Factors Affecting Vascular Access At A Renal Service Of The University Hospital Valle De Hebron

Ms. Mancinho continues to strive for excellence and patient care improvements in her position as staff nurse in the hemodialysis unit. She is currently the primary nurse for five of our chronic dialysis patients. All of her primary patients exceed recommended adequacy guidelines and maintain patent, infection free arterial venous fistulas/grafts. While participating in monthly interdisciplinary care plan meetings, she makes suggestions that have led to positive outcomes such as: changes in dry weights, reviews of patients medications with the nephrologist to facilitate warranted medication adjustments as needed, referrals/close coordination with other disciplines such as podiatry and wound care to prevent infection/amputation in patients with advanced vascular disease, and endocrinology for educational purposes for well controlled blood sugars. She is able to quickly assess subtle changes in her patients to then notify the charge nurse and physician for appropriate guidance in facilitating positive patient care outcomes. Through her acute assessment skills she prevented an access from clotting. Prevention of clotting leads to extended longevity of the access. She applies the nursing process to systems or processes at the team/unit/work group level to improve Veteran care. She worked with flow in the new unit which led to better patient care and staff satisfaction. She developed the time out policy: a requirement for

With a quantitative approach, a descriptive, prospective, cross-sectional method was used to collect data. Utilizing medical records from 51 patients hospitalized between February and April of 2013, data such as age, Braden Scale scores, comorbidities and length of stay were collected. Clinical data obtained was then organized in an Excel table and input into the statistical software, Epi Info, to be arranged for statistical analysis (Oliveira de Carvalho et al.,

Chronic kidney disease (CKD) is a common disorder and occurs in the elderly population. In younger patients, it

There were several dependent variables which were significant predictors of complications. First females older than 70 with HTN and renal failure were identified. Second the presence of a venous sheath was found to be an important indicator and finally female gender with a high BMI stood out as well for a higher complication

There were no significant differences between either of these labs or the blood volume processed before or after Ateplase push or dwell administration (Vercaigne, Zacharias, & Bernstein, 2012). Push administration injects a small amount of Ateplase into circulation, while the dwell method doesn’t. Often time patient catheters are dwelled with Ateplase in between treatments, as the dwell method requires at least two hours (Vercaigne, Zacharias, & Bernstein, 2012). Hemodialysis units operate on a stringent schedule per shift that decreases flexibility of time. As a result of this the push method is most widely ordered. Within this author’s clinic, once the push method is unsuccessful after two attempts the dwell method is then implemented. In conclusion, the push method was found to have the best immediate and long term results within this study. The authors identified that the sample size was inadequate, which ultimately decreased the validity of this finding (Vercaigne, Zacharias, &

Provides leadership in the application of the nursing process by delivering quality care to the veterans as evidenced by exceeding unit benchmarks in adequacy, access and anemia management. Ms. Upham remains the units’ Vascular Access Surveillance Coordinator. Her role is to track access function and refer accordingly. In the past year the unit has had 0 episodes of clotted access leading to longevity of the access. The unit continues to maintain high standards for this indicator and due to her diligence has been awarded the End Stage renal Disease Network Fistula First Award. Fistula rates are maintained at 77-80% which is 16% above the national average of 60%. Ms. Upham recently advocated for her primary patient resulting in a better quality of life for the patient. The nephrologist was increasing all

Underdiaxonsied and undertreated it is a major concern for the aging population of the United States. One of the first steps is educating the public on early detection techniques and risk factor for developing CKD. High blood pressure and diabetes is a major contributor in developing the disease and thus high risk factor groups should be identified early. This way the individuals can begin implementing lifestyle changes that can not only decrease the rate of kidney function decline but improve it as well. Management of the disease focus on the major complications. Anemia, dyslipidemia, CKD-MBD, nutrition and cardiovascular are the forefront of the disease management. Management with not only medications, but lifestyle changes creates a holistic care plan specialized to each individual patient. By treating not CKD but the individual patient, outcomes will improve. Implementing the health care team as a whole will unify the strengths in modern medicine and thus relieve a huge financial burden that chronic kidney disease yields at a national and local

For people with various comorbidities it would not be wise to keep inserting and discontinuing IV’s. In addition, most of these patients need to use medications that are known vesicants and can damage skin, vascular and other tissues. According to the researcher Rita Bonczek, “All patients that have multiple co-morbidities in need of regular medical follow up and management, need reliable long term vascular access to provide care” (Bonczek 2012). Notably, the key to maintain this high of reliability is the success rate of all the health

With the increase in life expectancy for chronically ill patients related to the advancements in medical care, it is becoming increasing important to develop a comprehensive plan of care to manage a patient’s healthcare accordingly. The continuity of care is the basic framework to establish programs geared towards producing better patient outcomes. Chronic kidney disease (CKD) is one such area where the development of a strong support system can not only ensure proper care is received but also prevent or delay complications. According to one report by the American Hospital Association (AHA), “Individuals with ESRD (end stage renal disease) require intensive treatment,

The method of this research was to analyze trends in door-to-ballon time and in hospital mortality using data from over 96,000 patients that had been admitted from July 2005 through July 2009; these patients were admitted for undergoing PCI for ST- segment elevation MI.

Describe complications that can occur as a result of dialysis and identify nursing measures that are designed to prevent these complications.

The most common complication of vascular access failure is an infection. Chng & Gilbert (2013, p. 1003) elaborated that the preferred management for infected vascular access is to start

The use of CVC has been linked to increased infection and mortality. The preferred vascular access for most patients is the arteriovenous fistula (AVF) due to the best outcomes that was evidenced through the use of informatics. The second choice for a permanent access is an Arteriovenous graft (AVG). Most dialysis companies have in place systems to track each clinic’s CVC rates. It is recommended that each dialysis clinic have a Vascular Access Team (VAT) to track and follow up on each CVC in use. This team will usually consist of a nephrologist, RN, and other team members. Responsibilities include planning, tracking, and following up to insure that each patient receives the best possible access they can, whether it would be an AVF or AVG. (Mbamalu et al, 2014) The information used for this process comes from the computerized system in place at each

Chronic kidney disease (CKD) is an irreversible condition that progresses causing kidney dysfunction and then to kidney failure. It is classified by a GFR of <60mL/min for longer than 3 months. There are five stages of CKD: Stage 1 has kidney damage but has a GFR ≥ 90. Stage 2 has mild damage and a GFR of 60-89. Stage 3 has moderate damage and a GFR of 30-59. Stage 4 has severe damage and a GFR of 15-29. Stage 5 is also known as end stage renal disease (ESRD), this is kidney failure with a GFR of ≤ 15 and theses patients are typically on dialysis or in need of an immediate transplant. The leading cause of CKD is diabetes. Hypertension is also a major cause. Since most DM patients have HTN,

stages, symptoms and risk factors. It also examines the process of kidney transplantation to treat