title: Nursing issues related to patient selection, vascular access, and education in quotidian hemodialysis.
abstract: 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.
authors.affiliation: Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Leitch
authors.forename: Michaelene
authors.initials: M
authors.lastname: Ouwendyk
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ferguson
authors.forename: Laurie
authors.initials: L
authors.lastname: Clement
authors.forename: Karen
authors.initials: K
authors.lastname: Peters
authors.forename: A Paul
authors.initials: AP
authors.lastname: Heidenheim
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lindsay
mesh_terms: 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