Nursing issues related to patient selection, vascular access, and education in quotidian hemodialysis.
BACKGROUND
Increased interest in quotidian hemodialysis (HD) programs requires that nephrology nurses have a larger role in transitioning patients to more frequent HD. Nursing issues include the selection, training, and education of patients before they begin more frequent HD therapy.


METHODS
The London Daily/Nocturnal Hemodialysis Study directly compared data from patients undergoing either short daily HD (n = 11) or long nocturnal HD (n = 12) with those undergoing conventional thrice-weekly HD (n = 22). Patient training, education, safety, and vascular access data were collected.


RESULTS
The patient training period varied from 10 to 25 days, with an average length of 16.64 days. Patients used 1 of 3 types of vascular access: native arteriovenous (AV) fistulae, grafts, or central catheters. No statistically significant differences in access flow rates between the study and control groups were noted or when comparing different types of access. A significant decrease in catheter infection rate was seen when patients switched to daily HD therapy. Patient cannulation surveys showed that patients with AV fistulae or grafts showed improvements with ease and comfort as the study progressed, and patients widely preferred the buttonhole technique to the rotating-needle method for cannulation.


CONCLUSIONS
With growing interest in the development of quotidian HD programs, HD nursing personnel face the exciting challenge of improving on existing training programs and treatment modalities.
Leitch
Rosemary
R
Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada.
Ouwendyk
Michaelene
M
Ferguson
Evelyn
E
Clement
Laurie
L
Peters
Karen
K
Heidenheim
A Paul
AP
Lindsay
Robert M
RM
D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006437:Hemodialysis, Home / Q000379:methods* / Q000451:nursing; D006701:Home Nursing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods; D018579:Patient Selection; D011446:Prospective Studies; D012449:Safety; D016896:Treatment Outcome