Intervention Value of Path-Type Health Education on Cognition and Renal Function of Patients with Diabetic Nephropathy.

OBJECTIVE: Analyze and examine the effectiveness of path-based health education for patients with diabetic nephropathy and renal function. METHODS: The 162 diabetic nephropathy patients admitted to our hospital from January 2018 to January 2021 were selected, and participants were randomly assigned to groups: study group (n = 79) and control group (n = 83). The control group received routine nursing care, whereas the study group received path-type health education. GQOLI-74, MUIS-A scores, biochemical indicators, dietary indicators, cognition, blood glucose levels, and renal function were compared between the two groups. RESULTS: The GQOLI-74 score of the two groups was substantially higher, while the MUIS-A score was significantly lower, although the study group changed more significantly (P < 0.05) than the control group. The biochemical markers in both groups decreased significantly, but the study group changed more dramatically (P0.05) than the control group; the nutritional index values of both groups increased significantly, but the study group's nutritional index values increased significantly (P0.05) when compared to those of the control group; the control group's awareness of drug treatment, basic knowledge, exercise, and diet was 79.4 percent, 78.9 percent, 73.4 percent, and 91.0 percent, respectively, and the study group's awareness of drug treatment, basic knowledge, exercise, and diet was 90.3%, 96.4%, 92.8%, and 94.0%. The study group exhibited greater awareness (P0.05) than the control group. The blood glucose indices of both groups were dramatically lowered; however, the study group's blood glucose level declined more significantly (P0.05) than the control group. The renal function indices of both groups were considerably lower, but the study group's renal function indexes were significantly lower (P0.05) than those of the control group. CONCLUSION: Pathway health education is a new nursing method that can adjust nutritional indicators, improve blood sugar and kidney function, and significantly increase patients' awareness of the disease, which can further improve patient compliance with treatment. This nursing method has high application feasibility and high clinical value.

Cuidados de enfermagem na hemodiálise / Nursing care in hemodialysis / Cuidados de enfermeria en la hemodiálisis

Objetivo: Identificar os cuidados de enfermagem realizados ao paciente em hemodiálise. Método: Revisão integrativa da produção científica brasileira sobre a temática do cuidado de enfermagem em hemodiálise produzida nos últimos dez anos, disponíveis na base de dados do Banco de Teses da Coordenação de Aperfeiçoamento Pessoal de Nível Superior. Para a avaliação da informação os autores elaboraram um instrumento com três variáveis relacionadas à questão que norteia o estudo. Resultados: A amostra final foi constituída por 22 estudos. Identificou-se um total de sete temáticas: relacionamento interpessoal, educação em saúde, cuidado centrado no paciente, cuidado da ingesta, cuidado do acesso venoso, adaptação à hemodiálise e segurança do paciente respetivamente. Conclusão: Ressalta-se a necessidade de um aprofundamento por parte de enfermagem no cuidado a partir das subjetividades que contextualizam ao paciente inserido em hemodiálise

Objective: To identify the nursing care provided to patients on hemodialysis. Method: An integrative review of the Brazilian scientific production on the theme of hemodialysis nursing care produced in the last ten years, available in the Database of Theses Database of the Higher Education Personal Improvement Coordination. To evaluate the information, the authors elaborated an instrument with three variables related to issue that guides the study. Results: The final sample consisted of 22 studies. A total seven themes were identified: interpersonal relationship, health Education, patient-centered care, care of the ingestions, care of venous access, adaptation to hemodialysis and patient safety respectively. Conclusion: The need for deepening on the part of nursing care is emphasized based on the subjectivities that contextualize the patient inserted in hemodialysis

Objetivo: Identificar los cuidados de enfermería realizados al paciente en hemodiálisis. Método: Revisión integrativa de la producción científica brasileña sobre la temática del cuidado de enfermería en hemodiálisis producida en los últimos diez años, disponibles en la base de datos de Banco de tesis de la Coordinación de Perfeccionamiento Personal de nivel superior. Para evaluar la información los autores diseñaron un instrumento con tres variables relacionadas a la pregunta norteadora de este estudio. Resultados: La muestra final fue constituida por 22 estudios. Se identificó un total de siete temáticas: relacionamiento interpersonal, educación en salud, cuidado centrado en el paciente, cuidado de la ingesta, cuidado del acceso venoso, adaptación a la hemodiálisis y seguridad del paciente respectivamente. Conclusión: Resalta la necesidad de una profundización por parte de enfermería en relación al cuidado a partir de las subjetividades que contextualizan al paciente insertado en hemodiálisis

Juicio clínico en diagnósticos de enfermería de pacientes renales crónicos en hemodiálisis / Clinical judgment in nursing diagnoses of chronic kidney patients on hemodialysis / Julgamento clínico em diagnosticos de enfermagem de pacientes renais crônicos em hemodiálise

OBJETIVO: Analizar el resultado del estado actual en pacientes renales crónicos en hemodiálisis. MÉTODO: Estudio cuantitativo, realizado con 25 pacientes sometidos a la terapia dialítica en un hospital terciario mediante realización de entrevistas semiestructuradas, examen físico y análisis de resultados de los exámenes de laboratorio. Para el análisis de las inferencias diagnósticas se utilizó el raciocinio clínico de Alfaro-LeFevre y luego se aplicó el Modelo de Análisis del Resultado del Estado Actual. RESULTADOS: Fueron inferidos 12 diagnósticos de enfermería encontrados en el 70% de la muestra, siendo la ansiedad, el diagnóstico prioritario. Para minimizar los cambios en la salud del paciente, las intervenciones seleccionadas fueron: enseñanza: procedimiento/tratamiento; promoción del ejercicio, relajación muscular progresiva; distracción/falta de atención; apoyo emocional; control de la nutrición, y la mejora de la socialización. CONCLUSIÓN: La técnica del raciocinio clínico utilizada por este modelo puede contribuir con la agilidad y ejecución del proceso de enfermería

OBJECTIVE: To analyze the result of the current state in chronic kidney patients on hemodialysis. METHOD: quantitative study performed with 25 patients undergoing dialysis therapy in a tertiary hospital through the accomplishment of semi-structured interviews, physical examination and analysis of laboratory test results. In order to analyze the diagnostic inferences, we used the clinical reasoning of Alfaro-LeFevre and then applied the Outcome-Present State Test Model. RESULTS: we inferred 12 nursing diagnoses found in 70% of the sample, where anxiety was the priority diagnosis. In order to minimize changes in the health of the patient, the interventions chosen were: teaching: procedure/treatment; exercise promotion; progressive muscle relaxation; distraction/inattention; emotional support; nutrition control; and improved socialization. CONCLUSION: the clinical reasoning technique used by this model can contribute to the agility and execution of the nursing process

OBJETIVO: Analisar o resultado do estado atual em pacientes renais crônicos em hemodiálise. MÉTODO: Estudo quantitativo, realizado com 25 pacientes submetidos à terapia dialítica em um hospital terciário mediante realização de entrevistas semiestruturadas, exame físico e análise de resultados dos exames laboratoriais. Para a análise das inferências diagnósticas utilizou-se o raciocínio clínico de Alfaro-LeFevre e em seguida aplicou-se o Modelo de Análise do Resultado do Estado Atual. RESULTADOS: Foram inferidos 12 diagnósticos de enfermagem encontrados em 70% da amostra, sendo a ansiedade, o diagnóstico prioritário. Para minimizar as alterações na saúde do paciente, as intervenções selecionadas foram: ensino: procedimento/tratamento; promoção do exercício, relaxamento muscular progressivo; distração/desatenção; apoio emocional; controle da nutrição; e melhora da socialização. CONCLUSÃO: A técnica do raciocínio clínico utilizada por este modelo pode contribuir com a agilidade e execução do processo de enfermagem

[Augmentation cystoplasty: Perioperative management for urologic nurses]. / L'entérocystoplastie d'agrandissement : indications et principes de prise en charge pour l'IDE en urologie.

INTRODUCTION: Augmentation cystoplasty (AC) is a surgical option to restore a good capacity bladder reservoir able to fill at low pressure. METHODS: The authors present the main principles for perioperative management for urologic nurses. RESULTS: AC is usually made with a piece of ileum patched to the bladder. Patient education programs are very important and are usually managed by urologic nurses. It begins in preoperative phase with the self-catheterization learning and continue in the postoperative phase with advises and prevention of the urinary mucus. CONCLUSION: AC are tricky surgeries but management and education of patients by urological nurses are key points to avoid chronic infection, stones or AC perforation.

Diseño y validación de un nuevo registro clínico de enfermería, para la continuidad de los cuidados y seguridad del paciente en hemodiálisis / Design and validation of a new nursing clinical registry for the continuity of care and patient safety in hemodialysis

Introducción: Diseñar y Validar una herramienta para la mejora del proceso de atención en enfermería en una unidad de hemodiálisis de un hospital de segundo nivel. Material y Método: Se desarrolló un estudio de mejora de la calidad de la atención, en el Hospital General Regional nº 1 "Vicente Guerrero" en Guerrero, (México), entre mayo-agosto de 2017. Se modificó la hoja de registros clínicos de enfermería de la unidad de hemodiálisis en dos etapas. Para la etapa de diseño se realizó un grupo focal con expertos y para la validación de contenido se aplicó el método Delphi. Los datos recolectados se procesaron y analizaron en el programa estadístico SPSS V.22. Resultados: El 70% de los expertos consideró el instrumento como bueno en cuanto a la calidad del registro. Hubo una discrepancia en el diseño encontrándose como parcialmente eficiente (70%) ya que cada experto evaluó de acuerdo al área que dominaba. Se incorporaron todas las observaciones realizadas en el diseño final. Conclusión: El instrumento se considera válido, proporcionando información adecuada del paciente previo al tratamiento hemodialítico, lo cual satisface los requerimientos legales respecto a la continuidad de los cuidados

Objective: To design and validate a tool for improving nursing care process in a hemodialysis unit of a secondary level hospital. Material and Method: A quality improvement study was developed at Regional General Hospital N°1 Vicente Guerrero in Guerrero, Mexico, between may-august 2017. Hemodialysis nurse clinical record sheet was modified in two stages. For the design stage, a focus group with experts was carried out and for content validation, Delphi method was applied. The collected data were processed and analyzed with statistics program SPSS V.22. Results: 70% of experts considered the instrument as good in terms of quality of the record. There was a discrepancy in the design, considered partially efficient (70%), since each expert evaluated according the area that dominated. All the observations made were included in the final design. Conclusion: The instrument is valid, giving the right information about the patient prior to hemodialysis, satisfying legal requirements regarding the continuity of care

Influencia de los pesarios en la calidad de vida de las mujeres con prolapso de órganos pélvicos / No disponible

El prolapso de órganos pélvicos es una condición patológica que impacta negativamente en la calidad de vida de la mujer. Ocurre cuando los músculos, los ligamentos y las fascias del suelo pélvico se estiran y se debilitan, dejando de proporcionar un sostén adecuado, pudiendo descender y salir al exterior (1). La prevalencia está estimada de un 43% a un 76% de la población femenina general, siendo la etiología compleja y multifactorial (2). El pesario es un dispositivo que se instala en la vagina para proveer soporte a los órganos pélvicos. La importancia de su utilización reside en mejorar significativamente la calidad de vida de la paciente y evitar una intervención quirúrgica. El tratamiento es mínimamente invasivo, de bajo coste, seguro y efectivo. Se recomienda cuando la cirugía representa un riesgo mayor a los beneficios (3)

Pelvic organ prolapse is a pathological condition that negatively affects women's quality life. It occurs when the muscles ligaments and tissues supporting the pelvic organs become weak or loose. Then, the pelvic organs can droop down and bulge out of the vagina. The prevalence in women is estimated to be between 43 and 76%, etiology is complex and multifactorial. A pessary is a device inserted into the vagina to support areas that are affected by pelvic organ prolapse. The potential benefit that derives form pessary use is the significant improvement in the patient's quality of life. Thus, pessary treatment allows surgery to be avoided. It is minimally invasive, inexpensive, safe and effective treatment. It is therefore recommended when surgery may pose greater risk than benefit

Sonda intravaginal. Una causa infrecuente de extravasación de orina por fuera de la sonda / No disponible

La colocación de una sonda en una mujer es una técnica sencilla, sin embargo, en casos de obesidad mórbida, vaginitis atrófica, retracción intravaginal del meatro uretral, cirugías o traumatismos pélvicos previos, inflamación o edema local, vulvitis radical y estenosis del meato uretral, esta maniobra resulta mucho más complicada (1-2). Las mujeres muy añosas suele presentar liquen escleroso y atrófico, consistente en una dermatosis crónica inflamatoria, no infecciosa y causa desconocida que retrae y cierra el introito vaginal produciendo lo que se denomina Craurosis vulvar (CV). La CV y la atrofia vaginal posmenopáusica hace que el meato uretral retroceda significativamente dentro de la vagina, lo que se hace imposible su cateterización bajo visión. En ocasiones, la sonda está correctamente colocada en la uretra, pero la paciente tiene la sonda obstruida y/o presenta contracciones vesicales no inhibidas que causan las contracciones del músculo detrusor como antimuscarínicos y espasmolíticos. Presentamos un caso donde un sondaje inadecuado fue erróneamente interpretado como una extravasación de la orina por fuera de la sonda y que no permite recordar qué maniobras debemos usar para resolver un sondaje difícil en la mujer

The placement of a catheter in women is an easy technique. However, in cases of morbid obesity, atrophic vaginitis, intravaginal retraction of urethra and meatus, surgeries or previous pelvic trauma, inflammation of local oedema, vulvitis and urethral meatal stenosis, this maneuver becomes more difficult than 1-2. Lichen sclerosus is most common in elderly women. The cause is unknown. It is a chronic inflammatory skin condition, non-infectious disease which leads to retraction and closure of the vaginal introitus resulting in what is termed "Klaurosis vulvae" (KV). with KV and postmenopausal vaginal atrophy, the urethral meatus recedes significantly along the vaginal wall making its visualization for catheterization impossible. In some cases, the catheter is correctly sited, but the patient can have an obstruction in the catheter and /or present uninhibited bladder contractions which cause the extravasation of urine. In these cases, it is recommended to use vesical washouts in order to unblock the catheter and/or drugs that inhibit the contractions of the detrusor muscle such as antimuscarinic and spasmolytic. We present a case where an inappropriate catheterization was wrongly interpreted as urinary extravasation. due to this, it is of pivotal importance to remember the type of maneuvers we have to perform in case of difficult catheterization in a woman

Atención integral al paciente ostomizado. Apertura de consulta de ostomía / No disponible

En el siguiente trabajo analizamos la puesta en marcha y la actividad de la consulta de enfermería especializada en Ostomía del Hospital Severo Ochoa de Leganés

In this paper we analyse the implementation and the activity of nursing consultation specializing on Ostomy in Severo Ochoa Hospital in Leganes

Complicaciones y cuidados de las urostomías / No disponible

Un estoma en general representa la pérdida de continuidad de la piel y por tanto de la barrera de protección que esta ofrece. Es por ello que existe un riesgo elevado de que se produzcan alteraciones tanto en el propio estoma como en la piel periestomal, un riesgo que se ve aumentado cuando se trata de ostomía que excretan secreciones líquidas (orina). Por tanto es de suma importancia hacer una correcta valoración y seguimiento tanto del estoma como de la piel que lo circunda para detectar cualquier anomalía y (minimizar el problema) poner solución

A stoma represents a loss of continuity of the skin, and so the skin barrier it offers. Therefore there is a high risk of alterations in the stoma and peristomal skin, this risk can increase when stomata excrete liquid secretions (urine). thus, it is of utmost importance to make an accurate assessment and follow-up care in order to detect and kind of abnormality and solve it

Does the intravascular volume status in haemodialysis patients measured by inferior vena cava ultrasound correlate with bioimpedance spectroscopy?

AIMS AND OBJECTIVES: To evaluate the accuracy of traditional clinical predialytic fluid assessment by renal nurses and the efficacy of 2 additional fluid assessment methods focussing on the potential preventative effect for intradialytic hypotension (IDH). BACKGROUND: Predialytic fluid assessment remains a daily challenge for renal nurses, when aiming for adverse event free haemodialysis treatments. Adding further objective parameters obtained through noninvasive methods into pre- and intradialytic fluid assessment could potentially improve health outcomes for haemodialysis patients. DESIGN: Comparative, observational study of three fluid assessment methods on their reliability on volume status and correlation to clinical outcomes. METHODS: Clinical predialytic nursing fluid assessments in 30 haemodialysis patients were compared with additional initial bioimpedance spectroscopy (BIS) measurements, and 3 serial intradialytic ultrasound scans of the inferior vena cava (IVC-US) performed by a second renal nurse concurrently during the same session. A retrospective data analysis compared all measurements in each individual for the predictive value for IDH. A STROBE checklist for observational cohort studies was used for the reporting of results. RESULTS: Seven subjects experienced episodes of symptomatic intradialytic hypotension (S-IDH), which would have been anticipated by IVC-US or by BIS in 5 patients (71%). Using an algorithm to predict IDH would have provided a sensitivity of 100% and specificity of 95%. CONCLUSION: Both additional fluid assessment methods would have provided critical information before and during each haemodialysis session. Therefore, we consider them as being potentially effective for the prevention of intradialytic hypotension, with IVC-US being similar to BIS. RELEVANCE TO CLINICAL PRACTICE: Traditional clinical nursing fluid assessment methods in haemodialysis patients do not provide sufficient information to prevent episodes of IDH. Additional objective fluid assessment methods are useful and likely to lead to improved health outcomes in HD patients when applied by renal nurses. A combination of IVC-US, MAP and BIS has potential to reduce the risk of IDH events in HD patients significantly.

Alteraciones del sueño más frecuentes en las personas en diálisis / Most frequent sleep disorders in dialysis patients

Introducción: La persona con enfermedad renal crónica en terapia dialítica presenta alteraciones en diferentes dimensiones de su vida, entre ellos el sueño, considerado una de las necesidades biológicas más importantes del organismo. Objetivo: Conocer las principales alteraciones del sueño en pacientes con enfermedad renal crónica en tratamiento dialítico, los factores que influyen en su aparición y cuidados de enfermería. Método: Revisión narrativa de la literatura. Los criterios de inclusión fueron estudios primarios y revisiones sistemáticas, tanto cualitativos como cuantitativos, sobre alteraciones del sueño en pacientes adultos con enfermedad renal crónica en terapia dialítica. Se consultaron las bases de datos Medline, Scielo y Epistemonikos. Resultados: La prevalencia de trastornos del sueño es alta en personas con enfermedad renal crónica que se someten a diálisis, las principales son síndrome de piernas inquietas y síndrome de apnea obstructiva del sueño. En el primero, el principal factor causal es el déficit de hierro y disfunción de dopamina, mientras que en el segundo son la sobrecarga de volumen y estrechez de vías respiratorias. El manejo responde a medidas farmacológicas como administración de hierro, agentes dopaminérgicos y uso de CPAP, además de medidas no farmacológicas que son transversales a ambos, como higiene del sueño. Conclusión: Las alteraciones del sueño en los pacientes en diálisis claramente repercuten en su calidad de vida, por lo que es un aspecto en que los profesionales de salud debiesen adquirir conocimientos y otorgar cuidados de enfermería específicos para prevenir, atenuar síntomas y evitar complicaciones

Introduction: The person with chronic kidney disease in dialysis therapy has alterations in different dimensions of life, including sleep, considered one of the most important biological needs of the organism. Objective: To know the main sleep alterations in patients with chronic kidney disease in dialysis treatment, predisposing factors and nursing care. Method: Narrative review of the literature. The inclusion criteria were primary studies and systematic reviews, both qualitative and quantitative, on sleep alterations in adult patients with chronic kindey disease in dialysis therapy. The Medline, Scielo and Epistemonikos databases were consulted. Results: The prevalence of sleep disorders is high in people with chronic kidney disease who undergo dialysis, the main ones being restless legs syndrome and obstructive sleep apnea syndrome. In the first, the main causative factor was iron deficiency and dysfunction of dopamine, while the second was the volume overload and narrow airways. The therapeutic approach responds to pharmacological measures such as iron administration, dopaminergic agents and the use of CPAP, as well as non-pharmacological measures, transversal to both such as sleep hygiene. Conclusion: Sleep disturbances in dialysis patients clearly affect their quality of life, being an aspect in which health professionals should acquire knowledge and provide specific nursing care to prevent, attenuate symptoms and avoid complications

Nephrology nurses' perceptions of discussing sexual health issues with patients who have end-stage kidney disease.

BACKGROUND: Despite sexual dysfunction (SD) being common among, and affecting quality of life in people with end-stage kidney disease (ESKD) receiving dialysis, sexuality is not a subject that patients and nephrology nurses usually discuss. OBJECTIVE: To explore Thai nephrology nurses' perceptions about discussing sexual health issues with patients receiving dialysis. MATERIAL AND METHODS: A phenomenological approach was applied and data were collected using semi-structured individual interviews. Purposive sampling was used to recruit 20 participants from four Southern regional hospitals in Thailand between April and June 2016. Recruitment continued until data saturation was reached. Data were analysed using Colaizzi's method. FINDINGS: Participants were aged between 27 and 53 years: mean 42.95 (±7.62 SD). Nineteen were female and sixteen were married. Five themes emerged: (1) improving knowledge in order to enhance confidence before discussing sexuality with patients; (2) gaining patients' trust before discussing sexuality; (3) finding an appropriate time to discuss sexuality; (4) organising a suitable setting in which to discuss sexuality and (5) feelings of appreciation for helping patients and their partners overcome their sexual health issues. CONCLUSION: These findings provide an understanding of Thai nurses' perceptions about the challenges in communicating with patients experiencing ESKD regarding sexual health problems and concerns. The findings suggest that sexual health education and training would enhance the confidence of Thai nephrology nurses in initiating sexuality-related discussions with their patients.

Agencia de autocuidado de la persona con enfermedad renal crónica en diálisis / Self-care agency in persons with chronic kidney disease in dialysis

Introducción: Las personas con Enfermedad Renal Crónica en diálisis permanentemente toman decisiones sobre lo que pueden y deben hacer en relación a su situación de salud, limitación y requerimiento personal para mantener la homeostasis y controlar los factores de riesgo; por lo tanto conocer y potenciar su capacidad de autocuidado es fundamental para diseñar estrategias que impacten sus necesidades. Objetivo: Determinar la capacidad de autocuidado de las personas con Insuficiencia Renal Crónica en diálisis, así como su relación con las características sociodemográficas y clínicas. Material y Método: Estudio cuantitativo descriptivo de corte transversal. La población estuvo conformada por 111 personas dializadas en una unidad renal de Florencia (Colombia). Se aplicaron los instrumentos: caracterización sociodemográfica y clínica, y capacidad de agencia de autocuidado en el paciente hipertenso. Los datos se analizaron mediante la estadística descriptiva. Resultados: Edad promedio de la población 56 años (DE:+14); género masculino 55.9%; su capacidad de agencia de autocuidado fue alta y media (80,2% y 19,8%) respectivamente; se encontró significación entre la variable capacidad de autocuidado y edad, que indica que a mayor edad, disminuye la capacidad de autocuidado (p=0,024<0,05), además manifestaron mejor percepción del estado de salud aquellas personas con mayor grado de capacidad de agencia de autocuidado (p=0,004<0,05). Conclusiones: La capacidad de agencia de autocuidado de las personas dializadas, se caracterizó por estar entre los niveles de alta y media capacidad, sin embargo se requiere de intervenciones del profesional de Enfermería y del equipo de salud, basadas en las necesidades individuales para mantener y mejorar su autocuidado (AU)

People with Chronic Kidney Disease in dialysis permanently make decisions about what they can and should do in relation to their health situation, limitation and personal requirement to maintain homeostasis and control risk factors; therefore, knowing and strengthening their self-care capacity is fundamental to design strategies that impact their needs. Objective: To determine the capacity of self-care of the people with Chronic Kidney Disease in dialysis, such as their relation with the sociodemographic and clinical characteristics. Material y Method: A quantitative, descriptive, cross-sectional study. The population was formed by one hundred and eleven dialyzed people at the Medilaser Renal Unit in Florencia (Colombia). Sociodemographic and clinical variables and capacity of self-care agency in hypertensive patient were obtained. Data were analyzed through descriptive statistics. Resultados: Mean age of the population: fifty-six (56) years old (SD±14); male gender: Fifty-five point nine per cent (55.9%); their capacity of self-care agency was high and medium (80,2% and 19,8%, respectively). Significance was found between the self-care capacity variable and age, which indicates that higher age the self-care capacity decreases (p=0.024), as well as a better perception of the state of health with greater capacity of people self-care agency (p=0.004). Conclusiones: The capacity of self-care agency of dialyzed people is between the high and medium capacity levels; however, it requires interventions from the nursing professional and health-care professionals, based on individual needs to maintain and improve their self-care (AU)

Las bacteriemias relacionadas con el catéter tunelizado de hemodiálisis y cuidados de enfermería / The bacteraemia to the tunnelled catheter of haemodialysis and nursing care

Introducción: En la actualidad, y debido a su avanzada edad y/o con comorbilidad diabética y cardiovascular asociada, un buen porcentaje de pacientes en hemodiálisis tienen que ser dializados mediante un catéter venoso central tunelizado. Objetivo: Conocer la producción científica existente sobre la bacteriemia relacionada con el catéter venoso central tunelizado de hemodiálisis. Material y Método: Se ha realizado una revisión sistemática mediante una búsqueda en las bases de datos SCOPUS, PubMed y ScieLo. Se incluyeron artículos escritos en inglés y español. Resultados: Fueron revisados 28 artículos, entre los cuáles se incluían guías de práctica clínica, revisiones y estudios de investigación. Tras el análisis de los mismos, se evidenció que la bacteriemia relacionada con el catéter afecta a un número considerable de pacientes que portan un catéter venoso central tunelizado para hemodiálisis y se encontraron diferentes actitudes terapéuticas para abordarla. En cuanto a su prevención, se encontraron numerosas publicaciones sobre la efectividad de diferentes medidas farmacológicas, y aunque fueron menos las publicaciones encontradas acerca de la profilaxis no farmacológica, estas recalcaron la importancia del estricto cumplimiento de medidas de higiene y asepsia, como herramienta principal para prevenir su aparición y situaron a enfermería como elemento fundamental para cumplirlas. Conclusiones: Las medidas de higiene y asepsia constituyen la base de la prevención de la bacteriemia relacionada con el catéter, siendo la enfermería un factor clave para que estas se cumplan; y debido a que la mayor parte de la literatura se centra en las medidas farmacológicas, son necesarios más estudios que evidencien su importancia (AU)

Introduction: Currently, and due to advanced age and / or associated diabetic and cardiovascular comorbidity, a good percentage of haemodialysis patients must be dialysed through a tunnelled central venous catheter. Objective: To know the existing scientific production on the bacteraemia related to the tunnelled central venous catheter of haemodialysis. Material and Method: A systematic review has been carried out through a search of the SCOPUS, PubMed and ScieLo databases. Articles written in English and Spanish were included. Results: 28 articles were reviewed, including clinical practice guidelines, reviews and research studies. After analysing them, it was evident that bacteraemia related to the catheter affects a considerable number of patients who have a tunnelled central venous catheter for haemodialysis and different therapeutic attitudes were found to address it. Regarding its prevention, numerous publications on the effectiveness of different pharmacological measures were found, and although there were fewer publications found about non-pharmacological prophylaxis, they emphasized the importance of strict compliance with hygiene and aseptic measures as the main tool to prevent its appearance and placing nursing as a fundamental element to consider. Conclusions: Hygiene and aseptic measures are the basis for the prevention of catheter-related bacteraemia, being nursing a key factor in ensuring that these are complied with; and as much of the literature focuses on pharmacological measures, more studies are needed to demonstrate its importance (AU)

DietaDialisisQuiz. A multiplayer competitive serious game for learning during dialysis

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Aportación de la ecografía realizada por enfermería a la exploración del acceso vascular / Contribution of the ultrasound performed by nursing to the exploration of vascular access

En los últimos años, ha comenzado a usarse por parte de enfermería la ecografía vascular en las unidades de diálisis, mejorando el conocimiento del acceso vascular (AV), ayudando en la elección de las zonas de canulación y aumentando la confianza en los AV nuevos o dificultosos. Nuestro objetivo es describir los motivos de exploración del AV con ecógrafo, los hallazgos encontrados y contrastarlos con el servicio de radiología. Es un estudio observacional, descriptivo en 22 pacientes con fistula arteriovenosa (FAV). Diseñamos un registro donde se recogieron los datos de las exploraciones ecográficas y se explotaron con el programa SPSS15. Se realizaron 37 exploraciones en 22 pacientes. Las principales causas de la exploración fueron: dificultad o dolor en las punciones, localización de nuevas zonas de punción, extravasaciones previas, vigilancia en la maduración de la FAV y seguimiento de FAV. Hallamos 35.1% con trombos, 8.1% circulación colateral, 5.4% colecciones/hematomas y 13.5% estenosis. De los 22 pacientes, 6 se derivaron a radiología y se contrastaron 2 estenosis, 1 disminución de flujo y 1 trombo. Las exploraciones ecográficas realizadas por enfermería de forma autónoma se identifican disfunciones del AV aportándonos mayor información sobre el AV (AU)

In recent years, vascular ultrasound has been used in nursing dialysis units, improving knowledge of vascular access (VA), helping in the selection of cannulation zones and increasing confidence in new or difficult VAs. Our objective is to describe the reasons for the exploration of VA with ultrasound, the findings found and contrast them with the radiology service. It is an observational, descriptive study in 22 patients with arteriovenous fistula (AVF). We designed a graph where data from ultrasound scans were collected and exploited with SPSS15. The sample consisted of 22 patients. There were 37 explorations. The main causes of the exploration were mainly difficulty or pain in the punctures followed by the localization of new areas of puncture, previous extravasations, surveillance in the maturation of AVF and follow-up of AVF. We found 35.1% with thrombi, 8.1% collateral circulation, 5.4% collections / hematomas and 13.5% stenosis. Of the 22 patients, 6 were referred to radiology and 2 stenosis, 1 decrease of flow and 1 thrombus were tested. A high number of ultrasound examinations by nursing are carried out autonomously with which AV dysfunctions are identified, contributing more information about AV (AU)

Análisis de los factores influyentes en la prevalencia de las úlceras de pie en pacientes en hemodiálisis / Analysis of influential factors in the prevalence of foot ulcers in hemodialysis patients

Introducción: Los pacientes en tratamiento renal sustitutivo con terapia de hemodiálisis, tienen elevado riesgo de sufrir úlceras en los pies, debido a la presencia de numerosos factores de riesgo asociados. Objetivos: El presente estudio, se plantea como objetivo principal establecer la prevalencia de úlceras en los pies, en los pacientes que realizan tratamiento con hemodiálisis en el Hospital San Rafael de A Coruña. Como objetivo secundario, valorar los factores de riesgo de ulceración del pie. Material y Método: Se realiza un estudio descriptivo transversal, en el que incluyen a los 131 pacientes con insuficiencia renal crónica (IRC) en tratamiento con hemodiálisis, que cumplen los criterios de inclusión. Se ha marcado como variable principal del estudio la presencia o ausencia de úlcera en el pie. Se valora el estado vascular, con la palpación de pulsos y con registro de sonido doppler de las arterias pedia y tibial posterior, además se realiza el cálculo del índice tobillo brazo (ITB). Se valora el estado neurológico, tras la exploración de la sensibilidad protectora con monofilamento y de la sensibilidad profunda con diapasón graduado. Resultados: El 10,7% de los pacientes del estudio tienen úlcera activa en el pie. No se logra palpar pulso en la arteria pedia en un 43,5% de los pacientes y en la arteria tibial posterior en un 60% de la muestra estudiada. El 25% de los pacientes presenta un valor de ITB, por debajo de 0,90 y un 13,5% presenta arterias no compresibles. Presentan alteración de sensibilidad profunda un 48,9% de los pacientes y alteración de la sensibilidad protectora un 44,3%. Conclusión: La prevención primaria a través de protocolos estandarizados de exploración del pie en las unidades de hemodiálisis, podrá minimizar la posibilidad de ulceraciones que comprometan la calidad de vida de los pacientes. Sistemáticamente habrá que realizar una valoración vascular, neurológica y de alteraciones podológicas, en la que se incluyan tanto a los pacientes con diabetes mellitus, como a los pacientes sin diabetes (AU)

Introduction: Patients on renal replacement therapy with haemodialysis therapy are at high risk of suffering foot ulcer. This is due to the large number of associated risk factors. Objective: The main goal of this study is to determine the prevalence of foot ulcers in patients who are being treated with haemodialysis therapy at San Rafael Hospital, A Coruña. The secondary aim is to analyze the risk factors associated to foot ulcers. Methods: A cross-sectional descriptive study is performed, including 131 patients suffering from chronic kidney disease. All these patients meet the inclusion criteria. Presence or absence of foot ulcers has been considered the main variable in this paper. A vascular examination is performed following the procedure of inspect, palpate and registration of doppler sound of pedis and posterior tibial artery. Furthermore, an ankle-brachial index (ABI) is calculated. A neurological examination is also performed. A monofilament is used to test protective sensation while a tuning fork is used to test deep sensitivity. Results: 10,7% of the patients studied suffer from active ulcer on the foot. We unsuccessfully attempted to palpate a pulse in the pedis artery in 43,5% of patients. The attempt to palpate a pulse in the posterior tibial artery was also unsuccessful in 60% of patients. 25% of patients were found an ankle-brachial index (ABI) less than 0,90 and a 13, 5% has noncompressible arteries. 49,9% of the patients under study show alteration of deep sensation and a 44,3% show alteration of protective sensation. Conclusion: The primary prevention through standardized protocols of the foot examination in the haemodialysis units will be able to reduce the chances of ulceration that can endanger patients’ quality of life. A vascular, neurological and podiatric disorders examination must be done systematically, including patients with and without diabetes mellitus (AU)