How to choose the appropriate cannulation technique for vascular access in hemodialysis patients.

The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.

Effects of demographic and clinical character on differences in self-care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approach.

INTRODUCTION: Hemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. METHODS: A cross-sectional study was conducted involving 89 patients. RESULTS: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. CONCLUSION: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.

Recorrência da internação por infecção do trato urinário em idosos / Recurrence of hospitalization for urinary tract infection in elderly / Recurrencia de la hospitalización por infección del tracto urinario en ancianos

Objetivos: Identificar, descrever e analisar a Infecção do Trato Urinário e sua recorrência em internação. Caracterizar os aspectos sociodemográficos, laboratoriais e clínicos dos idosos com ITU. Método: Estudo transversal com delineamento descritivo, abordagem quantitativa do tipo analítica, realizada nos prontuários eletrônicos dos idosos que foram internados no ano de 2017 e reinternaram em 2018, na unidade de Geriatria de um hospital de ensino. Na estatística foi usado Teste Exato de Fisher, considerado p<0,05. Resultados: Dos 1.835 prontuários, foram selecionados 550 (29,97%) idosos, destes, foram investigados 121 (22%) com ITU. A maioria foi do sexo masculino com idade entre 80 e 89 anos. Dentre eles, 51,2% usaram algum tipo de sonda vesical e 52,9% usaram frauda. Os exames alterados foram os de creatinina, Proteina-C-Reativa, urina I (proteínas e leucócitos), além de urocultura positiva para Escherichia Coli. Dos 121 pacientes investigados, 50,4% tiveram reinternação por Infecção urinária, destes, 42,6% morreram e, dos que não tiveram recorrência, foram 18,3% óbitos (p= 0,00054).Conclusão: O idoso tem predisposição maior para adquirir infeção urinária, além de apresentar recidivas, principalmente os que fazem uso de sonda vesical e fralda, o que ocasiona aumento da frequência de hospitalizações, do estadiamento no hospital e da mortalidade. (AU)

Objective: Analyze the Urinary Tract Infection and its recurrence in hospitalization in the elderly, characterizing the sociodemographic, laboratory and clinical aspects. Methods: Cross sectional study with descriptive design, quantitative approach of an analytical type, carried out on the electronic medical records of the elderly who were hospitalized in 2017 and readmitted in 2018, in the Geriatrics unit of a teaching hospital. Fisher's exact test was used in statistics, considered p <0.05. Results: Of the 1,835 records, 550 (29.97%) elderly were selected, of these, 121 (22%) with Urinary Tract Infection were investigated. The majority were male aged between 80 and 89 years. Among them, 51.2% used some type of bladder catheter and 52.9% used fraud. The altered tests were those of creatinine, C-Reactive Protein, urine I (proteins and leukocytes), in addition to positive urine culture for Escherichia Coli. Of the 121 patients investigated, 50.4% had readmission for urinary tract infection, of these, 42.6% died and, of those who did not have recurrence, 18.3% died (p = 0.00054). Conclusion: The elderly is predisposed greater to acquire urinary infection, in addition to relapses, especially those who use a bladder catheter and diaper, which causes an increase in the frequency of hospitalizations, hospital stay and mortality. (AU)

Objetivo: Analizar la Infección del Tracto Urinario y su recurrencia en la hospitalización del anciano, caracterizando los aspectos sociodemográficos, de laboratorio y clínicos. Métodos: Estudio transversal con diseño descriptivo, abordaje cuantitativo de tipo analítico, realizado sobre la historia clínica electrónica de los ancianos que fueron hospitalizados en 2017 y readmitidos en 2018, en la unidad de Geriatría de un hospital universitario. En estadística se utilizó la prueba exacta de Fisher, considerada p <0,05. Resultados: De las 1.835 historias clínicas, se seleccionaron 550 (29,97%) ancianos, de estos se investigaron 121 (22%) con Infección del Tracto Urinario. La mayoría eran hombres de entre 80 y 89 años. Entre ellos, el 51,2% utilizó algún tipo de sonda vesical y el 52,9% utilizó fraude. Las pruebas alteradas fueron las de creatinina, proteína C reactiva, orina I (proteínas y leucocitos), además de urocultivo positivo para Escherichia Coli. De los 121 pacientes investigados, el 50,4% tuvo reingreso por infección del tracto urinario, de estos, el 42,6% falleció y, de los que no presentaron recidiva, falleció el 18,3% (p = 0,00054). Conclusión: Los ancianos tienen mayor predisposición a adquirir urinaria infección, además de recaídas, especialmente en quienes utilizan sonda vesical y pañal, lo que provoca un aumento en la frecuencia de hospitalizaciones, estancia hospitalaria y mortalidad. (AU)

Suspensões de cirurgias ortopédicas por motivos extrínsecos em pacientes idosos / Suspension of orthopedic surgeries for extrinsic reasons in older patients / Suspensiones para cirugía ortopédica por razones extrínsecas en pacientes ancianos

Objetivo: Verificar taxa e motivos extrínsecos de suspensões de cirurgias ortopédicas eletivas em idosos e o percurso até sua realização, reconhecendo sexo biológico, faixa etária, procedência e tipo de cirurgia. Método: Estudo retrospectivo, com delineamento descritivo, abordagem quantitativa do tipo analítica, com correlação entre variáveis, realizado em um hospital de ensino no período de janeiro a junho do ano de 2018 com idosos de 60 anos e acima, pacientes de cirurgias ortopédicas. Resultados: Das 543 cirurgias ortopédicas de idosos agendadas, 93 (17,41%) foram suspensas. O maior motivo para a suspensão foi extrapolação do tempo da cirurgia anterior (35,48%); a cirurgia foi cancelada uma vez e realizada entre um e dois dias após a suspensão (91,87%), com significância estatística (p=0,00). Conclusão: Constatou-se que a taxa de suspensão cirúrgica nos idosos ortopédicos, por motivos extrínsecos, foi de 17,41%. A suspensão cirúrgica ainda é um grande desafio aos profissionais e às instituições de saúde, demonstrando grande envolvimento do enfermeiro em detectar e solucionar o atraso cirúrgico, de modo a diminuir sua incidência.

Objective: To identify the rates and extrinsic reasons for the suspension of elective orthopedic surgeries in older adults and the course until their performance, according to sex, age group, origin, and type of surgery. Method: This is a retrospective descriptive study with a quantitative analytical approach and variable correlation, carried out in a teaching hospital from January to June 2018. The sample consisted of orthopedic surgery patients aged 60 years and older. Results: Out of the 543 orthopedic surgeries scheduled for older adults, 93 (17.41%) were suspended. The main reason for suspension was the previous surgery lasting longer than expected (35.48%); the surgery was canceled once and performed 1­2 days after the suspension (91.87%), with statistical significance (p=0.00). Conclusion: We found that the rate of surgical suspension for extrinsic reasons in orthopedic older patients was 17.41%. Surgical suspension remains a great challenge for professionals and health facilities, showing the significant involvement of nurses in detecting and solving surgical delays in order to decrease their incidence.

Objetivo: Verificar la tasa y motivos extrínsecos de las suspensiones electivas de cirugía ortopédica en ancianos y la vía para su realización, reconociendo el sexo biológico, grupo de edad, origen y tipo de cirugía. Método: estudio retrospectivo, con diseño descriptivo, abordaje analítico cuantitativo, con correlación entre variables, realizado en un hospital de enseñanza, de enero a junio del año 2018, con ancianos de 60 años y más, sometidos a cirugía ortopédica. Resultados: De las 543 cirugías ortopédicas programadas para ancianos, 93 (17,41%) fueron suspendidas. El mayor motivo de suspensión fue la extrapolación del momento de la cirugía anterior (35,48%); la cirugía se canceló una vez y se realizó entre uno y dos días después de la suspensión (91,87%), con significación estadística (p=0,00). Conclusión: Se encontró que la tasa de suspensión quirúrgica, en el anciano ortopédico por razones extrínsecas, fue del 17,41%. La suspensión quirúrgica sigue siendo un gran desafío para los profesionales y las instituciones de salud, demostrando la gran implicación del enfermero en la detección y resolución del retraso quirúrgico, con el fin de reducir su incidencia.

Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in Brazil.

The purpose of this study was to evaluate the psychometric properties of the Brazilian Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis. Cross-sectional validation study, followed the recommendation provided by Sousa and Rojjanasrirat. Content validity, explanatory and confirmatory factor analyses used to check validity and Cronbach's alpha was the reliability measure. Three hundred hemodialysis patients with arteriovenous fistula were included in the study. The expert committee assessed the content validity. Exploratory factor analysis confirmed the same two-factor structure found for the original scale, explaining 60.10% of the variance. Such solution was checked by confirmatory factor analysis with Cronbach's alpha equal to 0.920, 0.810, and 0.884 for the overall scale, the self-care in management of signs and symptoms and the self-care in prevention of complications subscales respectively. The scale has good psychometric properties to assess self-care behaviors and can be used with Brazilian patients on hemodialysis with arteriovenous fistula.