Current practice in dialysis central venous catheter management: Multi-disciplinary renal team perspectives.

AIM: To explore the current practices related to the insertion, management and removal of dialysis central venous catheters (CVCs) used in patients with chronic kidney disease requiring haemodialysis. METHODS: This qualitative descriptive study involved semi-structured interviews with surgeons, interventional radiologists, renal physicians, dialysis nurses, renal access nurses and renal researchers involved in the care of patients with chronic kidney disease requiring haemodialysis. Data were collected from staff at eight hospitals in six states and territories of Australia. Thirty-eight face-to-face interviews were conducted. A modified five-step qualitative content analysis approach was used to analyse the data. RESULTS: Improved visualization technology and its use by interventional radiologists has steered insertions to specialist teams in specialist locations. This is thought to have decreased risk and improved patient outcomes. Nurses were identified as the professional group responsible for maintaining catheter access integrity, preventing access failure and reducing access-related complications. While best practice was considered important, justifications for variations in practice related to local patient and environment challenges were identified. CONCLUSION: The interdisciplinary team is central in the insertion, maintenance, removal and education of patients regarding dialysis CVCs. Clinicians temper research-based decision-making about central dialysis access catheter management with knowledge of individual, environmental and patient factors. Strategies to ensure guidelines are appropriately translated for use in a wide variety of settings are necessary for patient safety.

Cuidados de enfermagem a clientes com fistula arteriovenosa: uma revisão integrativa da literatura / Nursing care to clients with arteriovenous fistula: an integrative review of the literature / Atención de enfermería a clientes con fístula arteriovenosa: una revisión integrativa de la literatura

Objetivo: descrever os cuidados da equipe de enfermagem aos clientes portadores de Fistula Arteriovenosa (FAV). Método: revisão integrativa de literatura, que utilizou como questão de busca: quais são os cuidados da equipe de enfermagem aos clientes portadores de fístula arteriovenosa? A busca foi realizada na Biblioteca Virtual de Saúde, nas bases de dados: MEDLINE, LILACS e BDENF; PubMed; Portal de Periódicos da Capes, nas bases SCOPUS e CINAHL, em agosto de 2018. Resultados: foram encontrados três artigos indexados na LILACS e dois na CINAHL. Emergiu a categoria analítica do estudo intitulada: Cuidados de enfermagem aos clientes portadores de FAV, e duas unidades de decodificação: "Incorporação de evidências sobre a FAV, para se pensar os cuidados de enfermagem" e "Atuação da equipe de enfermagem na preservação da FAV: pensando o autocuidado". Conclusões: os cuidados de enfermagem aos clientes portadores de FAV perpassaram pela durabilidade e a manutenção do seu funcionamento

Objective: to describe the care of nursing staff to customers bearers of Arteriovenous Fistula (AVF). Method: integrative Review of literature, which used as search question: what are the care of nursing staff to customers bearers of arteriovenous fistula? The search was conducted in the health Virtual Library, in the databases BDENF, LILACS and MEDLINE; PubMed; Capes Journal Portal, CINAHL, SCOPUS and bases in August 2018. Results: were found three articles indexed at LILACS and two in CINAHL. Analytical category emerged the study entitled: nursing care to clients suffering from AVF, and two units of decoding: "incorporation of evidence about the FAV, to think about nursing care" and "performance of nursing staff in preservation of FAV: thinking self-care". Conclusions: the nursing care to clients suffering from perpassaram FAV durability and maintenance of your operation

Objetivo: para describir el cuidado de enfermería personal para portadores de clientes de la fístula arteriovenosa (AVF). Método: integral revisión de la literatura, que utiliza como pregunta de la búsqueda: ¿Cuáles son los cuidados de enfermería personal para portadores de fístula arteriovenosa de los clientes? La búsqueda se realizó en la Biblioteca Virtual, de la salud en las bases de datos, BDENF, LILACS y MEDLINE; PubMed; CAPES Portal diario, CINAHL, SCOPUS y en agosto de 2018. Resultados: se encontraron tres artículos indizados en LILACS y dos en CINAHL. Categoría analítica surgió el estudio titulado: atención a clientes de AVF y dos unidades de decodificación de enfermería: "incorporación de la evidencia acerca de la FAV, a pensar en cuidados de enfermería" y "rendimiento del personal de enfermería preservación de la FAV: autocuidado de pensamiento" . Conclusiones: la atención de enfermería a clientes que sufren de perpassaram FAV durabilidad y mantenimiento de su operación

Evolution of Nephrology Nursing as Reflected in the Early Nursing Literature.

This article provides a historical overview of some of the early nursing literature. These articles reveal early perceptions and writings about renal anatomy and physiology, and nursing implications for care, including acute and chronic kidney disease, peritoneal and hemodialysis, and kidney transplantation.

Evidence-Based Reviews: Trends in Nephrology Nursing.

Evidence-based practice (EBP) is one of the essential components of nephrology nursing. Reviews of such evidence are important as a means to synthesize research findings into one meaningful form of data. Publication trends of evidence reviews in nephrology nursing are unknown. The purpose of this systematic review was to identify trends in publications of evidence reviews in the Nephrology Nursing Journal. Titles of all publications in the Nephrology Nursing Journal from January 2003 to September/October 2018 were reviewed. A total of 23 evidence reviews were identified and formed the basis of this systematic review. Narrative analysis and concept mapping were used to synthesize data. There was a trend toward systematic reviews of quantitative studies, as well as evidence reviews that focused on the topics of quality of life and access to health services. The need for systematic rigorous reporting is recommended for EBP, as well as future reviews on identified priority areas of research.

Trends in Social Work. Nephrology social work meets integrated care: A partnership for the road ahead.

Integrated care has brought changes to the field of nephrology social work. In turn, nephrology social work has brought innovative contributions to the field of integrated care. The new social work service delivery systems described in this article are sure to help the industry reach its goals to keep care patient-centered while maintaining quality and reducing the costs of treating end stage renal disease. Social workers are called to serve the needs of the client, the family, the community and the society at large. Nephrology social workers are right where they belong in the ESRD integrated care environment. They feel right at home.

Cenário atual da enfermagem em nefrologia do Recife e região metropolitana / Escenario actual de nefrología enfermería y región metropolitana de Recife / Current scenario of nephrology nursing and Recife metropolitan region

Objective: To identify how nephrology has been developing within the nursing, and the profile of nurses working in hemodialysis clinics in Recife and the metropolitan region. Method: cross-sectional study, exploratory quantitative approach, developed in 14 hemodialysis clinics. The sample consisted of 84 nurses. The data were collected through a questionnaire was completed. Data analysis was performed with SPSS version 13. Approved research protocol number 2151-11 and CAAE No. 0280.0.099.000-10. Results: nurses have specialist title in nephrology (66.7%), and acquired on average 62.8 months after the start of the activity in the area. Achievements were reached by category, such as professional autonomy, recognition and respect for patients and society. Conclusion: non-specialized nurses are being admitted to hemodialysis services due to the lack of these professionals in the job market.

Objetivo: identificar como a nefrologia vem se desenvolvendo dentro da Enfermagem, e o perfil dos enfermeiros que trabalham em clínicas de hemodiálise da cidade do Recife e Região Metropolitana. Método: estudo transversal, exploratório de abordagem quantitativa, desenvolvido em 14 clínicas de hemodiálise. A amostra foi composta por 84 enfermeiros. A coleta de dados ocorreu mediante preenchimento de questionário. A análise dos dados foi feita no software SPSS versão 13. Pesquisa aprovada sob protocolo nº2151-11 e CAAE nº 0280.0.099.000-10. Resultados: os enfermeiros possuem título de especialização em nefrologia (66,7%), e o adquiriu em média, 62,8 meses depois de iniciada a atividade na área. Conquistas foram alcançadas pela categoria, como a autonomia profissional, o reconhecimento e respeito pelos pacientes e pela sociedade. Conclusão: enfermeiros não especializados estão sendo admitidos nos serviços de hemodiálise, devido à carência destes profissionais no mercado de trabalho.

Objetivo: Determinar la forma en nefrología se ha desarrollado dentro de la enfermería, y el perfil de las enfermeras que trabajan en las clínicas de hemodiálisis en Recife y en la Región Metropolitana. Método: Estudio transversal, exploratorio enfoque cuantitativo, desarrollado en 14 centros de hemodiálisis. La muestra estuvo conformada por 84 enfermeras. Los datos fueron recolectados a través de un cuestionario se completó. El análisis de datos se realizó con elprograma SPSS versión 13. Número de protocolo de investigación aprobado 2151-11 y CAAE No. 0280.0.099.000-10. Resultados: las enfermeras tienen título de especialista en Nefrología (66,7%), y adquirieron un promedio de 62,8 meses después del inicio de la actividad en el área. Los logros fueron alcanzados por categoría, tales como la autonomía profesional, el reconocimiento y el respeto de los pacientes y la sociedad. Conclusión: las enfermeras no especializados están siendo admitidos en los servicios de hemodiálisis, debido a la falta de estos profesionales en el mercado laboral.

The changing landscape of the nephrology nursing care environment in the United States over the last 45 years.

The nephrology landscape has changed significantly over the last 45 years. We are providing more options for patients and utilizing safer and more advanced technology, and remain grounded in a desire to continue to improve. In a description of the nurse's role during hemodialysis in 1950, responsibilities included technical aspects of the treatment, infection prevention, patient assessment and monitoring, documentation, medication administration, fluid management, patient education, and providing comfort and encouragement (Coleman & Merrill, 1952). Although the manner in which these roles are carried out has changed with time, the skills remain important today. Additionally, despite the technological differences throughout the last several decades, nephrology nursing has remained focused on humanizing the process for people with complex care needs, preserving the patient's dignity, teaching, supporting, and involving the patient and family in their care (Hoffart, 1986b). Throughout our historical journey, it is apparent that nephrology nurses have always been responsible for a significant amount (or majority) of the care of patients with kidney disease and that nursing care is much more than delivering a treatment (Lynaugh & Fairman, 1989). Nephrology nursing is grounded in patient and family-centered care based on both physiological and psychosocial needs. Nephrology nurses have touched every aspect of the kidney care community shaping the service, government, and product sectors. Nephrology nursing has been vital from the initial development years and continues to be an undeniable force in improving nephrology care to a patient population with very complex patient needs. Many changes have taken place since the inception of the ESRD program in July 1973. Advances in technology, demonstration projects, research, and reimbursement changes have reshaped the landscape of our care delivery models. In the same way, our knowledge of kidney disease has progressed substantially, resulting in improved diagnosis and treatment in an effort to reduce complications and improve outcomes for patients with ESRD.

Advanced urology nursing practice.

Urology nursing has developed as a specialty over the past few decades in response to several factors, workload demands being a prime reason. Nurses are taking on additional roles and activities including procedures such as cystoscopy and prostate biopsy, and running nurse-led clinics for a variety of urological conditions. Audits of advanced urological nursing practice have shown this care to be of a high standard and investigative procedures performed by these nurses match the diagnostic quality of existing services. Professional urological nursing organizations support the professional needs of these nurses, but the provision of education and training for advanced practice activities remains an unaddressed need. A range of confusing advanced urology nursing titles exists, and uncertainty regarding the roles and scope of practice for these nurses remains a concern. Acceptance and support from medical colleagues is required for the success of advanced urological nursing practice, but opinions on these roles remain divided.

An Overview of Transplant Immunosuppression--History, Principles, and Current Practices in Kidney Transplantation.

From the historical first transplant in 1954 to the current transplant era, tremendous strides have been made in transplant immunology and immunosuppression. The most common immunosuppressive regimens use a combination of agents with differing modes of action to maximize efficacy and minimize the toxicities associated with each class of agent. The general categories of immunosuppressives are glucocorticoids, antimetabolites, calcineurin inhibitors, anti-lymphocyte antibody therapies (monoclonal and polyclonal), costimulation blockers, and mTOR inhibitors. This article reviews immunosuppressant medications, their actions, and significant side effects; discusses clinical management issues of immunosuppression; and describes future directions for the development of immunosuppressive medications.

The Development of Kidney Transplant Nursing.

An analysis of published literature, interviews with early transplant nurses, and other primary source materials shows how evolving medical treatments for rejection, nurses' ability to learn on the job, and their commitment to patients influenced the development of kidney transplantation as a specialized area of practice. The work of these nurses work is discussed in the context of unfolding nursing specialization at the middle of the twentieth century.