Improving practice in accessing haemodialysis central venous catheters.

In children, haemodialysis is used as a form of renal replacement therapy and is typically delivered via a central venous catheter (CVC). It is necessary to access the CVC for dialysis and blood sampling regularly, and safe line practice is essential to minimise complications associated with CVCs, including infection. The authors had concerns about the rate of CVC infection in their children's haemodialysis unit, which prompted a practice review. A questionnaire was emailed to all other children's haemodialysis units in the UK, which identified variations in practice and training. The authors subsequently modified their unit's CVC access guidelines and blood sampling technique, and developed a new competency-based 'haemodialysis CVC access only' training programme for nursing staff. A willingness to review practice in the unit, supported by comparison and communication with other units, assisted in implementing this change in practice.

Pediatric kidney recipients may benefit from monitoring for donor-specific antibodies.

There are limited data regarding the presence of DSAs and their effect on graft function in pediatric renal transplantation. The role for serial DSA monitoring in routine clinical practice is unclear. All patients attending a regional transplant clinic were tested for DSAs, measured using Luminex single/mixed antigen beads. Any patient having a positive result subsequently underwent historic testing on samples previously obtained. DSA-positive patients underwent prospective monitoring of DSAs, and correlation with clinical events was studied. Nine of a total of 50 patients (18%) were DSA-positive, of whom six had graft dysfunction. The DSA-positive cohort had significantly increased episodes of AR (p = 0.01). There were two graft losses in the DSA-positive group and none in the DSA-negative group. Eight of the DSA-positive group had potentially reduced exposure to IS because of either adherence issues or clinical indications. DSAs were associated with increased risk of rejection. There appears to be a role for serial monitoring of DSAs in patients where there has been a reduced exposure to IS so that early intervention with optimized IS can be considered.

Implementing the new BCG vaccination guidelines--a maternity hospital-based clinic approach.

BACKGROUND: With the recent changes to the UK BCG vaccination programme, the emphasis on childhood immunisation changes to identification and immunisation of at risk neonates. We report our experience of improving the system for provision of early BCG immunisation to high-risk infants born in the east of Glasgow. METHODS: A maternity hospital-based BCG clinic was established, together with a programme designed to increase awareness among midwifery and junior medical staff. RESULTS: Neonatal identification of at risk infants increased by 300% and was associated with high rates of clinic attendance and a 93% uptake of BCG immunisation in early infancy. Almost all infants were immunised within the first three months of life. CONCLUSION: Targeting parents prior to discharge from the maternity unit is an effective means of implementing BCG immunisation guidelines. The clinic model described is a successful and easily implemented example of co-operation between acute and community services.