home haemodialysis
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2022 ◽  
pp. 112972982110676
Author(s):  
Catherine Fielding ◽  
Louise Bramley ◽  
Carol Stalker ◽  
Sarah Brand ◽  
Suzanne Toft ◽  
...  

Introduction: Cannulation is an essential part of haemodialysis with arteriovenous access. Patients’ experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients’ experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon. Methods: Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients’ experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings. Results: This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness. Conclusions: Cannulation is a pervasive procedure that impacts on patients’ experiences of haemodialysis. This review illuminates further patients’ experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation. Registration: PROSPERO (CRD42019134583).


2021 ◽  
Author(s):  
◽  
Nicholas Raymond Polaschek

<p>This nursing study seeks to understand the experience of one group of people with chronic renal failure using renal replacement therapy, Pakeha men living on home haemodialysis. It is based on the assumptions that people living on dialysis have distinctive experiences that are characterized by common concerns reflecting their shared position as subjects of renal illness and therapy, but that these are not easy to discern because they are obscured by the professional viewpoint that is dominant in the renal setting. In order to understand the experience of people living on dialysis this study develops a critical interpretive approach, seeking the participant's own interpretation of their individual experiences, but then reinterpreting them from a critical standpoint, recognizing that they can only be adequately understood by contextualizing them, in order to discern the common perspective underlying them in contrast to the dominant professional viewpoint in the renal setting. Using some ideas derived from the thought of Michel Foucault this study develops a critical nursing view of the renal setting, as a specialized healthcare context that is constituted by several interrelated discourses, primarily the dominant professional discourse, but also by several other discourses, in particular a client discourse that is a response to the dominant discourse. The different discourses reflect contrasting perspectives based on the different positions of various groups within the renal context. The study presents accounts, derived from interviews, of the experience of six Pakeha men living on home haemodialysis. Reflecting on these accounts as a set, by contextualizing them in terms of the critical nursing view of the renal setting, I outline four concerns of Pakeha men living on home haemodialysis. Together these make up the renal client discourse that models the distinctive perspective from their position within the renal context, underlying each of their individual accounts of their experience of illness and therapy. These concerns include symptoms from chronic renal failure and dialysis, limitations resulting from the negotiation of the therapeutic regime into their lifestyle, their sense of ongoingness and uncertainty of living on dialysis, and the altered interrelationship between autonomy and dependence inherent in living on dialysis. The study suggests that the individual accounts can be understood as resulting from the interaction of the various dimensions of their own personal social locations, including their gender and ethnicity, with the concerns of client discourse, reflecting their common position as people living on dialysis. One important implication of this understanding is that the role of nursing in the renal setting can be articulated as a response to the experience of the person living on dialysis. The nurse can support the renal client in seeking to integrate the requirements of the therapeutic regime, reflecting the dominant discourse, into their personal situation, reflecting the interaction of their own personal location with their position as a person living on dialysis, outlined in the client discourse.</p>


2021 ◽  
Author(s):  
◽  
Nicholas Raymond Polaschek

<p>This nursing study seeks to understand the experience of one group of people with chronic renal failure using renal replacement therapy, Pakeha men living on home haemodialysis. It is based on the assumptions that people living on dialysis have distinctive experiences that are characterized by common concerns reflecting their shared position as subjects of renal illness and therapy, but that these are not easy to discern because they are obscured by the professional viewpoint that is dominant in the renal setting. In order to understand the experience of people living on dialysis this study develops a critical interpretive approach, seeking the participant's own interpretation of their individual experiences, but then reinterpreting them from a critical standpoint, recognizing that they can only be adequately understood by contextualizing them, in order to discern the common perspective underlying them in contrast to the dominant professional viewpoint in the renal setting. Using some ideas derived from the thought of Michel Foucault this study develops a critical nursing view of the renal setting, as a specialized healthcare context that is constituted by several interrelated discourses, primarily the dominant professional discourse, but also by several other discourses, in particular a client discourse that is a response to the dominant discourse. The different discourses reflect contrasting perspectives based on the different positions of various groups within the renal context. The study presents accounts, derived from interviews, of the experience of six Pakeha men living on home haemodialysis. Reflecting on these accounts as a set, by contextualizing them in terms of the critical nursing view of the renal setting, I outline four concerns of Pakeha men living on home haemodialysis. Together these make up the renal client discourse that models the distinctive perspective from their position within the renal context, underlying each of their individual accounts of their experience of illness and therapy. These concerns include symptoms from chronic renal failure and dialysis, limitations resulting from the negotiation of the therapeutic regime into their lifestyle, their sense of ongoingness and uncertainty of living on dialysis, and the altered interrelationship between autonomy and dependence inherent in living on dialysis. The study suggests that the individual accounts can be understood as resulting from the interaction of the various dimensions of their own personal social locations, including their gender and ethnicity, with the concerns of client discourse, reflecting their common position as people living on dialysis. One important implication of this understanding is that the role of nursing in the renal setting can be articulated as a response to the experience of the person living on dialysis. The nurse can support the renal client in seeking to integrate the requirements of the therapeutic regime, reflecting the dominant discourse, into their personal situation, reflecting the interaction of their own personal location with their position as a person living on dialysis, outlined in the client discourse.</p>


2021 ◽  
pp. 089686082110292
Author(s):  
Mohamed Ahmed Elbokl ◽  
Claire Kennedy ◽  
Joanne M Bargman ◽  
Marg McGrath-Chong ◽  
Christopher T Chan

Home dialysis (peritoneal dialysis (PD) and home haemodialysis (HHD)) are ideal options for kidney replacement therapy (KRT). Occasionally, because of technique failure, patients are required to transition out of home dialysis, and the most common option tends to be to in-centre HD. There are few published studies on home-to-home transition (PD to HHD or HHD to PD) and dynamics during the transition period. We present a retrospective review of 28 patients who transitioned from a home-to-home dialysis modality at our centre over a 24-year period. We observed a total of 911 home dialysis patients with technique failure (826 PD patients and 85 HHD patients) with only 28 patients (3% of the total with technique failure) having successful home-to-home transition. During the transition period, 11 patients (39%) were hospitalized and 13 patients (46%) required variable periods of in-centre HD. After a median follow-up of 48 months following dialysis modality transition, four patients switched to in-centre HD permanently (home dialysis technique survival of 86% censored for death and kidney transplantation) and four patients died resulting in a patient survival of 86% (censored for switch to in-centre HD and transplantation). In our centre, home-to-home transition is a feasible strategy with comparable patient and technique survival. A significant proportion of patients switching from a home-to-home dialysis modality required variable intervals of hospitalization and in-centre HD during transitions. Future efforts should be directed towards assessment and home dialysis education during the entire process of dialysis transition.


Author(s):  
Guy Rostoker ◽  
Belkacem Issad ◽  
Hafedh Fessi ◽  
Ziad A. Massy

AbstractThe health crisis induced by the pandemic of coronavirus 2019 disease (COVID-19) has had a major impact on dialysis patients in France. The incidence of infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first wave of the COVID-19 epidemic was 3.3% among dialysis patients—13 times higher than in the general population. The corresponding mortality rate was high, reaching 21%. As of 19th April, 2021, the cumulative prevalence of SARS-CoV-2 infection in French dialysis patients was 14%. Convergent scientific data from France, Italy, the United Kingdom and Canada show that home dialysis reduces the risk of SARS-CoV-2 infection by a factor of at least two. Unfortunately, home dialysis in France is not sufficiently developed: the proportion of dialysis patients being treated at home is only 7%. The obstacles to the provision of home care for patients with end-stage kidney disease in France include (i) an unfavourable pricing policy for home haemodialysis and nurse visits for assisted peritoneal dialysis (PD), (ii) insufficient training in home dialysis for nephrologists, (iii) the small number of administrative authorizations for home dialysis programs, and (iv) a lack of structured, objective information on renal replacement therapies for patients with advanced chronic kidney disease (CKD). We propose a number of pragmatic initiatives that could be simultaneously enacted to improve the situation in three areas: (i) the provision of objective information on renal replacement therapies for patients with advanced CKD, (ii) wider authorization of home dialysis networks and (iii) price increases in favour of home dialysis procedures.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Abdallah Guerraoui ◽  
Roula Galland ◽  
Flora Belkahla-Delabruyere ◽  
Odile Didier ◽  
Pierre Sauvajon ◽  
...  

Abstract Background and Aims A quarter of the patients did not receive any information on any modality before the start of Renal Remplacement Therapy (RRT). We have therapeutic education workshops for all RRT except for home haemodialysis (HHD). We aimed to identify and describe the needs of patients and caregivers for RRT with HHD. Lastly, to conceive and carry out a Therapeutic Education Workshop. Method Two sequential methods of qualitative data collection were undertaken: (1) interviews with a patient who had been on HHD and a doctor specialized in HHD. (2) semi-structured interviews with HHD patients in our center. Analytic Approach Thematic analysis. We used thematic analysis and systematically coded and identified themes inductively from data. To ensure that the range and depth of data were reflected in the analysis, transcripts were independently analyzed by 2 research team members experienced in qualitative research. Transcribed interviews were entered into RQDA 3.6.1 (2019-07-05) software for data organization and coding purposes (Version 3.6.1). Patient interviews were ceased when no new codes were identified (data saturation) after five consecutive interviews. Results We identified six themes related to the barriers, facilitators, and potential solutions to home dialysis therapy: (1) HHD allows autonomy and freedom with constraints, (2) safety of the care environment, (3) the caregiver and family environment, (4) patient’s experience and experiential knowledge, (5) self-treatment experience - Impact on life, and (6) factors that impact the choice of treatment with HHD. we designed a model for a therapeutic education workshop in a group of 4 patients and 4 caregivers. Our approach is the person-centered model of care. The workshop is composed of 4 educational sequences Conclusion Our study confirmed previous results obtained about the major barriers, facilitators, and potential solutions to HHD. There are three important points regarding HHD: (1) the impact of the HHD on the caregiver, (2) the experience of patients already treated with HHD, and (3) the role of nurses and nephrologists in informing and educating. A program to develop patient-to-patient peer mentorship, allowing patients to discuss their dialysis experience, would be invaluable.


2021 ◽  
Vol 17 ◽  
pp. S60-S63
Author(s):  
Sandip Mitra ◽  
Kunaal Kharbanda ◽  
Leonard Ebah
Keyword(s):  

2021 ◽  
Vol 4 (1) ◽  
pp. 199-202
Author(s):  
Haroon Ayub ◽  
Rauri Clark ◽  
Shalabh Srivastava ◽  
James Andrews ◽  
Debra Sweeney ◽  
...  

 The cannulation  of vascular access specially becomes difficult in elderly, diabetic and obese  hemodialysis patients. The accessibility of an AV fistula largely relies on the condition of the patient’s veins, which often leads to difficulty in cannulation with the traditional blind method. South Tyneside and Sunderland NHS Foundation Trust (STSFT) Renal unit adopted ultrasound mapping of new cannulation sites for arteriovenous fistulas and arteriovenous grafts. The aim of this study was to evaluate the qualitative impact of this practice on the dialysis patients. This was a qualitative study and was conducted in the Renal Unit at STSFT. Haemodialysis patients with deep or small vessels for cannulation, a vessel with problems and a vessel whose cannulation on the first attempt was vital were included in the study. AVF/AVG were mapped using Doppler ultrasound (US) undertaken by a consultant Interventional Nephrologist (IN). The map of the AVF/AVG and new cannulation sites were captured as an image on the patients’ smart phone to act as record to show the dialysis nurse cannulating the AVF/AVG. It was hoped that this would encourage rope laddering and AVF/AVG preservation. Patients reported no significant improvement in cannulation process even after US mapping of new cannulation sites. Patients did report a better understanding of the AVF/AVG geometry especially amongst the self cannulators on home haemodialysis. According to the patients the successful cannulation was mainly dependent on the skills of dialysis nurses rather than the US mapping of the AVF/AVG being of any assistance.


Author(s):  
Joonas Rautavaara ◽  
Tuomas Kerola ◽  
Kati Kaartinen ◽  
Mari Vilpakka ◽  
Atte Aitkoski ◽  
...  

Abstract Background Knowledge of arrhythmias in patients with end-stage renal disease (ESRD) is mainly based on ambulatory electrocardiography (ECG) studies and observations during haemodialysis. We used insertable cardiac monitors to define the prevalence of arrhythmias, focusing on bradyarrhythmias, in ESRD patients treated with several dialysis modes including home therapies. Moreover, we assessed whether these arrhythmias were detected in baseline or ambulatory ECG recordings. Methods Seventy-one patients with a subcutaneously insertable cardiac monitor were followed for up to three years. Asystole (≥4.0 secs) and bradycardia (heart rate &lt;30 bpm for ≥4 beats) episodes, ventricular tachyarrhythmias and atrial fibrillation were collected and verified visually. A baseline ECG and a 24-48-hour ambulatory ECG were recorded at recruitment and once a year thereafter. Results At recruitment, forty-four patients were treated in in-center haemodialysis, 12 in home haemodialysis and 15 in peritoneal dialysis. During a median follow-up of 34.4 months, 18 (25.4%) patients had either an asystolic or a bradycardic episode. The median length of each patient’s longest asystole was 6.6 seconds and that of a bradycardia 13.5 seconds. Ventricular tachyarrhythmias were detected in 16 (23%) patients, and atrial fibrillation in 34 (51%) patients. In-center haemodialysis and type II diabetes were significantly more frequent among those with bradyarrhythmias whereas no bradyarrhythmias were found in home haemodialysis. No bradyarrhythmias were evident in baseline or ambulatory ECG recordings. Conclusions Remarkably many patients with ESRD had bradycardia or asystolic episodes, but these arrhythmias were not detected by baseline or ambulatory ECG.


2021 ◽  
pp. 389-400
Author(s):  
Daljit K. Hothi ◽  
Claus Peter Schmitt
Keyword(s):  

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