ABSTRACT
Objective:To discuss the effects of biofeedback dialysis mode of blood volume monitoring on cardiac function in the maintenance hemodialysis (MHD) patients with intra-dialytic hypotension (IDH).Methods:40 patients who underwent maintenance hemodialysis in Suzhou Hospital Affiliated to Nanjing Medical University from September 2018 to December 2020 and had IDH for many times were selected. They were divided into standard dialysis (SHD) group and biofeedback dialysis mode of blood volume monitoring (BVM) group, with 20 cases in each group. In the first 12 weeks of the first stage, the patients in both groups were treated with standard dialysis, and in the second 12 weeks, they were treated with maintenance hemodialysis according to standard dialysis and biofeedback dialysis mode of blood volume monitoring. The incidence of IDH and the changes of blood pressure before and after dialysis, body weight, ultrafiltration volume, B-type brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPW), inlet ventricular septal defect (IVSD), mitral valve flow spectrum E/A value (E/A) and left ventricular mass index (LVMI) were observed.Results:(1) In the second stage of treatment, the number of IDH requiring nursing intervention in BVM group was significantly lower than that in SHD group ( P<0.05). (2) The difference of blood pressure change in BVM group during the second stage of treatment was significantly lower than that in the first stage and SHD group ( P<0.05). (3) In the second stage of treatment, the ultrafiltration volume of patients in BVM group was significantly higher than that in the first stage, and the BNP and body weight were significantly lower than that in the first stage (all P<0.05). However, the body weight, BNP and ultrafiltration volume of patients in SHD group had no significan change in the two stages of treatment (all P>0.05). (4) After treatment, the LVID, LVPW, IVSD and LVMI in BVM group were significantly lower than those before treatment, and LVEF and E/A were significantly higher than those before treatment (all P<0.05). However, there was no significant change in echocardiographic indexes in SHD group before and after treatment (all P>0.05). Conclusions:The biofeedback dialysis mode of blood volume monitoring can significantly reduce the occurrence of IDH, and this dialysis mode can effectively improve the cardiac function of MHD patients with hypotension.
ABSTRACT
BACKGROUND: Blood cultures are essential in diagnosing and treating sepsis. There are several factors that affect the diagnostic yield of blood cultures such as the number of blood sampling episodes, the incubation period, the type and volume of culture media, and the amount of blood drawn. This study aimed to elucidate whether monitoring the volume of blood drawn with an educational intervention could affect the diagnostic quality of blood cultures. METHODS: We implemented quality monitoring for the blood volume drawn during blood culture testing for adults in an emergency room. We instructed the nurses in the emergency room to draw the optimal amount of blood and to reduce the number of blood culture sets from three to two. We analyzed and compared the amount of blood drawn, the rate of positive blood cultures, the contamination rate, and time to positivity (TTP) between 908 patients pre-intervention and 921 patients post-intervention. RESULTS: The amount of blood drawn increased from 0.7±0.3 mL per bottle (pre-intervention) to 6.5±1.7 mL per bottle (post-intervention) (P<0.0001). The rate of positive blood culture post-intervention (12.14%) was higher than that pre-intervention (6.65%) (P<0.0001). The contamination rate post-intervention (1.82%) was also significantly greater than that pre-intervention (0.60%) (P<0.0001). Except for anaerobes, there was no significant difference in the distribution of microorganisms between the pre- and post-intervention periods. The TTP for anaerobe bottles post-intervention was significantly shorter than that of pre-intervention (16.1±16.3 versus 18.6±18.3 h). CONCLUSION: This study suggests that continuing education about adequate blood volume and aseptic techniques is needed to increase the rate of positive blood cultures and reduce the contamination rate of blood cultures.