Specialist pediatric dialysis nursing improves outcomes in children on chronic peritoneal dialysis.
Chronic peritoneal dialysis (PD) for children in Singapore was instituted in 1988 at the National University Hospital with adult nurses providing dialysis services during the first 10 years. In 1998, a specialist pediatric dialysis nursing team was recruited. This study was conducted to determine the impact of dialysis nursing service on PD-related outcomes during the two nursing periods. Comparing the adult (group 1) and pediatric (group 2) nursing periods, the peritonitis rate was significantly higher in group 1 (RR 1.90; 95%CI 1.27-2.84), and this association did not weaken after adjusting for age, gender, and exit site infections. Exit site infection rate (RR 2.16; 95%CI 1.44-3.23), risk of peritonitis during the first year (RR 3.65; 95%CI 1.68-7.90), and multiple peritonitis attacks (RR 2.45; 95%CI 1.32-4.55) were higher in group 1. The peritonitis rates for adult patients cared for by the same adult nurses declined sharply from 1.05 episodes per patient-year between 1989 and 1992 to 0.41 episodes per patient-year between 1995 and 1997, however the corresponding pediatric rates did not change (1.48 to 1.06 episodes per patient-year, respectively) until the second era when specialized pediatric nurses were available. In conclusion, establishment of a specialist pediatric dialysis nursing team resulted in significant improvement in infection-related PD outcomes.
Gunasekara
W D Vindya N
WD
Shaw-NKF Children's Kidney Centre, University Children's Medical Institute, National University Health System, Singapore, Singapore.
Ng
Kar-Hui
KH
Chan
Yiong-Huak
YH
Aragon
Eric
E
Foong
Pei-Pei
PP
Lau
Yew-Weng
YW
Lim
Lee-Kean
LK
Liew
Chien-Wyei
CW
Yeo
Wee-Song
WS
Yap
Hui-Kim
HK
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010371:Pediatric Nursing / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000451:nursing*; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome