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S 05 Parallel Session
Title: Peritoneal Dialysis
Sunday, September 7, 9:00 – 10:30
Beta
Programme of the session
GS: D.G. Struijk
Peritoneal dialysis – State of the art
O 05
Better results with peritoneal catheter insertion by nephrology team
Nurit Cohen (Israel)
O 06
Peritoneal dialysis for patients with urgent need for renal replacement therapy (RRT)
Dana Hrubá (Czech Republic)
O 07
Evidence and best practice-based educational program for peritoneal dialysis nurses
Christiane Schaepe (Germany)
O 08
A practical manual of peritoneal dialysis for nurses – Project based preparation
Gábor Fekésházi (Hungary)
Abstracts
GUEST SPEAKER
Peritoneal Dialysis - State of the art
D. Struijk1
1Dialysis, Dianet, location AMC, Amsterdam, Netherlands
Background: Within a few years, peritoneal dialysis in its current continuous treatment modes will be 40 years old. During that period many secrets have been unraveled about the way the peritoneal membrane works. Simultaneously many improvements have been made to the treatment, so that the survival of peritoneal dialysis patients nowadays more than equals the outcome of hemodialysis. Some of these important improvements are the reduction of peritonitis, the acknowledgement of the value of residual renal function and the focus on fluid status within the subject of dialysis adequacy.
Objectives: This lecture will start with an overview on the current position of peritoneal dialysis in the world. Than the most recent findings in the field will be discussed. The focus of the presentation will be on the impact of our current knowledge on the best clinical practices in peritoneal dialysis and its effects on clinical outcomes.
BIOGRAPHY OF THE GUEST SPEAKER
O 05
Better results with peritoneal catheter insertion by nephrology team
R. Morgenstern1, M. Voroviov1, N. Cohen1, L. Shwarz1
1Nephrology, Soroka University Medical Center, Beer-Sheva, Israel
Background: Peritoneal dialysis (PD) as a modality for CKD treatment decreased during last decade. In past years our department was leading in PD area in our country. One of the reasons for decreasing numbers was catheter insertion technical problems. There was no dedicated surgeon for this procedure; therefore each patient underwent different techniques, which caused variation of post-operative complications such as: malposition, leaks, exit-site infection, haemorrhage, obstruction of catheter, catheter tip migration, malfunction, etc. This led to drop – out of patients from PD.
Objectives: Decreasing post-operative complications and technique failure by catheter insertion by nephrologists.
Methods: Since 2007 we started the implementation of peritoneal catheter insertion by nephrologists. The PD team learned the procedure from other medical centres that already succeeded. Both doctors and nurses beome acquainted with the patient: from evaluation for PD, than as a surgical team, and follow him at PD treatment. Exclusion criteria: previous abdominal surgery; infectious disease carriers; patients who needed general anesthesia.
Results: 82 catheters were inserted during 7 last years, 51 (62%) by nephrologist and 31 (38%) by surgeons. Retrospective analysis was performed of 35 available charts- 24 by nephrologist(N) and 11 by surgeons (S), other charts will be evaluated in the next step. Average age: N= 63.2, S=55.2 years. Postoperative complications: leak N=1(4%), S=9(81%); exit-site infection N=4(16%), S=3(27%); bloody fluid N=1(4%), S=6(54%).
Conclusion/Application to practice: Our experience showed that catheter insertion by nephrologists is better for the patient: less post-operative complications, local anesthesia, short recovery after operation, and more physically and mentally friendly for the patient.
Disclosure: No conflict of interest declared
O 06
Peritoneal dialysis for patients with urgent need for renal replacement therapy (RRT)
D. Hruba1, R. Knirova1, P. Gajdosova1
1Dialysis Center Sokolov, Fresenius Medical Care, Sokolov, Czech Republic
Background: Advantages have been reported for PD as preferred treatment rather than HD: Longer preservation of residual renal function, earlier onset of graft function after transplantation, and elimination of central venous cannulation risks in cases where dialysis is required immediately.
Objectives: To present our initial experience with urgent initiation of PD immediately after catheter insertion.
Methods: From May 2011 to December 2013 we used the combination of puncture and laparoscopic technique for PD catheter placement in 46 cases of PD patients. Seven patients required urgent initiation of renal replacement therapy.
Results: We performed acute automated peritoneal dialysis (APD) in seven patients in a special PD room in our dialysis centre for 6 to 9 hours a day. Every patient was constantly monitored by an experienced PD nurse.
Advantages:
1. Safe practices (using small volumes and APD in supine position): we did not observe any leakage or other catheter associated complications.
2. We did not observe any unpleasant symptoms associated with acute haemodialysis (dysbalance).
3. Better levels of compliance in new patients (all seven decided to continue PD).
Disadvantages:
1. This method is time-consuming for the dialysis team.
2. A suitable room must be provided for this treatment.
Conclusion/Application to practice: The advantages of peritoneal dialysis include longer preservation of residual renal function and no need for venous access.
Our experience shows that initiation of peritoneal dialysis immediately after catheter insertion is possible and safe. We believe it might be an alternative to acute haemodialysis generally used in patients with an urgent need of RRT.
Disclosure: No conflict of interest declared
O 07
Evidence and best practice-based educational program for peritoneal dialysis nurses
M. Bergjan1, C. Schaepe1, N. Dubisz2
1Institute of Health and Nursing Science, Charité - Universitätsmedizin, Berlin, Germany; 2Baxter Germany GmbH, Unterschleißheim, Germany
Background: Peritoneal dialysis (PD) requires patients to take an active role in therapy as they have to manage more than 90% of their care by themselves. Because PD therapy encompasses various educational challenges, nurses need to possess special pedagogical skills in order to enable patients to self-care. However, not all PD nurses have a pedagogical background and educational programs in Germany are mainly experience-based and not evidence- based.
Objectives: To develop an evidence and best practice educational program for PD nurses who train staff and patients.
Methods: Firstly, systematic literature reviews on nursing interventions (n=21) and educational interventions (n=18) in PD therapy were conducted to gain an overview of the current state of research. Secondly, a qualitative structural content analysis using deductive category and inductive subcategory application of five group interviews (n=20) with PD nurses was used to explore their experiences, strategies, challenges, and further needs in both patient and PD nurse education.
Results: The literature reviews show, for example, that PD nurses should foster patients’ self-management skills and counsel them to a greater extent on diet and physical activity. Empirical data show that patient education has to be highly individualised which requires specific assessment skills. PD nurses, who train both patients and staff, need to employ various teaching strategies and know how to adapt them to the needs of each individual patient.
Conclusion/Application to practice: The results of both steps were synthesized and form the foundation for a continuing nurse education program in renal care, which will be integrated in the PD-nurse training program by Baxter Germany.
Disclosure: This evidence-based and best –practice educational program is developed for Baxter Germany, which funded this project. However, Baxter Germany played no role in study design, data collection, and analysis of data.
O 08
A practical manual of peritoneal dialysis for nurses - Project based preparation
G. Fekésházi1, E. Ladányi1
1Fresenius Medical Care, Budapest, Hungary
Background: The nurses in our network have fifteen years of professional experience in peritoneal dialysis (PD). However, PD practice varies among clinics depending on local conditions. Thus, the idea was born to prepare a standardised practical guideline including the most important theoretical knowledge defining
- education standards for nurses and patients
- competence levels
- validated procedures during treatment
- an indicator system of professional nursing audits.
Objectives: To introduce the project “Practical Manual of Peritoneal Dialysis for Nurses”, prepare and implement the manual and evaluate the impacts of its implementation.
Methods: The project was launched in April 2012. Authors were four highly skilled and experienced PD nurses and two national head nurses. The authors’ consensus on the individually prepared chapters was followed by approval by medical professionals.
Results: The first edition of the final document was published in July 2013. From September 2013, regional audits were performed on the basis of this manual after evaluation of the professional nursing status.
Conclusion/Application to practice: The project based preparation of the “Practical Manual of Peritoneal Dialysis for Nurses” had largely simplified the work process. The document laid the foundations of the professional education, based on a standardised practice. It provided the opportunity of process monitoring, feedback management, implementation of improvements and standardisation of our processes.
Disclosure: No conflict of interest declared
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