Leitch Rosemary, Ouwendyk Michaelene, Ferguson Evelyn, Clement Laurie, Peters Karen, Heidenheim A Paul, Lindsay Robert M
Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada.
Am J Kidney Dis. 2003 Jul;42(1 Suppl):56-60. doi: 10.1016/s0272-6386(03)00539-0.
Increased interest in quotidian hemodialysis (HD) programs requires that nephrology nurses have a larger role in transitioning patients to more frequent HD. Nursing issues include the selection, training, and education of patients before they begin more frequent HD therapy.
The London Daily/Nocturnal Hemodialysis Study directly compared data from patients undergoing either short daily HD (n = 11) or long nocturnal HD (n = 12) with those undergoing conventional thrice-weekly HD (n = 22). Patient training, education, safety, and vascular access data were collected.
The patient training period varied from 10 to 25 days, with an average length of 16.64 days. Patients used 1 of 3 types of vascular access: native arteriovenous (AV) fistulae, grafts, or central catheters. No statistically significant differences in access flow rates between the study and control groups were noted or when comparing different types of access. A significant decrease in catheter infection rate was seen when patients switched to daily HD therapy. Patient cannulation surveys showed that patients with AV fistulae or grafts showed improvements with ease and comfort as the study progressed, and patients widely preferred the buttonhole technique to the rotating-needle method for cannulation.
With growing interest in the development of quotidian HD programs, HD nursing personnel face the exciting challenge of improving on existing training programs and treatment modalities.
对每日血液透析（HD）方案的兴趣增加，这要求肾脏病护士在帮助患者过渡到更频繁的血液透析中发挥更大作用。护理问题包括在患者开始更频繁的血液透析治疗之前对其进行选择、培训和教育。
伦敦日间/夜间血液透析研究直接比较了接受短程每日血液透析（n = 11）或长程夜间血液透析（n = 12）的患者与接受传统每周三次血液透析（n = 22）的患者的数据。收集了患者培训、教育、安全性和血管通路数据。
患者培训期从10天到25天不等，平均时长为16.64天。患者使用3种血管通路类型中的1种：自体动静脉（AV）内瘘、移植物或中心静脉导管。在研究组和对照组之间，或者在比较不同类型的血管通路时，未发现血管通路血流量有统计学上的显著差异。当患者转为每日血液透析治疗时，导管感染率显著下降。患者插管调查显示，随着研究的进行，有AV内瘘或移植物的患者在插管的轻松程度和舒适度方面有所改善，并且患者普遍更喜欢扣眼技术而非旋转针技术进行插管。
随着对每日血液透析方案发展的兴趣日益浓厚，血液透析护理人员面临着改进现有培训方案和治疗方式这一令人兴奋的挑战。
