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In the early 1960s, when hemodialysis for chronic kidney disease was new and there were too few machines and too little money to buy all that could be needed, allocation [...]

This study evaluated the prevalence and risk factors for endocarditis in patients undergoing hemodialysis with central venous catheter (CVC) and to identify the microorganisms isolated from the bloodstreara, This cohort study followed 94 patients with end stage renal disease (ESRD) who developed bacteremia after the insertion of a CVC for dialysis in the hospital Sao Paulo, UNIFESP, Brazil. They were divided into two groups: patients with endocarditis (E +) and patients without (E-). The prevalence of endocarditis was 29%. Among risk factors, the time of hospitalization and residence of the catheter were significantly higher (p < 0.001) in group E+. The mortality rate was 15% and lethality of endocarditis was 55%. Of the 38 microorganisms isolated in group E+, 20 were S. aureus and 45% of those were MRSA. Group E+ with MRSA presented 100%o mortality. High mortality and lethality in the E+ group was observed, and of the microorganisms isolated, MRSA was the most lethal. This article provides an overview of the findings of this study., Goal To provide an overview of the prevalence and risk factors for endocarditis in patients undergoing hemodialysis by means of a central venous catheter. Objectives 1. Explain the complication of [...]

Actual blood flow rate delivered by a dialysis machine is often less than what is prescribed. The Gambro Phoenix machine calculates the actual blood flow rate, reporting it as 'compensated' blood flow rate. This study compared two methods of setting the prescribed rate, using Kt/V to determine the effectiveness of each. Results verified that patients achieve a higher Kt/V when the prescribed blood flow rate is set as the compensated blood flow rate., When setting the prescribed blood pump speed on a hemodialysis machine, the actual blood flow rate delivered is often less than what is prescribed. It has been difficult to accurately [...]

Is your patient adequately sedated? If you' re relying solely on vital signs and traditional sedation scales, your answer is little more than an educated guess. According to one study, [...]

The portabiltty of non-invasive ultrasound has resulted in an expansion of its utilization into a variety of clinical settings. Since ultrasound is recommended for initial vein cannulation during catheter placement, [...]

Over the past 2 decades the use of central venous catheters (CVCs) for hemodialysis has become commonplace. While these devices have provided much needed temporary access to the bloodstream, they often become thrombosed and require procedures to restore patency. This article examines the lytic enzymes that are currently available and focuses on the assessment and treatment of thrombosis. Goal: To discuss the characteristics, pathophysiology, and assessment of thrombosed central venous catheters and their treatment with lytic enzymes. Objectives: 1. Describe the pathophysiology of thrombotic occlusions of CVCs. 2. Summarize the current lytic enzymes available and their pros and cons. 3. List the steps in the assessment of the malfunctioning CVC and treatment with a lytic enzyme., The use of central venous catheters (CVCs) for hemodialysis began in 1979 with the advent of the single lumen Uldall subclavian catheter (Uldall, Woods, Bird, & Dyck, 1979). Prior to [...]

A new subcutaneous device -- the LifeSite® Hemodialysis Access System (Vasca, Inc., Tewksbury, MA) -- was designed to overcome limitations of transcutaneous dialysis catheters and is now available for use in the United States. A fully implantable device, the LifeSite System provides immediate, reliable, high flow vascular access. The durable stainless steel and titanium LifeSite valve is implanted in a subcutaneous tissue pocket, typically below the clavicle. It is connected to a biocompatible silicone cannula that is tunneled to a central vein. The device is cannulated using a virtually pain-free, buttonhole technique. The valve is designed to allow cleansing of the valve, valve pocket, and buttonhole site with 70% isopropyl alcohol before and after each use to minimize the risk of infection. One hundred fifty-day results from an ongoing multicenter trial designed to compare the LifeSite System to a Tesio® Cath dialysis catheter are reviewed. These results demonstrate that the LifeSite System is associated with statistically significant higher blood flow rates (p < 0.001) and lower rates of adverse events (p < 0.0004), injection (p < 0.032), and thrombolytic infusions (p < 0.044) than a standard dialysis catheter. The positive clinical experience with the LifeSite System carries significant implications for the dialysis team, indicating that this subcutaneous, pain-free route to vascular access may offer a safer, more effective bridge to a permanent arteriovenous (AV) access than a tunneled dialysis catheter. Potential implications of these benefits include improved outcomes, greater convenience for patients, improved efficiency and time management for the nursing staff, along with reduced direct and indirect costs related to vascular access management., Vascular access care is one of the primary responsibilities of nephrology nurses, yet vascular access complications continue to represent the 'weak link' -- the Achilles' heel -- of hemodialysis. Vascular [...]

While hemodialysis machines measure and display arterial and venous pressures and notify operators when these pressures fluctuate outside of an established alarm limit, caregivers are responsible for correctly interpreting these readings. Caregivers mast determine how effectively or safely a treatment is being performed and when to initiate appropriate interventions. This article will help nurses recognize arterial or venous pressures during hemodialysis that indicate potential complications with the patient's vascular access or the extracorporeal circuit. Goal: To recognize arterial or venous pressures during hemodialysis that indicate a potential complication with the patient's vascular access or the extracorporeal circuit. Objectives: 1. Identify the clinical information available from interpretation of prepump arterial, postpump arterial, delta, and venous pressure monitoring. 2. Discuss the complications of excessive pressures in the extracorporeal circuit. 3. Identify symptoms and potential causes of hemolysis related to the hemodialysis treatment., One of the functions of a hemodialysis machine is to measure and display arterial and venous pressures as well as to notify the operator when these pressures fluctuate outside of [...]

BiCart columns have been tested over 6-weeks at Roper Hospital to determine the level of bacterial growth in columns primed and partially used significantly before reuse. The columns showed no growth with the exception of a water-borne Pseudomonas strain, which was killed by increased heat. The lack of bacterial growth is most likely due to the high sodium concentration in the column solution. Based on these results, Roper Hospital is allowing primed columns to be used up to 24 hours later., Q: Our unit recently began using BiCart[R] columns on our COBE Centrysystem[R] 3 hemodialysis machines to replace liquid bicarbonate mixed in large containers for each hemodialysis machine. It often happens [...]

BACKGROUND: The vascular community continues to search for the ideal vascular access graft that will allow early cannulation and avoid temporary central venous catheters. METHODS. This is a review of the Cranley Surgical Associates, experience with the use of the Gore-Tex DIASTAT (W.L. Gore & Associates, Inc., Flag-staff, Arizona) vascular access graft in 20 patients compared with 20 control patients matched for age, sex and risk factors. RESULTS: Although the DIASTAT graft is touted for early accessibility and decreased need for central venous access, that was not found to be the case as 14 patients in the DIASTAT group received temporary access catheters. There was significantly more edema in the DIASTAT patients (P = 0.0048). Comparing the time to the first thrombosis or to revision revealed an average of 18 weeks for the DIASTAT group and 56 weeks for the control group. The length of time to thrombosis or revision was significantly longer in the control group (P = 0.0058). Comparison of the number of weeks of function and serviceability of the grafts revealed the average DIASTAT graft functioned for 34 weeks and that of the control group for an average of 70 weeks (P = 0.0131). Comparison of the two groups showed a significant increase in early thrombotic events (

Under the end stage renal disease (ESRD) program, begun in 1972, the Health Care Financing Administration (HCFA) of the federal government covers 80% of the costs of dialysis for all [...]

Not all hemodialysis patients are good candidates for the traditional methods of access into the circulatory system. In some, diabetic vascular disease or IV drug abuse has made the blood [...]

Neutrophils, a type of white blood cell, can become activated during sepsis, widespread infection in the bloodstream. Neutrophils are also activated by C5a, a fragment released as part of activation of complement, a step in the immune response. C5a and related complement complexes are noted after regular hemodialysis treatment (RDT). RDT is a treatment for kidney failure in which the blood is removed from the body, filtered through a machine, and returned. C5a is found after RDT when the dialyzers are made of cuprophane (a kind of cellulose), but not when they are made of noncellulosic materials. It is therefore possible that neutrophils in dialysis patients with acute renal failure (ARF) and sepsis would become excessively activated, resulting in detrimental changes in white blood cell function. To study this, investigators took blood samples from 21 patients in ARF, 11 of whom had also developed sepsis, who underwent dialysis with dialyzers of both cuprophane and polysulfone (a noncellulosic material). Control values were obtained from patients with uremia (high blood levels of urea) who underwent RDT. Results showed that white blood cell counts fell in all three groups (ARF with sepsis, ARF without sepsis, and controls) during dialysis with cuprophane dialyzers, with much smaller drops after polysulfone dialysis. This indicated that granulocytes had moved into the small blood vessels in the lungs, a sign that their adherent properties had been altered. Patients undergoing RDT showed increased levels of most granulocyte-associated enzymes during dialysis with cuprophane, and patients with ARF without sepsis showed an even greater increase. Those with ARF and sepsis showed the greatest increase, however. All groups showed only mild elevations after dialysis with polysulfone dialyzers. Since excessive neutrophilic degranulation (activation) can lead to increased susceptibility to infection, the development of dialysis membranes that are more biocompatible may be indicated. (Consumer Summary produced by Reliance Medical Information, Inc.)

How to embarrass the government into providing health care IN TONGZHOU, a town near Beijing, one group of people appears to have reaped immediate benefits from official efforts to put [...]

Product Briefs * bioMerieux (Marcy L'Etoile, France) has received FDA clearance to market Vidas B*R*A*H*M*S PCT. The test will be used with critically ill patients on their first day of [...]

Byline: David Kohn IT IS A PROSPECT that terrifies bioweapons experts: Terrorists release smallpox into an American city, spreading sickness and panic. Because the disease is unbeatable and vaccines no [...]

The deaths, in 15 days, of 12 patients receiving haemodialysis in three Spanish hospitals has led the Spanish health ministry to withdraw two batches of a membrane dialyser. To date, [...]

In the article, 'Dialyzer Reprocessing: Improved Treatment Quaility and Increased Dialyzer Reuse Using a Team Approach,' by Therese Slyby, Gayle Huff, and Mary Jo Henger (see October 2000 issue, volume [...]

Use of the performance improvement process can yield unexpected positive results. Through the implementation of performance improvement concepts, the Dialysis Centers of Dayton LLC East was able to increase the average dialyzer reuse number and achieve economical benefits while improving the quality of patient care delivered. Employment of the team approach, staff education, and communication was vital to the success of this project. Over the last 10 years, the use of dialyzer reprocessing has steadily increased in dialysis units across the country. If the reuse average was down in a unit, it was not uncommon to look to the reuse staff for an explanation, since it is 'their' job to keep the numbers up. After consultation with a Minntech representative, the Dialysis Centers of Dayton LLC East staff discovered that the most effective methods to increase the average reuse number were those implemented on the dialyzer before it ever reached the reprocessing area. Several technical changes were initiated, including the use of standardized heparin protocols, all of which contributed to the improvement in the reuse average. Although some of these changes had been done previously, they were not implemented and reviewed according to the formal performance improvement model. Two methods for calculating the reuse average were employed. Over a 12-month time frame, reuse numbers increased from 7.1 and 7.5 to 36.6 and 18.1, respectively (utilizing the Hartline [1996] and conventional method of reuse calculation). Review of patient adequacy showed no detrimental effects and a slight improvement in the percentage of patients with a Kt/V of more than 1.2. Focusing on performance improvement in the reprocessing area has yielded many benefits to both patients and staff., The past decade has seen marked improvement in the quality of dialysis treatment of patients with end stage renal disease (ESRD) in the United States as measured by a decrease [...]

Complications associated with vascular access remain one of the greatest challenges for dialysis providers and clinicians when trying to achieve a minimum targeted clearance for ESRD bemodialysis patients. A new subcutaneous access device (LifeSite® Hemodialysis Access System, Vasca, Inc., Tewksbury, MA) has been designed to offer a superior alternative in this challenging patient population. Consisting of a titanium alloy valve with attached silicone cannula, this device is implanted subcutaneously below the clavicle during an outpatient procedure. Two valves are implanted, one for draw and one for return, and the cannulas are tunneled from the jugular vessel to the valve, with tips positioned in the right atrium. The device is accessed utilizing standard 14-ga dialysis needles. When the needles are inserted, the internal metal pinch clamp of the valve opens allowing fluid flow through the device; when the needles are removed, the pinch clamp closes and fluid flow stops. During the feasibility trial, we have seen a variety of benefits that may make this device an effective alternative to current methods of hemodialysis access. Flows more than 400 mL/min have been routinely seen, providing the patients very effective dialysis, with a mean Kt/V of 1.51. This device is more esthetically acceptable than all other options and has far fewer lifestyle limitations. Patients especially appreciate the pain-free cannulation with the developed buttonhole site, improved body image and resulting improved quality-of-life. Acceptance of the LifeSite System among dialysis center staff has been excellent. LifeSite provides a simple cannulation procedure and can be used immediately following implantation. The unique pinch clamp design eliminates post-dialysis access bleeding with less than 4-min. for routine hemostasis. The LifeSite System has tested in vitro to the equivalent of 38 years of hemodialysis without failure. With this innovative technology from Vasca, we now achieve the benefits of subcutaneous valve access., Judy Cheesman, RN, Ottawa Hospital, Civic Campus, Ottawa [...]