Getting the consistency right in thickened liquids using Viscgo Sticks: A validation study.

BACKGROUND: Dysphagia is a condition whereby a person's ability to swallow, eat and drink is impacted. One strategy to manage dysphagia and aid safe swallowing is the modification of food and drink, including using thickening agents to thicken drinks. Drinks are thickened to levels appropriate to a person's swallowing abilities and the underutilised 'syringe flow test' is currently the recommended method for checking thickness levels. Viscgo Sticks were developed as a practical alternative to the flow test. METHODS: This is a real-world validation study designed to determine validity and reliability of Viscgo Sticks. Independent researchers and healthcare professionals tested Viscgo Sticks (Viscgo Limited) against the flow test in three levels of thickened drinks. Researchers also conducted tests with different thickening agents and different drink types: water, milk, orange juice and hot tea. RESULTS: The intra- and inter-rater reliability of Viscgo Sticks was moderate to almost perfect (κ = 0.45-0.98) within and between researchers and substantial (κ = 0.66-0.67) within and between healthcare professionals. When tested by researchers and healthcare professionals against the flow test, Viscgo Sticks correctly classified 83.33%-100% of thickened drinks with high accuracy (area under curve = 0.70-1.00). CONCLUSIONS: A simple and reliable tool like Viscgo Sticks, which can verify a prescribed thickness level of liquid, is invaluable in healthcare settings where day-to-day drink preparation occurs. Overall, Viscgo Sticks provide a reliable and valid means to test thickened drinks in clinical practice with a few exceptions identified.

Did stopping ultrasound surveillance during COVID-19 result in an increase of the dialysis access thrombosis rate?

PURPOSE: The COVID-19 pandemic resulted in cessation and subsequent reduction of routine care including the outpatient ultrasound surveillance of AVF. This un-planned service disruption allowed evaluation of effectiveness of US surveillance in reducing AVF/AVG thrombosis. METHODS: This study was a secondary data analysis of monthly access patency for all in-centre patients receiving haemodialysis using an AVF or AVG over a 2-year period (April 2019-March 2021). The study included 298 patients with age, access type, patency and COVID status measured as variables. Thrombosis rates for the 12 months prior to COVID-19 and then during the first 12 months of the pandemic were also measured. Statistical analysis to assess mean and standard deviation for relevant variables was used. A p-value of <0.05 was deemed significant. RESULTS: At the end of the study an increase in thrombosis rate (%) in the non-surveillance year was observed ((1.20) thrombosis/patient/year in the surveillance group vs (1.68) thrombosis/patient/year in the non-surveillance group). Monthly mean of thrombosed access during surveillance (M = 3.58, 95% CI 2.19-4.98, SD = 2.193) and non-surveillance (M = 4.92, 95% CI 3.52-6.31, SD = 2.19); t(7148) = 2.051, p = 0.038. CONCLUSION: Reduction in routine Ultrasound surveillance following the COVID-19 pandemic was associated with a significant increase in access thrombosis rate. Further research is needed to unpick whether the associations seen were directly due to service changes, associated with COVID-19 or other factors during the pandemic. This association was independent of SARS-CoV-2 infection status. Clinical teams should consider alternative service delivery options including out-reach, bedside surveillance to balance risks of access thrombosis versus reducing the risk of nosocomial infection with hospital visits.

Caring for patients with kidney failure.

Patients with end-stage renal disease can present to unscheduled care settings for different reasons, but are managed in the same way. This article aims to increase emergency nurses' knowledge of the main areas of concern and management associated with this condition, including fluid management, blood transfusion, pain control and hyperkalaemia. The article also includes a case study to illustrate how nurses can put this knowledge into practice.