Observations in the Field Concerning Home Dialysis.

This article describes observations and findings related to home dialysis therapy. Dialyzing at home provides many benefits, giving patients more flexibility and autonomy. Ensuring proper education and training, and home adaptation is critical for patient safety. Survey findings related to group training, home visits, medical records, and the use of patient care technicians in home dialysis are reviewed. Implications for nephrology nursing in each scenario are discussed, including survey guidance for transitional care dialysis.

Observations in the Field Concerning Infection Control Practices in Dialysis.

This article describes observations and findings related to infection prevention and control in dialysis facilities. Ensuring infection control best practices is critical for patient safety. Survey findings related to hand hygiene, disinfection practices, medication preparation and administration, central venous catheter management, and hepatitis B surveillance are reviewed. Implications for nephrology nursing in each scenario are discussed, including survey guidance for COVID-19 post-pandemic.

Observations from the Field Concerning Water and Dialysate for Hemodialysis.

This article describes survey observations and findings related to water and dialysate in hemodialysis facilities. Ensuring the quality of the water and dialysate is critically important for patient safety. Survey findings related to monitoring of the pH and conductivity, microbiology and disinfection, water system monitoring, water in the home dialysis setting, and quality assessment and performance improvement are reviewed. Implications for the nephrology registered nurse in each of the scenarios are discussed.

Observations from the Field Concerning the Use of 1 mEq/L Potassium Dialysate, Equipment Monitoring, Staffing, and Total Chlorine Testing.

Patient safety and survey readiness should be top priorities for dialysis facilities. Hemodialysis is a complex process that redisposes staff and patients to possible errors and patient harm. Some observations seen by surveyors in dialysis facilities include an increased use in 1 mEq/L potassium dialysate, incomplete testing of hemodialysis machines, incorrect total chlorine testing, and staffing shortages. This article discusses the implications for the nephrology nurse in each of these situations.

The LifeSite hemodialysis access system: implications for the nephrology nurse.

A new subcutaneous device--the LifeSite Hemodialysis Access System (Vasca, Inc., Tewksbury, MA)--was designed to overcome limitations of transcutaneous dialysis catheters and is now available for use in the United States. A fully implantable device, the LifeSite System provides immediate, reliable, high-flow vascular access. The durable stainless steel and titanium LifeSite valve is implanted in a subcutaneous tissue pocket, typically below the clavicle. It is connected to a biocompatible silicone cannula that is tunneled to a central vein. The device is cannulated using a virtually pain-free, buttonhole technique. The valve is designed to allow cleansing of the valve, valve pocket, and buttonhole site with 70% isopropyl alcohol before and after each use to minimize the risk of infection. One hundred fifty-day results from an ongoing multicenter trial designed to compare the LifeSite System to a Tesio Cath dialysis catheter are reviewed. These results demonstrate that the LifeSite System is associated with statistically significant higher blood flow rates (p < 0.001) and lower rates of adverse events (p < 0.0004), infection (p < 0.032), and thrombolytic infusions (p < 0.044) than a standard dialysis catheter. The positive clinical experience with the LifeSite System carries significant implications for the dialysis team, indicating that this subcutaneous, pain-free route to vascular access may offer a safer, more effective bridge to a permanent arteriovenous (AV) access than a tunneled dialysis catheter. Potential implications of these benefits include improved outcomes, greater convenience for patients, improved efficiency and time management for the nursing staff, along with reduced direct and indirect costs related to vascular access management.