Background Haemodialysis is a treatment option for end-stage kidney disease (ESKD). A functioning long-term vascular access (VA) is essential for effective treatment; however, cannulation of an arteriovenous fistula or arteriovenous graft for haemodialysis can be challenging for patients and staff alike and may result in cannulation trauma if not cannulated properly.
Method We used a scoping review methodology to evaluate the current literature regarding cannulation practices in haemodialysis. This method is systematic and rigorous and allows rapid summation of research and identification of gaps in knowledge.
Results This review ascertains the primary cannulation techniques used in practice, examines the limitations of these, highlights assistance devices which may support cannulation, and identifies the incidence of cannulation difficulties and contributing factors which may inhibit successful cannulation.
Conclusion This review demonstrates that there are three main types of VA – arteriovenous fistula, arteriovenous graft and central venous catheter (CVC). The cannulation techniques used when accessing an arteriovenous fistula or graft are well defined as rope-ladder, buttonhole and area cannulation, with cannulation complications a recognised adverse event. We highlight the ideal conditions to support cannulation success, with maturation of a VA aiming to adhere to the rule of 6s. This review also highlights the alternative of single needle treatment for new and developing arteriovenous fistulas, and the positive contribution of ultrasound devices as a tool to support cannulation. However, limited evidence exists on the actual incidence of cannulation success rates in Australia and New Zealand and further research is needed to explore this.
Extensive chronic tinea corporis (EC-TC) is common in people living in tropical environments and in individuals living with diabetes and chronic kidney disease (CKD). However, adults with end-stage kidney disease (ESKD) who seek kidney transplant (KTx) wait-listing require an infection-free medical clearance. Australian clinical care guidelines suggest tinea corporis is cured by antifungal treatment within 2 weeks in the general population, but there are no specific treatment guidelines for adults with severely reduced kidney function who require haemodialysis.
Aim To describe factors contributing to delayed KTx wait-listing in a patient with EC-TC.
Method: We undertook a case review to address both treatment response for EC-TC for a 43-year-old female with a history of diabetic nephropathy following haemodialysis initiation, and the time it took for her to achieve KTx wait-listing. Follow-up interviews with the client and supporting clinicians were completed in order to learn more about individual perspectives of care.
Results We observed cure of EC-TC on day 394, and achievement of KTx wait-listing on day 496. The treatment algorithm used to achieve cure involved extended courses of oral terbinafine (250 mg post-dialysis three times weekly, partial response) and oral fluconazole (cure within 3 weeks; 100 mg weekly at dialysis). Holistic care during KTx work-up was valued by the patient.
Conclusion Delayed cure of EC-TC contributed to delayed KTx wait-listing. The in-depth interviews therefore identified healthcare innovations to assist systematic identification and treatment initiation for EC-TC. Furthermore, specific research to improve the treatment response is recommended.
Background Promoting exercise and physical activity is crucial to people with chronic kidney disease (CKD). This review aims to identify patients’ perceived barriers and motivators to facilitate exercise participation.
Method English language, peer-reviewed papers published electronically between January 2000 and October 2018 were considered for review. Patients with chronic kidney failure aged 18 years or older were included, but those with acute kidney injury were excluded.
Results People with CKD viewed exercise or physical activity as beneficial and believed in their capability of participation. Fatigue, lack of motivation and safety issues were the main barriers identified, whereas internal drive of health improvement or self-efficacy promotion, and the support from family, friends, peers or the healthcare professional were the commonly reported motivators.
Conclusion People with CKD want to maintain physical function and understand the importance of exercise. A multidisciplinary team approach is therefore required to maintain effective exercise programmes that promote physical function. Staffing issues and workload need to be evaluated to incorporate an exercise promotion programme into routine clinical practice. Furthermore, involving patients, family and friends in the development of an exercise promotion programme is crucial to ensure both effectiveness and sustainability. Additionally, it was determined that the elderly and those people with less confidence or low self-esteem will need more encouragement and support to promote participation. In summary, an intradialytic exercise (IDE) programme may be possible but needs further research to address its safety issues, and must include the use of technology to provide ongoing support.
The complexity of care for renal transplant recipients when they are admitted to hospital presents many challenges for nurses. With their immunocompromised state and exacting medication requirements, these patients are encouraged to have a strong sense of independence and responsibility for their own health, and therefore have high expectation of the nurses managing their care.
Motivated by the lack of documented nursing perspectives and in response to patient experience studies, this quality improvement project aimed to understand nurses’ experience of caring for a renal transplant recipient when they are admitted to a renal ward, as well as to evaluate the effect of three specific education interventions on their experience, namely renal transplant in-service education sessions, a self-directed renal transplant learning package, and renal replacement therapy (RRT) cheat sheets.
The project surveyed nurses twice over a 6-month period. The baseline survey established participant demographics, their levels of comfort and confidence with renal transplant recipients, and their transplant-specific knowledge. The second survey at the end of 6 months remeasured the nurses’ levels of comfort and confidence and also addressed their perceptions of the effectiveness of the three educational interventions.
The project showed that nurses looking after renal transplant recipients did not always feel they had the necessary skills to care for them. In addition, while the three educational interventions were effective in increasing knowledge, they did not increase the nurses’ comfort nor confidence in dealing with renal transplant recipients. The study therefore concluded that providing nurses with opportunities to expand their knowledge – for example through role-modelling by senior nurses and increased and open communication channels – can support them when caring for renal transplant recipients who are admitted to hospital.