Symptom distress and day-to-day changes in functional status in chronic hemodialysis patients.

The purposes of this study were to examine changes in center-based hemodialysis patients' levels of daily functional status (FS) during the week and to examine the extent to which symptom distress explained variations in daily functional status. A correlational panel study design was used. The sample consisted of 104 chronic incenter hemodialysis patients recruited from two outpatient hemodialysis centers in a mid-Atlantic state. The Inventory of Functional Status was administered daily for 7 consecutive days to assess daily functional status. The Kidney Disease Quality of Life Symptom Scale was administered daily for 7 consecutive days to examine daily symptom distress. Study findings indicated suboptimal levels of FS at baseline, a significant decline in FS the day before the first dialysis session of the week compared to baseline, and a significant decline in FS on the second dialysis day of the week compared to the previous and subsequent nondialysis days. Symptom distress explained 6% of the variation in FS on these 2 days. In conclusion, incenter hemodialysis patients' baseline levels of FS are suboptimal, and FS declines further on the day before the first dialysis session of the week and the second dialysis day of the week. Symptom distress partially accounts for the decline in FS on those days. These findings indicate a need for ongoing FS assessment, implementation of strategies to improve FS, and symptom management in center-based chronic hemodialysis patients.

Replacement of failing tunneled hemodialysis catheters through pre-existing subcutaneous tunnels: a comparison of catheter function and infection rates for de novo placements and over-the-wire exchanges.

PURPOSE: Tunneled hemodialysis catheter dysfunction often occurs from fibrin sheath formation. As a way to preserve existing catheter venous access sites, the authors evaluated over-the-wire exchange of catheters through pre-existing subcutaneous tunnels as an alternative to catheter removal and de novo catheter replacement. PATIENTS AND METHODS: One hundred nineteen catheters were placed in 68 patients. Seventy-seven catheters were placed de novo and 42 catheters were placed through the pre-existing subcutaneous tunnels of failing catheters. Technical success, short-term complications, infection rates, and functional catheter longevity were evaluated. RESULTS: Technical success for catheter exchange was 93%. Infection rates were comparable to those of de novo catheter placement: 0.15 and 0.11 infections per 100 catheter days for de novo and exchanged catheters, respectively. Catheter duration of function was not significantly different for de novo versus exchanged catheters: 63% and 51% at 3 months, 51% and 37% at 6 months, and 35% and 30% at 12 months, respectively. CONCLUSIONS: Over-the-wire exchange of tunneled hemodialysis catheters is safe and easily performed. It causes no increase in infectious complications and provides similar catheter longevity to de novo catheter placement. The procedure is an important option for prolonging tunneled hemodialysis catheter access sites.

The Inventory of Functional Status-Dialysis: development and testing.

OBJECTIVE: Development and psychometric testing of the Inventory of Functional Status-Dialysis (IFS-Dialysis), which was designed to measure functional status in persons who are receiving chronic incenter hemodialysis treatment. DESIGN: Three-phase instrument development design: Phase 1--content validity assessment; Phase 2--examination of internal consistency reliability; Phase 3--examination of construct validity. SAMPLE/SETTING: 175 chronic hemodialysis patients recruited from an urban, free-standing, outpatient dialysis center. METHODS: Content validity was determined using Popham's average congruency proceudre. Internal consistency reliability was determined using Cronbach's alpha reliability coefficient. Construct validity was examined by bivariate correlations between the IFS-Dialysis and the Karnofsky Performance Scale (KPS), and the Medical Outcomes Study Short Form-36 Health Survey (SF-36) in a subsample of 60 patients. RESULTS: Content validity was established at 90%. The alpha reliability coefficient for the IFS-Dialysis was 0.86. Subscale alpha coefficients ranged from 0.71-0.82. Correlation between the IFS-Dialysis and the KPS was 0.55. Correlations between the IFS-Dialysis and SF-36 subscales ranged from 0.14-0.53. CONCLUSIONS: The IFS-Dialysis has acceptable content validity, internal consistency, and initial construct validity. Use of the IFS-Dialysis in clinical practice is appropriate.

Transvenous removal of fibrin sheaths from tunneled hemodialysis catheters.

PURPOSE: Long-term hemodialysis catheters are prone to significant dysfunction due to fibrin accumulation around their tips. The authors assessed the efficacy of transvenous snare removal of fibrin to prolong function of these catheters. PATIENTS AND METHODS: Twenty-four procedures were performed in 20 patients with tunneled hemodialysis central venous catheters. Technical success was gauged by venography and the ability to infuse and aspirate catheters. Durable efficacy was assessed by improvement in hemodialysis. RESULTS: Twenty-two of 24 procedures were performed successfully. In two cases residual material remained despite repeated stripping. Mean preprocedure hemodialysis blood-liters processed per hour increased from 15.1 to 19.1 L/h in the first dialysis session after stripping, and blood flow rates of 300 mL/min or greater were restored. By the fifth dialysis session after stripping, the blood-liters processed per hour dropped to 15.9 L/h as catheter flow rates returned to unacceptable levels. CONCLUSIONS: Percutaneous fibrin removal with a loop snare provides no durable benefit in improving function of failing hemodialysis catheters.

Nursing interventions related to vascular access infections.

Vascular access infection is a common cause of the loss of a vascular access. Education of both nursing staff and patients is essential for preventing vascular access infections and for treating infections early. The use of strict aseptic technique is essential when providing vascular access care. Central venous catheters require special assessment and care. Dialysis staff can have a critical role in prevention and early treatment of vascular access infections.

Case study of the anemic patient: epoetin alfa--focus on vascular access.

Thrombosis and stenosis are the most common complications associated with prosthetic grafts in hemodialysis patients. Nurses can play a key role in the prevention, early identification, and correction of problems associated with vascular access and thereby maximize the outcome of hemodialysis therapy.