Ms Ginger Chu

© 2016 International Society for Hemodialysis Introduction Heparin is commonly used after hemodialysis treatments as a locking solution to prevent catheter thrombosis. The comparative efficacy and safety of different heparin concentrations to maintain catheter patency has been previously reported in retrospective studies. We conducted a prospective, randomised, controlled study of 1000 U/mL heparin (low dose) versus 5000 U/mL heparin (high dose) locking solution to maintain patency of tunnelled catheters. Methods One hundred patients receiving chronic, unit-based hemodialysis with newly placed tunnelled hemodialysis catheters (less than 1 week) were randomly assigned to either a low dose (n = 48) or high dose heparin (n=52). The primary intention-to-treat analysis examined time to malfunction in both groups over a 90 day period. A secondary analysis compared baseline patient characteristics in relation to catheter malfunction. Findings Overall rate of catheter patency loss was 32% of catheters by 90 days. There was no significant difference in time to malfunction of catheters locked with low dose or high dose heparin (P = 0.5770). Time to catheter malfunction was not associated with diabetic, hypertensive or smoking status. There was no difference in mean delivered blood flow rate, venous and arterial pressure, and dialysis adequacy between low dose and high dose groups. No patient suffered a hemorrhagic complication requiring hospitalisation during the study period. Discussion Low dose heparin is adequate to maintain tunnelled hemodialysis catheter patency when compared with high dose heparin. The study also suggests that there is no relationship between catheter malfunction and diabetic, hypertensive or smoking status.

Background Peritonitis is the most common infection and cause of treatment failure for patients receiving peritoneal dialysis (PD). Peritonitis can be life-threatening if treatment is not initiated in a timely manner. We have identified in our facility that patients presenting to the emergency department (ED) with peritonitis often have delayed treatment. This could be due to a lack of understanding from ED clinicians and/or poor communication between ED and the renal department. Therefore, a local clinical pathway was developed to optimise peritonitis patient care. Aims To evaluate the effectiveness of a local peritonitis clinical pathway designed to reduce time for patients with PD-related peritonitis receiving their first antibiotic treatment. Setting All patients with PD peritonitis presenting through a tertiary hospital ED. Main outcome measured Time for patients with PD-related peritonitis receiving their first antibiotic treatment in hospital. Results The average time for peritonitis treatment decreased from 6 hours and 49 minutes to 5 hours and 18 minutes after the clinical pathway was implemented. Currently there is no published data to benchmark our result, even though the results indicated that the local clinical pathway may have been effective. Implications for clinical practice Since the implementation of this project, three patients were able to be safely discharged from ED without needing hospital admission and this is due to prompt management and good communication between ED and the renal department. Delayed treatment not only causes increased demand in ED service, but also results in unnecessary hospital admission, which impacts on both the patient and the overall health care system.

Catheter-related blood stream infection (CRBSI) contributes to hospitalisation and death in the haemodialysis population. Increasing numbers of catheter infections prompted a unit practice development program to reduce infection episodes. Objective/hypothesis: Improvement in clinical practice in dialysis catheter care would decrease dialysis CRBSI in the haemodialysis population. Context: Five dialysis units and one nephrology ward in regional Australia. Participants: Nephrology nurses working with haemodialysis patients who have central venous dialysis catheters (CVDC) in situ. Method: Use of a practice development framework to engage clinicians in reviewing their clinical practice and developing strategies to decrease dialysis CRBSI. Clinical practice was measured by undertaking clinical audits of CVDC care. The CRBSI rate was monitored and reported by the infection control department annually. Results: Rates of dialysis CRBSI have decreased from 4.39 per 100 patient-months to 3.42 per 100 patient-months (p<0.001) 12 months after the implementation of the project. There was a statistically significant association between improved staff practice and infection outcome measures. Conclusion: Dialysis CRBSI is a common, yet preventable complication in the dialysis unit. The results show that dialysis nurses play a significant role in preventing dialysis CRBSIs. Basic infection control standards are paramount and should be strictly followed for effective CVDC care.