- 1A: The effects of a mindful self-compassion (MSC) 8-week course on nephrology nurses’ levels of self-compassion, burnout, and resilience
- 1B: Lived experiences of the transplant journey: Learning from patients and families
- 1C: Empowering patients through shared care/self-cannulation
- 1D: The role of the renal perfusionist
- 2A: The collaborative practice approach of SLED treatments in an ICU setting
- 2B: Being a Pancreas is hard work: Diabetes post-transplant
- 2C: What is wrong with this picture: The hemodialysis patient fells faint, yet the blood pressure is elevated?
- 2D: Immunosuppressant Medications for Glomerulonephritis
- 3A: Introducing a coaching program to optimize resiliency and agility peri- and post-pandemic to renal staff: An advanced practice fellowship
- 3B: Long Term Outcomes after Kidney Donation
- 3C: Collective consensual analysis: Sharing learning and insights from an Indigenous kidney health research initiative
- 3D: Home hemodialysis technology
- 4A: Cultural Sensitivity Indiginous Community
- 4B: Transplant Tourism
- 4C: Implementation of a new hemodialysis central venous catheter dysfunction and administration of Cathflo® (Alteplase) protocol
- 4D: Introduction to Geriatric Nephrology: Improving Care for Our Elderly Patients
- 5A: Water Treatment: From Out of Line to Online
- 5B: An Update on Assisted Peritoneal Dialysis
- 5C: Hyperphosphatemia in CKD and Dialysis
- 6A: Getting to Peritoneal Dialysis
- 6B: Diagnosis and Management of Chronic Limb Threatening Ischemia
- 6C: Understanding CKD-Associated Pruritus: From Physiology to Management
- 6D: Beyond the Blood Test: Mental Health Concerns of ESRD Patients and Tips for Frontline Workers
- 7A: CNS Palliative Care
- 7B: Living kidney donation: The preferred treatment option for CKD patients
- 7C: Hemodialysis orientation week: It takes a village
- 7D: The Older Donor
- 8A: A multifaceted peritoneal dialysis training program for nurses
- 8B: Simultaneous Islet Kidney (SIK) Transplant
- 8C: The Nurse-Tech Model of Care. The PB & J of Dialysis at St-Joseph’s Healthcare Hamilton
- 9A: Guiding best practice: Routine use of ultrasound in hemodialysis is important to optimize health, function, and longevity of the AV fistula/graft
- 9B: The etiology and classification of bloodstream infections among patients receiving dialysis at long-term care facilities in 2020-2022
Jacqueline Crandall, RN(EC), PhD, CNeph(C)1,2,3,4
Lori Harwood, RN(EC), PhD, CNeph(C)1,2,3
Barb Wilson, RN(EC), MScN, CNeph(C)1,2,3
Catherine Morano, MSW, RSW1
1Renal Care Program, London Health Sciences Centre, London, Ontario (retired)
2Lawson Health Research Institute, London, Ontario
3Arthur Labatt School of Nursing, Western University, London, Ontario
4King’s University College, London, Ontario
Purpose: Caring for individuals with chronic kidney disease can place nurses at risk for emotional exhaustion and burnout. This study explored the effects of Germer and Neff’s MSC 8-week course on nephrology nurses’ self-reported levels of self-compassion, resilience, and burnout.
Method: Using a mixed methods design and after ethics approval, nurses working in an urban renal program were recruited. Upon consent, participants completed a demographic questionnaire followed by a survey at three time points (pre-, post-, and 3-month post the MSC training). The survey contained five validated instruments: (1) Neff Self-Compassion scale; (2) Professional Quality of Life scale; (3) Freiburg Mindfulness Inventory; (4) Maslach Burnout Inventory; and (5) Conner-Davidson Resilience scale. A focus group explored nurses’ experiences of the MSC training.
Results: Twelve nurses enrolled in the study, and eight completed all surveys. Results indicated that the MSC training significantly increased nurses’ levels of self-compassion and resilience, while decreasing levels of burnout. The focus group revealed the central theme of enhanced resilience, while subthemes included creating a community of support, awareness and discovery, and the mastery of the techniques.
Conclusions: In the midst of the COVID-19 pandemic, the MSC training was an effective intervention to gain essential skills for building and maintaining self-compassion and resilience; skills integral to maintaining an effective workforce.
Implications for Nephrology Care: Ensuring a strong nursing workforce is critical to the quality of nephrology care given now and in the future. The MSC training is one example of how leadership can facilitate good self-care among staff.
Sandra Davidson, RN, PhD, FAAN, FCAN1
Kristi Coldwell, BA, CCLS2
Carrie Thibodeau, BSc, BA3
Danielle Fox, RN, MN, CNeph(C)1
Marc Hall, MSc, CCRP1
Lydia Lauder, BN3
Sarah Dewell, RN, PhD4
1University of Calgary, Calgary Alberta
2Transplant Research Foundation of British Columbia
3Kidney Foundation of Canada, Montreal, Quebec
4University of Northern British Columbia, Prince George, British Columbia
Background: The Organ Donation and Transplantation (ODT) system is a complex network of organizations and health authorities. This creates challenges and barriers for patients to navigate the transplant journey and advocate for themselves.
Purpose: 1. To illuminate the patient lived experiences of the Organ Donation and Transplantation (ODT) system in Canada.
2. To identify the needs of donors, recipients, and caregivers within the ODT system and make patient-led and patient-focused recommendations to improve it.
Methods: This convergent parallel mixed-methods stud, captured data from patients and family caregivers across Canada through eight focus groups (n=20) and an online survey (n=944). Survey and focus group questions were co-created with members of a national Patient/Advocate Advisory Committee. Focus group transcripts and open-ended narrative responses were analyzed using an inductive content analysis approach. Survey data was analyzed using descriptive statistics.
Results: The following overarching themes emerged: (1) More Holistic Person-Centered Care; (2) Improved Access to Accountable Care; (3) Collective Impact of Transplant Journey on all Facets of Life; (4) Navigating Uncertainty; (5) Importance of Connection; and (6) Advocacy. Five opportunities for improving the ODT system were identified: (1) enhancing mental health support; (2) establishing formal peer support programs; (3) improving continuity of care; (4) improving knowledge acquisition; and (5) expanding access to financial support and other needed resources.
Conclusions: Based on the findings of this study recommendations will be socialized to all levels of government thus informing future ODT system transformation to better meet the needs of the patients.
Implications for Nephrology Practice/Education: Nephrology nurses play a vital role in the holistic care of patients undergoing transplantation. The results of this study will support nurses and other healthcare providers to optimize and individualize care for patients. This knowledge could be further leveraged at a health systems level to improve patient-centered health services delivery for those undergoing kidney transplantation.
Lilla Ploszaj, RN, CNeph(C)1
1Vascular access coordinator, Scarborough Health Network, Scarborough, Ontario
Background: The Scarborough Health Network vascular access team and nursing staff from our in-facility and satellite programs were able to recognize that patients wanted to become more involved in their access assessment, preparation, and cannulation for initiating dialysis. In vascular access, important components of the shared care model are: access preservation, access assessment, and cannulation. Patients are assessed for suitability and encouraged to be active participants in the management and care of their accesses for hemodialysis.
Description: Since February 2019, 11 patients have learned different tasks related to shared care (e.g., AV fistula assessment, infection prevention, and preparation for rope ladder or buttonhole technique self-cannulation). Three patients dropped out as they did not wish to continue, and one patient received a transplant. One patient was unsuitable due to vision impairment.
Results: By implementing shared care/self-cannulation, the renal program has seen enhanced patient satisfaction such as during educational forums where the patients openly speak about their experiences. Encouraged by their progress, patients are also taking a more active role in various patient committees where they promote self- cannulation and self-empowerment.
Conclusion: The ability to self-cannulate can increase a patient’s confidence and offers them a greater sense of control over their treatment. It is important to involve patients and their families to learn shared care tasks, which allow them to become drivers of their care. Through patient empowerment, they can advocate for themselves, inspire others, reinforce proper technique, and help preserve their own vascular “lifelines.”
Jeffrey Bellenie , Senior Technologist1
1St. Joseph’s Healthcare Hamilton, Hamilton, Ontario
Since the inception of the St. Joseph’s Healthcare, Hamilton (SJHH) dialysis technical department, it was quickly recognized throughout the hospital that the technologists were very capable and proficient at many different skills. The hemodialysis technologists at SJHH are utilized by many departments within the hospital including the maintenance of water treatment systems in other departments. The comprehensive skills of the nephrology technologist have allowed the techs to guide their way into further clinical capacities such as clinical technologist and the role of the renal perfusionist.
The purpose of this presentation is to showcase the role of the renal perfusionist in a multidiscipline allied healthcare team. The renal perfusionist is trained to facilitate in the procurement of donor kidneys. The presentation is intended to bring to light the skills and knowledge that perfusionist brings to the multi-disciplinary healthcare team. Adherence to all Health Canada standards, methods of procurement, equipment and supplies used, will all be part of the presentation.
The outcomes of having highly trained versatile staff with experience has served the department well. We are able to liaison effectively with the urology surgeons, communicate in timely manner with the recipient coordinators, renal transplant unit and operating room to ensure a positive experience for the recipients and their families while delivering the best possible patient care. The versatility of the SJHH nephrology technologist is unrivaled by any organization to my knowledge. The achievements of this group and their proven track record will surely guide the profession into taking on further roles and responsibilities in the future as healthcare needs will continually grow.
Siva Kanthasamy, RN, BA, CNeph(C)1
1Nephrology Program, University Health Network Toronto General Hospital, Toronto, Ontario
Purpose: This presentation will demonstrate the shared-care responsibilities between hemodialysis nurses and intensive care unit (ICU) nurses during the provision of daily Sustained Low Efficient Dialysis (SLED) treatment in ICU.
Background: Continuous Renal Replacement Therapy (CRRT) previously has been regarded as superior by ICU practitioners largely in part due to the amount of convective clearance achieved and the ability to administer treatment independently of nephrology services. SLED is an increasingly popular renal replacement therapy for patients in the ICU. SLED has been reported to provide good solute control and hemodynamic stability. SLED as a treatment option has been developed as a conceptual and technical hybrid between CRRT and intermittent hemodialysis (IHD) for patients with cardiorenal syndrome and advanced heart failure.
Nephrologists developed new acute orders set to support transition of the patient from SLED to IHD, ordering parameters including: (1) reduced rate of ultrafiltration for optimized hemodynamic stability; (2) low-efficiency solute removal to minimize solute disequilibrium; and (3) sustained treatment duration to maximize dialysis dose.
Description: During SLED, blood is filtered through countercurrent dialysis flow at 300mL/min and hemofiltration flow at 200mL/min for varying durations (8, 10, 12, or 24 hours) on a daily or alternate-day basis. All aspects of SLED are handled by hemodialysis nurses before transitioning care to ICU nurses. ICU nurses are responsible for monitoring and adjusting clinical parameters, patient outcomes, and solute levels.
Evaluation: SLED was studied in critically ill acute renal failure patients. The patients did not experience any episodes of intradilaytic hypotension or other complications.
Implications: SLED has important implications for improved nurse and patient outcomes. SLED can lead to workload reduction for ICU nurses, improved patient safety, significant cost savings, and increased flexibility in the patients’ schedules to accommodate other vital therapies such as physiotherapy.
Judy Ukrainetz, RN, BN, CNeph(C)1
Breanne Linttell, RN2
Branko Braam, MD, PhD3
1Alberta Health Services, Alberta Kidney Care North, Edmonton, Alberta
2Covenant Health, Alberta Health Services, Edmonton, Alberta
3University of Alberta, Edmonton, Alberta
Background: Hypertension and hypotension importantly predict cardiovascular outcomes in hemodialysis patients.
Purpose: A hemodialysis patient reported she felt like fainting during a hemodialysis session, while the BP was elevated. This triggered a multi-level analysis of its background.
Description: Our case study involves a 64-year-old female patient dialyzing three times per week for four hours. A single standing BP was 176/71 mmHg and a single sitting BP 169/67 mmHg – she was talking during the measurements answering the nurse’s questions. The BP cuff was too large related to the arm circumference and taped in place because the Velcro was not functioning. Home systolic BP readings ranged from 110–130 mmHg while the hemodialysis machine recorded SBPs between 180-200 mmHg. An additional antihypertensive was prescribed and the target weight was lowered. The patient experienced hypotensive symptoms during hemodialysis, but the BP remained high. Multiple manual BP readings taken by a nephrologist and an RN, not part of the hemodialysis team, averaged 110/54 mmHg. Korotkoff sounds during manual readings were incorrectly identified by the patient’s nurse. Only one manual device out of five in the HD unit was functioning.
Evaluation/Outcome: This analysis revealed technical issues with BP assessment, indicating a discrepancy between a measurement with an oscillometric and manual device. At a higher level, this pointed at educational gaps for the nursing staff regarding BP assessment. Inconsistent BP measurement technique, and a lack of standardization of BP measurements and calibration of devices, contribute to the variability of BP readings in hemodialysis patients potentially affecting patient cardiovascular outcome.
Implications for Nephrology Practice/Education: This single observation indicates that BP assessment in hemodialysis units is addressed in a systematic way regarding equipment issues, knowledge gaps, and correct BP measurement technique.
Julie Ann Lawrence, RN(EC), MScN, CNeph(C)1
1Nurse Practitioner, Renal Program, Kidney Care Centre, London Health Sciences Centre, London, Ontario
The impact of the pandemic on all stakeholders and clients is obvious. Certainly, the impact on nurses, allied health, and leaders playing pivotal roles in an arena where clients face multi-morbid conditions can deepen holistic exhaustion and suffering of the team every day. Purposeful coaching can shift individual and group dynamics from catabolic to anabolic energies, thereby enhancing engagement, satisfaction with work/life balance, and work relationships. Consciously shifting from a mindset of suffering, exhaustion, and mental anguish to one dedicated to wellbeing, exceptionalism, happiness, and optimism, can widen one’s perception of reality that is based in more positivity. Volatility, complexity, uncertainty, and ambiguity (VUCA) within health care may not change. Yet, as individuals and teams, we can learn to respond in a more anabolic manner that serves to enhance self- and team-preservation while also striving for excellence. How can we thrive instead of just survive? With this as the vision (purpose), an Advanced Practice Fellowship was granted to implement a coaching program to pilot and explore this manifestation. Research has demonstrated that those who manifest optimism and are informal influencers, may in turn positively impact teams. When teams are stronger and more effective than the sum of their parts, outcomes include individuals and teams with vigor, resilience, and positive energy. Formal coaching programs are leading edge interventions in countries outside of Canada, yet these are quickly gaining traction within organizations to enhance pandemic recovery. The implication for renal programs may include coaching models to reduce turnover and burnout of staff, while enhancing retention and recruitment.
Mary Smith, PhD1
Jovina Concepcion Bachynski, MN-NP(Adult),2 CNeph(C), PhD Student3
Vanessa Silva e Silva, RN, PhD4
1Volunteer for the Beausoleil First Nation’s Kidney Program; Principal Applicant for the Kidney Foundation of Canada’s funded research, Circles towards Indigenous solutions for kidney health: A strength-based approach, May 2019-June 2022
2Nurse Practitioner, University Health Network, Toronto General Hospital, Toronto, Ontario
3Queen’s University, School of Nursing, Kingston, Ontario
4Assistant Professor, Brock University, Department of Nursing, St. Catherines, Ontario
Background: The collective consensual data analytic procedure (CCDAP) is described as a methodology to engage community and further kidney health.
Purposes: We describe the research, Circles towards Indigenous solutions for kidney health: A strength-based approach, in relation to its methodology, CCDAP. We depict CCDAP and the processes involved from inception to training to implementation. The intent is to further understand CCDAP and its relevance within research for Indigenous people experiencing kidney disease.
Method: Living experiences from interviews and groups were transcribed verbatim. The data underwent thematic analysis, breaking down the chunked data into minor themes and keywords phrases (KWPs) on PowerPoint slides. The KWPs were read out load and placed on the Microsoft Excel horizontally under major theme headings determined by group consensus. Fifteen themes were identified.
Results: We depict the impact of COVID-19 on the community and travel associated with off-community dialysis and the importance of culturally safe care. For example, one participant reported that “a lot of tests” were booked but had to be delayed because of COVID-19. The impact of the pandemic was evident in more than half of the themes. Another participant spoke to the hardships associated with hemodialysis travel, stating that “it takes so much effort for them to travel back and forth.”
Conclusion: The research and methodology need to be consistent with relational community goals with outcomes to contribute to the betterment of the community.
Implications: The implications for nephrology care embrace the potential of the CCDAP methodology to engage Indigenous communities within all phases of the research towards improving kidney health care with Indigenous people.
Jeffrey Bellenie , Senior Technologist1
1St. Joseph’s Healthcare Hamilton, Hamilton, Ontario
The intent of this abstract is to showcase the scope of practice and innovative technologies that are used in the St. Joseph’s Healthcare, Hamilton (SJHH) nephrology technical department. We are proud to present that we incorporate several aspects of care that we believe are unique to the SJHH program. Furthermore, we would like to demonstrate how the use of new technology is allowing us to care for our patients now and will guide us into the future.
The general talking points for our presentation/poster will be about specific details about the SJHH program. Such details will include our geographic service area, methods of home installation and set-up, patient education administered by the home dialysis technologist and patient support systems just to name a few. More specifically we will present the development and utilization of our local downloadable monitoring system which was designed within the SJHH technical department. The purpose of this endeavor was to secure a method of observing the dialysis machine function intradialytically while not physically present at the patient’s home. The result is a system where we can download logging parameters and view treatment specific information. The outcome has shown us that we can confirm detailed disinfection history, dialysis frequency and many operational parameters which can help the technologist troubleshoot the machine.
Using technology to help guide us into the future is an encouraged philosophy and is practiced within the SJHH technical department and promoted in our departmental culture. The changes of today will help implement the use of further technologies that will aide in providing the best patient care quality and experience.
Leora Wanounou, MN-NP, CCN(C)1,2
Kathleen McIntosh, RN, CNeph(C)1
Sadie Webster, RN1
Elizabeth Poisson, RN1
1Hemodialysis Unit, Kidney and Metabolism Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario
2Adjunct lecturer, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
In the hemodialysis unit at St. Michael Hospital (SMH) in Toronto, Ontario, our team noticed a rise in the use of Alteplase, which therefore led to a rise in the amount of money the unit spent on this medication. To help streamline the use of Alteplase, an algorithm and protocol was created and implemented. In order to create the protocol, one of the unit nurse practitioners worked with the Vascular Access Nurses (VACs) and the medical director of the hemodialysis unit. After conducting a literature review and seeking out protocols from other hemodialysis units, the team created an algorithm that the hemodialysis nurses could follow and administer Alteplase prn as per protocol.
In the years prior to the creation of the protocol, the hemodialysis unit was spending an average of $22,300 per month, with a high of $33,000, on the medication. Since the implementation of the protocol in July 2021, Alteplase use and cost have gone down to an average of $15,000 per month with the max usage of $20,900. The implementation of the algorithm and protocol has been successful from a cost perspective, and feedback from the unit nurses has been that it has given them more autonomy and has been easy to follow.
Patricia Hooker, RN1
Wedlyne Pierre, RN1
1Department of Transplant, McGill University Health Center, Montreal, Quebec
To receive a kidney from a deceased donor, the name of the recipient needs to be on a waiting list. The waiting time can be a few months to several years. The success rate for a kidney transplant from a deceased donor is 85-90% after one year. The kidney lasts in its new body on average between 10 to 15 years, whereas the success rate for a kidney transplant from a living donor is high, at 90-95% after one year. The new kidney lasts on average between 15 to 20 years.
The purpose of our presentation is to raise awareness about living kidney donation with health care professionals, patients, and their families. We will provide an overview into what a living donor evaluation entails. We will cover the eligibility criteria to be a potential living donor along with discussing the myths about who can be a donor. In addition, a brief overview of the testing required, statistics on living donation from our program, what happens if the two are not a match, a brief description of how the Canadian Kidney paired donation program works, and how we ship kidneys since the COVID pandemic. As well, we will discuss how to help patients find living donors and what to consider regarding social media. By providing education about the living donor program, we hope to increase the number of living kidney donors. The implications for nephrology practice and education would be to include living donor education as part of the routine information given to CKD patients and their families.
Jennifer Latulippe, RN, MN, CNeph(C)1
Tracy Olson, RN, BScN, CNeph(C)1
1Department of Nursing Education, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario
Purpose: In October 2020, St. Joseph’s Healthcare Hamilton (SJHH) Kidney Urinary Program (KUP) initiated an education program, Hemodialysis Orientation Week (HOW), for new nurses, nursing students, and clinical technologists. This monthly comprehensive program includes sessions facilitated by the director, managers, nurse practitioners, modality nurse, vascular access nurses, social workers, registered dietitians, renal pharmacists, certified diabetes educators, clinical nephrology technologists, nephrology research coordinators, nephrologists, and nurse educators.
Description: Incoming staff and students to hemodialysis required education, resources, and skill practice in preparation for their new clinical role. In-person presentations, skill practice sessions, and emergency scenarios were created in advance of the HOW launch. Topics included dialysis machine training, chronic kidney disease, acute kidney injury, hemodialysis, peritoneal dialysis, vascular access, ultrasound use and cannulation practice, hemodialysis bloodwork, anemia management, fluid assessments, wound care, patient modalities, medical escalation policy, collaborative model of care, diabetes care, renal diet, renal medications, and hemodialysis complications and emergencies.
Outcomes: Anecdotally, participants reported that they were very satisfied with the new education program, the availability of resources and quick reference guides. Post orientation surveys are sent to participants each month. This formal feedback has been very positive, and suggestions received have been used to further improve sessions. To date, 62 participants have attended HOW, with sessions facilitated by 34 rotating staff members. SJHH KUP healthcare professionals have provided for and interacted positively with new staff and students to professionally grow in a safe and healthy work environment.
Implications for Practice: The current healthcare human resources shortage, particularly in a specialty such as nephrology, may require renal programs to review and update their new staff orientation programs to further support recruitment and retention of staff and students. To provide quality patient care, new hemodialysis staff and students must be prepared and supported with a robust educational program.
Lisa Robertson, RN, BScN, CNeph(C)1
Jessica Gates, RN, BScN, CNeph(C)1
Shaguftah Patel, RN, BScN, CNeph(C)1
1Peritoneal Dialysis Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario
Purpose: To develop a comprehensive peritoneal dialysis (PD) training program whereby nurses develop a basic competence in delivering PD and managing its complications.
Description: Peritoneal dialysis is a treatment option available to patients with end-stage renal disease. PD is a home therapy that is not available as an in-centre treatment. As a result, patients (or their family members) are either independent with PD or receive assistance from community nurses. When these patients are admitted to hospital, having inpatient nurses trained in PD allows the patient to continue receiving PD during their admission. Community nurses, and at times, the inpatient nurses have limited resources available to them, so need to be competent in the skill.
All initial PD training and routine recertification is provided jointly by the PD clinic and the PD nurse educator. The goal was to create a comprehensive training program that would provide a good foundation on which the nurses could practice safely and independently. Malcolm Knowles’ principles of adult education were utilized in creating the workshop and recertification programs. Components of the workshop and recertification include: self-learning package, quizzes, case studies, videos, pictures, discussions, resources, and hands-on practice.
Evaluation and Implications for Practice: Evaluations from both the workshop and the recertifications have been extremely positive. The workshop and recertifications have been fine-tuned over the years based on feedback and general observations. Overall, nurses demonstrate competence in performing PD and applying concepts learned.
Christine Morton, BScN, CNeph UK1
Rick Luscombe, BSN (retired)
1Director of Renal Clinical Services and Education, Nipro Corporation Canada
In this presentation/workshop, we will review the uses of the handheld ultrasound device to enhance vascular access assessments, and ultrasound guided needling and troubleshooting when clinically managing the arterio-venous fistulas (AVF) and arterio-venous grafts (AVG) for hemodialysis patients. Management strategies of AVF/AVG are evolving to include the routine use of ultrasound guided needle insertion, which has been shown to offer short- and long-term health benefits for vascular access. We will review the use of ultrasound for clinical assessment, and how this tool can both enhance best practice and vascular access safety. The presentation will demonstrate how ultrasound can be used for routine assessment of AVF /AVG pre dialysis to help the nurse with troubleshooting general access problems including needle repositioning needle during dialysis, as well as its use for ultrasound guided needling. The simplicity and ease of use, of a small handheld ultrasound, makes this device easy to learn, handle and use. We will include training tools to assist with developing staff training for routine ultrasound to promote vascular access management and health.
Implications for Nephrology Care: Optimizing vascular access health and safety by the routine use of ultrasound, takes us another step closer to enhancing vascular access short- and long-term outcomes. Routine use of ultrasound with AVF/AVG enables the healthcare team to clinically manage the access, detect issues during dialysis, and promote optimal long-term access health.
Farahnaz Behrozishad, RN, MN, NP Student1,2
1LTC Primary Nurse, Nephrology Department, Humber River Hospital, Toronto, Ontario
2D’Youville University, School of Nursing, Buffalo, New York
Background: During the pandemic, long term care (LTC) facilities had to adjust to numerous new infection prevention and control practices, and cope with the COVID outbreaks. To overcome this challenge, for the first time in Ontario, Humber River Hospital piloted an initiative in which hemodialysis (HD) was administered at LTC facilities instead of having the patients come for in-centre treatments.
Tunneled dialysis catheters (TDC) are commonly used as a vascular access in hemodialysis. Catheter-related bacteremia (CRB) is the most common clinical problem for patients receiving HD, especially for those residing in LTC facilities. CRB leads to increased rates of morbidity and mortality for this patient population.
Purpose of Study: This feasibility pilot study was designed to evaluate the rate of CRB for patients who received hemodialysis at LTC instead of the hospital.
Methods: LTC facilities located within the previous Central Local Health Integration Network (LHIN) were engaged to participate in this pilot project. Chronic hemodialysis patients receiving outpatient HD were consented and enrolled in the LTC dialysis program. A retrospective cohort review was conducted in 12 different LTC facilities in Toronto, Ontario from April 2020- March 2022.
Results: Forty-two patients were evaluated. Five patients had CRB, and three patients died post hospital admission. Only five CRB (11%) episodes were reported during the two-year time period at LTC facilities, which proved that patients are safe to receive hemodialysis at LTC facilities instead of the in-centre setting.
Conclusion: Offering chronic dialysis in LTC facilities is a safe, efficient, and cost-effective model of care. The risk of CRB is low, and dialysis quality is the same compared to the usual in-centre setting. The anecdotal feedback shared by patients and family members validates our assumption that this model of care is patient-centered and conducive to maintaining patients’ quality of life.