Cordelia Ashwanden PhD RN,
Editor

Patients’ experience of transition onto haemodialysis: a qualitative study.

Mitchell A. BSc. MA. MSc. AFBPsS. Cpsychol., Farrand P. BA. PGCert. PhD. AFBPsS. CPsychol Csci., James H. BSc. MSc., Luke R. RGN., Purtell R. MA., Wyatt K. BSc. PhD

Correspondence
Ms Annie Mitchell
Clinical Director and Senior Lecturer,
Doctorate in Clinical Psychology,
School of Applied Psychosocial Studies,
Faculty of Health and Social Work,
University of Plymouth,
Peninsula Allied Health Collaboration,
Derriford Road,
Plymouth,
Devon
PL6 8BH

Abstract
Transition onto haemodialysis is a time of increased psychosocial difficulty, yet many renal patients exhibit personal resilience in continuing to lead productive lives. Using a positive psychological methodology, this qualitative study aims to identify factors identified by patients as helpful in the transition onto haemodialysis. Semi-structured interviews were undertaken with ten patients within 6 months of starting haemodialysis. Interpretive content analysis identified three main themes (each with sub-themes) in patients’ accounts – preparation, cognitive style and social support. Limited differences arose between patients who underwent a gradual versus acute transition onto haemodialysis. Themes are discussed with reference to implications for practice development.

Key words 
haemodialysis, transition, qualitative, preparation, cognitive style, support.

Dr Rolf Nystrand

Correspondence
Dr Rolf Nystrand
Bio-TeQ Nystrand Consulting
Gullbackegatan 12
S-212 30 Malmö
Sweden
phone+46 40 49 90 04
Email rolf.nystrand@swipnet.se

Abstract
Recommendations/guidelines regarding the microbiological and chemical quality of fluids in dialysis are increasing in numbers, both national and international. As dialysis is a worldwide issue, with many elements being similar regardless of geographical area, it is logical to have the same quality requirements on fluids used in dialysis. At present there are large differences between the different documents. This situation makes studies where several nations participate more difficult to interpret as the fluids used in dialysis are crucial for the dialysis session. A special situation applies for substitution fluid produced “On-Line” for haemodiafiltration and haemofiltration, where some recommendations are questionable from a scientific standpoint.

The International Organisation for Standardisation (ISO) is in process of finishing a collection of standards including guideline for fluids in dialysis (water, concentrates, dialysis fluid, substitution fluid) and equipment used for water preparation. To have the same quality for reference worldwide will facilitate the interpretation of international studies as well as give dialysis patients treatments based on the same quality baseline.

Key words
Quality, fluids in dialysis, standards, microbiology, chemistry.

M. M. van Loon¹, A.G.H. Kessel², F.M. van der Sande³, J.H.M. Tordoir¹

¹Department of Surgery,
²Department of Clinical Epidemiology and Medical Technology Assessment,
³Department of Internal Medicine, Division of Nephrology University Hospital Maastricht, The Netherlands.

Correspondence
M.M. van Loon, RN
Department of Surgery
University Hospital Maastricht
P. Debeijelaan 25
PO Box 5800
6202AZ Maastricht
The Netherlands
T (31) 43 387 5491
F (31) 43 387 5473
E-mail magdavanloon@home.nl

Abstract
Background: Little is known about the relationship of cannulation practices in dialysis facilities with the frequency of failed cannulations, complications, and subsequent vascular access (VA) failure.
Methods: In an observational study the incidence of miscannulations and related complications were observed. Patient characteristics, co-morbidities, and VA characteristics like type of VA, were correlated with occurrence of cannulation-related complications. In addition the cannulation technique and practice patterns like needle direction, tourniquet use, and years of experience of dialysis nurses were registered.
Results: During the study period, 37% of patients with autogenous arteriovenous fistulae (AVF), and 19% of patients with arteriovenous grafts (AVG) had more than 10 miscannulations. Cannulation-induced hematoma resulted into single needle (SN) - and catheter dialysis in 40 % of the patients. The use of central venous catheters (CVC) and SN dialysis were significant predictors of VA failure (P<0.0001).
Conclusion: This study demonstrated a high incidence of unsuccessful cannulation procedures and cannulation-related complications necessitating catheter and SN dialysis. The type and location of the VA is significantly related to occurrence of unsuccessful and complicated cannulation.

Key words
Haemodialysis, Nursing, Vascular Access, Arteriovenous fistulae, Cannulation, Cannulation-related complications

Smeeta Sinha*¹, Diana Chiu*¹, George Peebles², Shabeer Kolakkat¹, Elizabeth Lamerton³, Sean Fenwick² and Philip A Kalra¹.

Department of Renal Medicine¹ and Pharmacy³, Salford Royal NHS Foundation Trust, Salford, UK
Department of Renal Medicine², City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
* Joint first authors

Corresponding Author
Dr Philip A Kalra
Department of Renal Medicine
Hope Hospital
Salford
M6 8HD
Tel: 0161 206 5998
Fax: 0161 206 5775
Email: Philip.kalra@srft.nhs.uk

Abstract
Background. Low molecular weight iron dextran (cosmoFer®) is the only form of parenteral iron that can be administered as a total dose infusion (TDI) in the United Kingdom (UK).  This study aimed to evaluate the safety and efficacy of TDI cosmoFer® in comparison to intravenous iron sucrose infusion (venofer®) in patients with Chronic Kidney Disease (CKD).
Methods and results. A retrospective study of out-patients with CKD undergoing intravenous TDI cosmoFer® or venofer® infusion was conducted at Salford Royal Hospital and Sunderland Royal Hospital. A total of 979 doses of cosmoFer® and 504 doses of venofer® were administered. There were 3 minor adverse events in patients receiving cosmoFer® compared with one minor event in a venofer® treated patient. There were no anaphylactoid type reactions in either group. Serum haemoglobin, ferritin and transferrin saturation improved significantly 4-6 months post infusion in both treatment groups.
Conclusion. TDI cosmoFer® is an efficacious method of replenishing iron stores in CKD patients in an outpatient setting. Furthermore TDI cosmoFer® is safe and not associated with an increase in adverse events compared to venofer®.

Key Words
Anaemia, Iron deficiency, Chronic kidney disease, Iron sucrose (Venofer) ®, Iron dextran (CosmoFer®)

Sofia Zyga¹, RN, BSc, MSc, PhD, Paul Sarafis¹, BSc, MSc, PhD, John Stathoulis², BSc, Peter Kolovos¹, BSc, MSc, Dimitris Theophilopoulos³, RN

¹ Nursing School, University Of Peloponnese, Sparta, Greece
² Biomedical Engineering Department, Sparta General Hospital, Sparta, Greece
³ Haemodialysis Unit, Sparta General Hospital, Sparta, Greece

Corresponding author
Sofia Zyga
University of  Peloponnese – Nursing School SRARTA
SPARTA Laconia 23100
Greece
Tel: 00302731021208
 Fax: 00302731089719

Abstract
Patients that are treated in an ICU show the need of recovery of their renal function.
The reason is that in this particular party of patients we have to maintain the necessary balance between body fluids, electrolytes and acid-base, try to suspend further renal damage and purify the patient’s blood to better accept the given therapy. In this paper, we try to demonstrate all the methods that can be used depending on the patient’s condition, the therapist’s preferences and the Hospital capabilities.

Keywords
Acute Renal Failure, Haemodialysis, Nursing

McCann M., Einarsdottir H., Van Waeleghem JP., Murphy F., Sedgewick J.

Correspondence
Margaret McCann
School of Nursing and Midwifery,
Trinity College Dublin,
24 D’Olier Street,
Dublin 2, Ireland.
Tel.: +003531 896 8542
Fax: +003531 896 3001
mccannm1@tcd.ie

Summary
This second article, in a three part Continuing Education series on Vascular Access Management, focuses on cannulation issues including complications relating to arterio-venous fistula and arterio-venous graft access.  The first article (McCann et al. 2008) gave an overview of vascular access while the final article in this series will focus on central venous catheters.

Keywords
Arterio-venous fistula, arterio-venous graft, cannulation, cannulation technique, complications