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S 21 Parallel Session

Title: Care of the child with end stage renal disease
Monday, September 8, 9:00 – 10:30

Programme of the session:

GS: Dr Gianoglio
Dietetic approach in children undergoing chronic dialysis towards kidney transplantation

O 38
CARPEDIEM as promising machine to treat neonatal and paediatric patients with acute renal failure

Martine Dick (Belgium)

O 39
Haemodialysis ultrafiltration rate: impact for the multidisciplinary team of focused communication on patient-centred care

Hanne M. Hermansen (Denmark)

O 40
Patient’s experience of kidney biopsies obtained by interviews. Nursing aspects

Yvonne Andersson (Sweden)

O 41
Treatment on time

Helder Araujo (Portugal)


Dietetic approach in children undergoing chronic dialysis towards kidney transplantation

B. Gianoglio1
1Pediatric Nephrology, Dialysis and Kidney Transplantation , Regina Margherita Children's Hospital, Torino, Italy

Conclusion/Application to practice: Children treated by chronic dialysis are particularly vulnerable to the consequences of malnutrition. A delayed growth started in early childhood, can be scarcely recovered  even in later life.
Often the protein-energy malnutrition manifests itself not only with growth retardation but it can hinder the inclusion in a program of renal transplantation that remains the most effective therapyDifferent actors play a role in the complex mechanism of growth retardation: severe anorexia, vomiting, gastro-oesophageal reflux, metabolic acidosis, renal sodium dispersants, altered gastrointestinal motility, state of psycho-social deprivation.
In children with chronic kidney disease, the delay in growth and the worsening of general condition are the main signs to start enteral nutrition as suggested by pediatric nutritional guidelines. The intensive nutritional approach should always be established early and technically can benefit both the use of the nasogastric tube that gastrostomy.It's known as the height-weight growth recognize in the caloric intake the driver almost unique in the first two years of life while in later years  a secondary role is played by hormonal stimulation. However, the early nutritional intervention is important for all ages, having a significant impact not only on the linear growth but also on indicators of long-term survival as the serum level of albumin.
Finally, it is very important to consider that also the period following to a well-functioning kidney transplantation needs again great effort to optimize  the food intake.

O 38
CARPEDIEM as promising machine to treat neonatal and pediatric patients with acute renal failure

M. Dick1, S. Claus1, A. Dhondt1, A. Raes2, J. Vande Walle2, S. Eloot1
1Nephrology, Ghent University Hospital, Gent, Belgium; 2Pediatric Nephrology, Ghent University Hospital, Gent, Belgium

Background: Among neonatal and pediatric patients admitted on intensive care unit, 8-20% develop renal failure. With the current hemodialysis machines, non-accurate weight loss and large extracorporeal blood volumes imply important risks. Recently, CARPEDIEMTM (Bellco, Italy) has become available for Slow Continuous Ultrafiltration (SCUF) or Continuous Veno Venous Hemofiltration (CVVH) pre or postdilution, in neonatal and pediatric patients from 2.5 to 10kg.
Methods: Three roller pumps guarantee accurate flows (1mL increments) for blood (2-50mL/min), infusion (0-1000mL/h), and ultrafiltration (0-1000mL/h). Fluid balance is controlled by infusion and effluent scales (accuracy 1g). At present, 3 kits are available: HCD0075/015/025 with a polysulfone dialyser of 0.075/0.15/0.25m² and 27/33/41mL priming volume, and a maximum ultrafiltration of 2.5/4/17mL/min.
Results:In our hospital, we successfully treated 2 patients of whom we discuss here one in detail: male child of 14 weeks, 5.2kg with multiple organ failure and cytomegalovirus infection. A right jugular 6.5Fr double lumen catheter (Gambro, Sweden) was inserted. With an estimated total blood volume of 80mL/kg body weight, and keeping extracorporeal volume below 10% of this, the HCD025 kit was used. The kit was primed with albumin (SOPP 4%). A bolus of heparin (150IU) was given at start and continuously during the session (75IU/h). Predilution hemofiltration (total infusion 6.5L) was performed during 10h with blood flow of 20-30mL/min, and ultrafiltration of 280mL.
Conclusion/Application to practice: In conclusion, CARPEDIEMTM is a promising machine to treat pediatric and even neonatal patients with renal failure.

Disclosure: No conflict of interest declared

O 39
Haemodialysis ultrafiltration rate: impact for the multidisciplinary team of focused communication on patient-centered care

H.M. Hermansen1, M.S. Ludvigsen1, M. Lindberg2,3
1Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; 3Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

Background: Empirical evidence suggests that rapid fluid removal influences patient outcome negatively. Since most haemodialysis units do not have on-site nephrologists, nurses initiate, monitor, and complete the dialysis treatment as well as manage any adverse events. Thus, patient outcome may be considerably influenced by the quality of nursing care. The ultrafiltration rate could be used to estimate quality of nephrology nursing; the rate should not exceed 10 ml/h/Kg. Results from a Scandinavian haemodialysis centre indicates that particular attention should be addressed to the younger haemodialysis population as well as patients with low body weight as they  tend to be predisposed to excess ultrafiltration rates during haemodialysis. However, patients may be reluctant to adhere to longer dialyses sessions.
Objectives:How focused communication about recommended ultrafiltration rates contributes to patient-centered haemodialysis care.
Methods: Results from the Scandinavian haemodialysis study will be outlined. Secondly, examples will be used to discuss challenges for the multidisciplinary team when they introduce  longer dialysis sessions.
Conclusion/Application to practice:The ultrafiltration rate is a global process indicator in renal nursing, and we will use the conference to initiate a debate regarding implications for haemodialysis nursing practice when adhering to current ultrafiltration rate recommendations.
Disclosure: No conflict of interest declared

O 40

Patient’s experience of kidney biopsies obtained by interviews: Nursing aspects
Y. Andersson1, B. Peters1, B. Olofsson2, B. Stegmayr3, H. Hadimeri1
1Department of Nephrology, Skaraborgs Hospital, Skövde, Sweden; 2Department of Nursing, Umeå University, Umeå, Sweden; 3Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

Background: Project “Clinical complications and risk factors in native and transplant kidney biopsies in Sweden” was started in 2006. If the patient is well informed, maybe the risk of complications decreases.  The aim of this study was to clarify how patients experience the process of kidney biopsies.
Methods:New documents were designed and patients received a written information letter two weeks before, describing the biopsy process. Oral information by physician and nurse was given at admission. A protocol for registration of various factors and complications associated with biopsies was used. Seven patients were telephone interviewed two weeks after biopsy.
Results: Six of seven patients expressed that they were "well informed", received the information letter in time and felt it was easy to read and understand. The patients were informed again by nurses and physicians on ward and at x-ray department. All seven patients felt they were "well informed" by all. About the feeling of pain during and after biopsy, five patients had "no pain", and two "mild pain". Six of seven patients rated that they were “very well“ taken care of, one rated it as "good". Two patients experienced that the noise of biopsy gun was unexpectedly loud.
Conclusion/Application to practice:In the biopsy process different specialties and personal categories are involved. Lack of routines and follow up can lead to an increased risk for the patient in this potentially dangerous procedure. With our new documents and routines we hope to reduce the frequency of complications. A change in the routine was made based on outcome.
Disclosure: No conflict of interest declared

O 41

Treatment on time
H. Araujo1, A. Lino1, C. Pissarra1, A. Bernardo1, J.M. Montalban1, R. Peralta2, J. Fazendeiro Matos2, M.T. Parisotto3

1NephroCare Dialysis Centre Covilhã, Fresenius Medical Care, Covilhã, Portugal; 2NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal; 3NephroCare Coordination, Fresenius Medical Care, Bad Homburg, Germany

Background: Planning of resources and needs in healthcare provides a strategic framework, taking into account the particularities of the individual patient in a centralized model.
• To increase patients’ satisfaction with regard to treatment schedules.
• To increase efficiency of care provided to haemodialysis patients.
Methods: The implementation of this project began with a characterization of all patients in the unit, their places of origin and their means of transport. To ensure success and adequacy of scheduling, patients were questioned individually about their needs and preferences. After that, pros and cons were assessed from patient and nurses perspectives.
Results: We evaluated the impact of our intervention in three dimensions: Patient and nurse satisfaction and efficiency in resource management.
Patients: 95% reported that they were satisfied with the new treatment schedule and that they would recommend it to other dialysis units due to the following reasons: Less waiting time before and after treatment, less confusion at the entrance into the treatment room.
Nurses: Positive: Better organization of their work, less conflicts between patients and with patients and increased efficiency of care. Negative: Lower influence of nurses on dynamic controls and workflows.
Efficiency in resource management: Overall gain of time at the end of the treatment day was an average of 13 minutes (22:56 vs. 22:43). Compliance with the scheduled connection time, 82.5%, treatments were started in the target time interval.
Conclusion/Application to practice:The implementation of a connection schedule enhances patient and nurse satisfaction as well as treatment efficiency.

Disclosure: No conflict of interest declared

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