mental and physical status was reassessed at 12 months. Our initial attempt to introduce these recreational activities as intradialysis therapy has been rated positively by all patients. After one year, anxiety decreased (without statistical significance) and willingness to participate in activities increased from 50.00% to 85.71% (p=0.019). No improvement was observed on the remaining studied variables. This preliminary initiative is promising. We plan to maintain these successful therapies and include others to help consolidate this program.

Resumen Introducción: Los pacientes en hemodiálisis deben someterse a tratamientos no curativos y altamente invasivos, implicando importantes cambios en el estilo, hábitos y calidad de vida. Objetivo: Conocer el estado psíquico y físico de los pacientes en programa crónico de hemodiálisis y su opinión acerca de su experiencia personal en las sesiones de hemodiálisis. Material y Método: Estudio observacional descriptivo de corte transversal. Se utilizaron diferentes escalas de valoración para conocer en profundidad el estado psico-físico de la muestra seleccionada. Resultado: Inclusión de 35 pacientes, con una media de 67,43±14,82 años y estancia mediana en hemodiálisis de 20 meses (P25 4; P75 62,5). El 71,43% presentaba algún grado de dependencia para las actividades básicas (Barthel) y el 85,71% para las actividades instrumentales (Lawton-Brody). El 71,43% presentaba algún grado de ansiedad (Hamilton) y el 77,14% la probabilidad de padecer depresión (Escala Goldberg). El 54,29% presentaba algún grado de deterioro cognitivo (Examen Minimental). El 88,57% percibe afectación en su calidad de vida en el aspecto físico y el 51,43% a nivel mental (SF-12). La experiencia en hemodiálisis fue valorada por el grupo como Regular, Mala o Muy Mala por el 51,43%, un 62,86% afirmó no hace nada durante las sesiones y un 57,14% se siente atraído por la idea de participar en un Programa de Actividades Recreativas (según cuestionario de elaboración propia). Discusión y Conclusiones: La mediana de los resultados en depresión, ansiedad, dependencia, deterioro cognitivo, percepción de calidad de vida y percepción del tratamiento está gravemente alterada. Según la bibliografía consultada, favorecer la realización de actividades lúdico-terapéuticas durante la hemodiálisis puede mejorar la actitud de los pacientes, ayudar a mantener un adecuado nivel de salud tanto físico como mental y mejorar la percepción del tratamiento. Abstract Introduction: Hemodialysis patients should undergo non-curative and highly invasive treatments, involving significant changes in style, habits and quality of life. Objective: To know the psychic and physical state of patients in a chronic hemodialysis program and their opinion about their personal experience in hemodialysis sessions. Material and Method: A cross-sectional observational descriptive study was carried out. Different rating scales were used to know in depth the psycho-physical state of the selected sample. Results: Thirty-five patients were included, with an average age of 67.43±14.82 years and a median hemodialysis time of 20 months (P25 4; P75 62.5). 71.43% had some degree of dependency for basic activities (Barthel) and 85.71% for instrumental activities (Lawton-Brody). 71.43% presented some degree of anxiety (Hamilton) and 77.14% the probability of suffering depression (Goldberg Scale). 54.29% had some degree of cognitive deterioration (Minimental Exam). 88.57% perceive impairment in their quality of life in the physical aspect and 51.43% in the mental level (SF-12). The experience in hemodialysis was rated by the group as ‘Regular’, ‘Bad’ or ‘Very Bad’ by 51.43%. A 62.86% reported doing nothing during the sessions and 57.14% are attracted by the idea of participating in a recreational program (according to a self-created questionnaire). Discussion and Conclusions: The median of the results in depression, anxiety, dependence, cognitive deterioration, perception of quality of life and perception of the treatment is seriously altered. According to the consulted bibliography, favoring the performance of ludic-therapeutic activities during hemodialysis can improve the attitude of patients, helping maintain an adequate level of both physical and mental health and improving the perception of treatment.