Cordelia Ashwanden PhD RN,
Editor

Dechlorination by ultraviolet radiation: A suitable alternative to activated carbon in dialysis water systems?
Ray James BSc MSc
Barts and The London NHS Trust, London, UK

CORRESPONDENCE
Ray James
Hanbury Dialysis Unit
The Royal London Hospital
Whitechapel
London, UK
E1 1BB
Tel: +44 (0)207 377 7229
Fax: +44 (0)207 377 7114
ray.james@bartsandthelondon.nhs.uk 

SUMMARY
Chlorine based products are widely used in the water supply industry, and the potential for adverse effects in the haemodialysis setting are well documented. To date, the most commonly used method of chlorine removal has been granular activated carbon (GAC) filters. An increasingly popular method of dechlorination is the use of high intensity, broad-spectrum UV systems to reduce both free chlorine and combined chlorine compounds (chloramines) into easily removed by-products.

UV radiation has been successfully used in the pharmaceutical and food industries to destroy free chlorine and/or chloramines present in water, and kill all known spoilage micro organisms including bacteria, viruses, yeasts and moulds (and their spores). This non-chemical method can offer significant advantages and benefits compared to conventional dechlorination technologies currently employed in dialysis water systems.

Whilst UV treatment at 254 nm wavelength has been routinely used for disinfection purposes in dialysis water systems, this paper considers whether UV radiation can be used as an alternative to more traditional methods of chlorine removal.

KEY WORDS
Ultraviolet light; dechlorination; dialysis water systems

Jennie King, RGN, BSc (Hons), Reg. Clin. Teacher.

CORRESPONDENCE
Jennie King
Practice Educator / researcher
Renal nurses office, North Block,
Royal Berkshire Hospital
London Road
Reading, Berkshire
RG1 5AN
jennie.king@royalberkshire.nhs.uk

SUMMARY
A report outlining experience gained from the practice of introducing the buttonhole (BH) method of arteriovenous cannulation using the Biohole^® device, a polycarbonate sterile peg, to form the tunnel tracks.  The author’s findings are discussed informally and compared with current published literature to provide encouragement to nursing colleagues who are interested in introducing this method of needling, using the peg, into a typically busy haemodialysis unit. 

KEY WORDS
arteriovenous cannulation . Biohole^® peg .  blunt needle .  buttonhole  .  fistula

Melero-Rubio, Esperanza; Párraga-Díaaz, Mateo; Gómez-Sánchez, M.Paz; Pellicer-Villaescusa, Silvia; Merchán-Mayado, Esteban
University Hospital Virgen de la Arrixaca - Dialysis Unit
Ctra. Madrid-Cartagena, s/n, El Palmar, Murcia 30120
Spain

CORRESPONDENCE
Esperanza Melero-Rubio,
University Hospital Virgen de la Arrixaca - Dialysis Unit
Ctra. Madrid-Cartagena,
s/n El Palmar Murcia 30120
Spain
T: 968369734
emeleror@terra.es

SUMMARY
Homocysteine is considered as independent predictors of cardiovascular risk. Patients treated with haemodialysis exhibit elevated homocysteine levels, even four times higher than the general population does.
The present study focuses on the determination of the vascular risk in patients treated with conventional haemodialysis and haemodiafiltration on-line. It was also considered important to determine whether there was a relationship between homocysteine and the variables given by the patient such as dialysis dose, obesity and treatment with folic acid, vitamin B6 and vitamin B12.
A one-year cross-sectional observational study was conducted on patients initially treated with renal replacement therapy such as HDF on-line and conventional HD. Data collected included patient's age, sex, aetiology, duration of dialysis treatment and associated with dialysis session, including data on BMI, waist circumference, treatment with vitamin B6, B12 and folic acid.
The results obtained conclusively indicate that patients treated with renal replacement therapy such as HDF on-line exhibit lower homocysteine levels than those treated with conventional HD. Therefore we can conclude that: homocysteine markers indicate that patients treated with HDF on-line are exposed to lower average vascular risk.

KEY WORDS
Homocysteine, Vascular risk, Haemodiafiltration On-line

Nick Polaschek, RN, PhD¹, Paul N. Bennett, RN, BN, MHSM², Liz McNeill, BHSc (Nurs), GCEd (TertEd) CCritCareNurs, MNg (Current), MRCNA²

¹Sector Capability and Innovation Directorate, Ministry of Health, New Zealand
²School of Nursing and Midwifery, Flinders University of South Australia, Australia

CORRESPONDENCE
Nick Polaschek
National Renal Service Improvement Project Manager,
Sector Capability and Innovation Directorate,
Ministry of Health, 1 The Terrace, Wellington,
New Zealand.
Nick.Polaschek@moh.govt.nz

SUMMARY
Background: Given increasing demand for renal replacement therapy, this study sought to identify of key workforce issues facing dialysis units, based on a “snapshot” of the current workforce.
Methods: A web-based survey of all dialysis unit managers in Australia and New Zealand, in October 2008, about their workforce.
Results: A significant minority of dialysis staff in most regions were not registered nurses. Many renal registered nurses worked part time. Staff/patient ratios in dialysis units varied significantly by region, reflecting the relative prevalence of home therapies. Most dialysis units were generally adequately staffed. The proportion of registered nurses with specific renal qualifications varied significantly by region.
Conclusion: The changing character of the workforce in the dialysis unit in the future will require clarification of the relationships between different categories of dialysis staff. Specialty education for nurses needs to be oriented to equipping staff to be effective in their changing work environment.

KEY WORDS
Dialysis, Workforce, nursing, renal, education

¹Susana San Miguel Grad Cert Edu, Grad Cert Renal NSg; ²Josephine Chow MBA, PhD, Grad Cert Edu, BAppSci.  Associate Professor

¹Area Renal Service, Western Zone, Sydney South West Area Health Service
² Area Cardiovascular Stream, Sydney South West Area Health Service

CORRESPONDENCE
Susana San Miguel
Renal Clinical Nurse Consultant
Liverpool Hospital, Sydney South West Area Health Service
Renal Unit, Locked Bag , BC 1871, Liverpool 2170
Tel:  +61 2 9828 5544
Email: Susana.Sanmiguel@sswahs.nsw.gov.au

SUMMARY
Aim: The aim of the project is to determine the effectiveness of using on-line access flow measurement, thermodilution method (Fresenius BTM™), in detecting and predicting thrombosis or stenosis of the haemodialysis fistula, so that early intervention could be instituted.
Methodology: All haemodialysis patients with permanent vascular dialysis access, either arteriovenous fistula (AVF) or arteriovenous fistula graft (AVG), in a large tertiary referral Dialysis Service in Australia were included in this prospective observational quality project, conducted over 12 months.
Results: Out of 165 patients studied, 36 patients were found to have poor dialysis access flow, defined as AVF – flow of <200ml/min or a decreased of 25% from last measurement or AVG – flow of <600ml/min or a decreased of 25% from last measurement.  Doppler ultrasounds were performed, and confirmed findings of significant stenosis, either on the arterial or venous sites, as indicated by poor dialysis access flow results.
Conclusion: Thermodilution technique is a reliable and effective method of detecting poor dialysis access flow for patients with permanent vascular access, comparable with other techniques.

KEY WORDS
Haemodialysis, Vascular Access, surveillance, access flow

Tai Mooi Ho

CORRESPONDENCE
Tai Mooi Ho Unitat d’Hipertension i Risc Vascular,
Servei de Nefrologia,
Hospital del Mar,
Barcelona,
Spain
+34.93.2483373
TMHo@imas.imim.es

SUMMARY
Hypertension is a risk factor for cardiovascular and kidney diseases. According to estimation, the prevalence of hypertension will increase unless extensive and effective preventive measures are implemented. The diversity of languages and cultures of the hypertensive patients requiring adequate blood pressure control make communications difficult in many instances.
Nursing intervention for patients to adopt a healthy lifestyle requires effective communication. But the communication problems encountered in a culturally diverse context can result in undesirable outcomes for the patients and the health care team. This paper describes the production of a document to assist staff address the difficulty in intercultural communication, which could be used anywhere in the world. This document can facilitate nursing intervention to achieve optimal hypertension management in a transcultural context, responding to the challenge regarding preventive measures to halt increase in hypertension prevalence.

KEY WORDS
Hypertension, Lifestyle modifications, Nursing intervention, Transcultural

Vamsee Yaganti, M.D¹. Firas Alani, M.D². Sushmita Yaganti, M.D³. Sheldon Goldberg, M.D., FACC⁴. Daniel McCormick, D.O., FACC⁵

¹Resident, Department of Medicine. Drexel University College of Medicine, Philadelphia, PA
²Cardiology Fellow, Department of Medicine. Drexel University College of Medicine
³Graduate Student, Department of Biological Sciences. Wright State University Dayton, OH.
⁴Clinical Professor, Department of Medicine. Drexel University College of Medicine
⁵Clinical Professor, Department of Medicine. Director, Cardiac Catheterization Laboratory. Drexel University College of Medicine. Philadelphia, PA

CORRESPONDENCE
Vamsee Yaganti, M.D.
200 Mt Pleasant Avenue,
# M7
West Orange, NJ, 07052
Tel: 215-622-0775
Fax: 862-520-3734
Email: vamsee_10@hotmail.com

SUMMARY
Use of iodinated contrast media (ICM) for angiography can result in contrast-induced nephropathy (CIN). Gadolinium-based contrast media (GCM) have been used in angiography with a goal to reduce the incidence of CIN. We performed a retrospective analysis involving 85 patients with renal insufficiency who underwent 97 carotid artery angiography and stenting (CAAS) procedures with a combination of GCM and ICM. The incidence of peri-procedural death, Q wave myocardial infarction (QWMI), stroke and CIN were recorded. Patients in GCM group had worse pre-procedure renal function compared to ICM group. There were no peri-procedural deaths or QWMI in both groups. The incidence of stroke was 2.2% in GCM group and 0% in ICM group. The incidence of CIN were similar in GCM and ICM groups (8.5% vs 10% respectively, p=NS). However the predicted risk of CIN was 18.5% for GCM group and 10.4% for ICM group. Use of GCM and ICM combination for CAAS resulted in a 50% reduction in the incidence of predicted CIN risk compared to ICM.

KEY WORDS
Contrast induced nephropathy; Gadolinium;  Iodinated contrast; Carotid artery stenosis; Carotid artery angiography; Carotid artery stenting.