S 13 Parallel Session

O 18
A nurse led clinical pathway for dialysis vascular access dramatically improves outcomes.
T. Ngcobo¹, D. Marquez¹, B. Al Kaddah¹, E. Suleiman¹, A. Delgado¹, M. Baguneid², M. Al Shehhi², M. Richards^1
1Nursing, SEHA Dialysis Services, Abu Dhabi, United Arab Emirates; ²Vascular Surgery, Al Mafraq Hospital, Al Mafraq, United Arab Emirates

Background: The gold standard for haemodialysis vascular access is an arteriovenous fistula (AVF). The use of indwelling dialysis catheters is associated with excess morbidity and mortality, and resulting central venous stenosis may preclude a successful AVF. In 2013 an AVF was present in 50% of dialysis patients within Abu Dhabi.
Methods: Following the appointment of a vascular surgery team, we established a multidisciplinary team (MDT) with a nurse leader. Analysis of the patient pathway identified numerous blocks to successful and timely access. A clinical pathway was developed to cover the entire Emirate which addressed these blocks through provision of clinics within the dialysis units, direct nurse referral to clinics, an appropriate needling strategy and timely removal of dialysis catheters.
Results: Six months following initiation of the pathway catheter use had fallen by 30%, the proportion of patients with AVF had increased by 22% to 70% overall and the catheter associated blood stream infection rate had fallen by 60%. Simultaneously mean dialysis blood flow rates increased from 324 to 360 ml/min and the % of patients achieving a spKt/V ≥ 1.4 increased from 73% to 87% (although some of this improvement may be related to changes in dialysis time). The annual cost saving associated with catheter locking solutions alone was 750,000 AED.
Conclusion/Application to practice: These data demonstrate that a nurse led MDT approach with a unified clinical pathway and appropriate resources can dramatically improve the provision of AVF for dialysis vascular access with long term clinical benefit to patients and financial benefit to the health economy.
Disclosure: No conflict of interest declared

O 19
Is home haemodialysis associated with reduced vascular access complications?
L. Haydanli¹, S. Cicek¹,G. Kaya Akay², F. Ozkan³, N. Caliskan⁴, C. Ceylan⁵, S. Arkac⁶, S. Erten¹, C. Demirci^2
1Sevgi Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ²Ege Nefroloji Center, Fresenius Medical Care, Izmir, Turkey; ³Kecioren Dialysis Center, Fresenius Medical Care, Ankara, Turkey; ⁴Bursa Dialysis Center, Fresenius Medical Care, Bursa, Turkey; ⁵Istanbul Dialysis Center, Fresenius Medical Care, Istanbul, Turkey; ⁶Aksaray Dialysis Center, Fresenius Medical Care, Aksaray, Turkey

Background: In-centre haemodialysis, vascular access management is a cardinal issue in home haemodialysis (HHD) patients.

Objectives: To determine the distribution of vascular access (VA) types and fistula cannulation techniques and the association between socio-demographical characteristics and VA complications.
Methods: Between April 2010 and June 2013 we evaluated demographic and VA data from 153 patients from 30 centres on HHD (most of them three times / week).
Results: Mean age was 42.5±12.5 years, 30.7% were female, 13.7% were diabetics and mean follow-up was 13.8 months. 56.2% finished primary school and 43.4% graduated from middle/high school or university. 85.6% received treatment via arteriovenous (AV) fistula, 3.3% via AV graft and 11.1% via catheter. The buttonhole technique was used in 57.4% of the fistulas; rope-ladder in 33.8%, and area technique in 8.8%. During the follow-up, we observed 25 events (loss of fistula or graft or revision) in 23 of a total of 136 patients (15.9 events/100 patient years). Suriet al. recently reported higher VA event rates: in 3 times/week in-centre HD (23/100 patient years) and nocturnal HHD 6 times/week (58/100 patient years).
Diabetic patients showed a tendency for increased vascular access problems (p=0.12). There was no apparent correlation between VA complications, socio-demographical parameters, and cannulation technique.
Conclusion/Application to practice: HHD patients had less AV fistula/graft revisions and loss as compared to patients receiving conventional dialysis or by frequent HHD, recently reported in literature. However, the high events rates reported for frequent HHD may partly be due to a higher frequency of vascular access connections.

Disclosure: No conflict of interest declared

O 20
Teaching self-cannulation - A way to autonomy
M. Agostinho¹, R. Pinto¹, A. Seabra¹, J. Fazendeiro Matos², M.T. Parisotto^3
1NephroCare Dialysis Centre Coimbra, Fresenius Medical Care, Coimbra, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal; ³NephroCare Coordination , Fresenius Medical Care, Bad Homburg, Germany

Background: Introduction of the needle is very stressful for dialysis patients, due to lac of control and association with pain. Needle fear does not mean that the patient is weak. Self-cannulating patients learn to overcome these fears and become actively involved in their care. The NKF-DOQI 2000 recommends: “Patients who are capable and whose access is suitably positioned should be encouraged to self-cannulate. The preferred cannulation technique is the buttonhole.”Objectives: To develop a programme for patient self-cannulation.
Methods: The teaching program was based on:
1. Pre-cannulation education to help patients overcome their needle fear.

2. Tandem-hand cannulation, i.e. guided help in learning how to cannulate.
3. Touch cannulation, i.e. a method of holding cannulation tubing for better control.
Results:We started the study with a pilot phase with one patient. The selected patient was a 32 year-old women who ahd undergone 8 months of cannulation using the buttonhole technique.

One month after the beginning of the programme, the patient had achieved the minimum requirements to perform the technique of self-cannulation.
After the first autonomous cannulations, the patient reported less pain on puncture and - most importantly - less fear of the needle insertion.
Conclusion/Application to practice:By self-cannulation patients don´t have to rely on their nurses, but take responsibility of their care and control of their lives. After introduction of autonomous cannulation our patient reported less pain and fear and more self-confidence. Considering the results reported in literature and our first observations, we would like to further explore and spread this method.
Disclosure: No conflict of interest declared

O 21
Prevention and delaying progression of chronic kidney disease
I. Amer^1
1Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates

Background: Estimated prevalence of chronic kidney disease in the world is about 380 million in 2013. The most recent report of the United States Renal Data System estimates that nearly one-half million patients in the United States were treated for End Stage Renal Disease in the year 2004, and by 2013 this figure increased by approximately 40%.  People on renal replacement therapy will reach about 2.5 million by 2013. More than 80% of  patients live in the developed world, because in developing countries it is largely unaffordable. Moreover there are a lack of facilities for early detection, prevention and treatment of chronic kidney disease.

Objectives:
Objectives are to:
• Describe the incidence and state of chronic kidney disease.
• Highlight the related patient, family and staff educational program.
• Describe the plan for prevention and slowing the progression of the disease.
• Identify ways that community can help to reduce chronic kidney disease.
Methods: Individualized and group, patient and family education programs through a multidisciplinary team approach.
Results
1. Patients awareness about the disease process has been enhanced.
2. Quality and continuity of care enhanced.
3. Knowledge and skills for self-care enhanced.
4. Better lifestyle.
5. Psychosocial conditions improved.
Conclusion/Application to practice:Chronic kidney disease is very common and expensive. Knowledge is power for the healthcare professionals and customers. The highest form of preventive measures is by educating patients, relatives, care givers and the community to make lifestyle changes to improve their health and quality of life.  Knowledge empowers patients awareness to slow disease progression, and to feel more safe and relaxed during anxiety producing situations  as their disease progresses.
Disclosure: No conflict of interest declared

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