Nephrology nursing journal : journal of the American Nephrology Nurses' Association
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Comparative Study Clinical Trial
The role of real-time ultrasound and physical examination measurements in placement of cuffed-tunneled hemodialysis catheters.
The portability of non-invasive ultrasound has resulted in an expansion of its utilization into a variety of clinical settings. Since ultrasound is recommended for initial vein cannulation during catheter placement, it is conceivable that ultrasound may also be used to verify catheter position. The purpose of this study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy. ⋯ The investigator, using dynamic ultrasound imaging, was able to identify correct position in 30 of the 31 subjects with catheters. Still echocardiographic images were reviewed by two cardiologists and determined to be inconclusive. Physical examination measurements correlated well with the interventional radiologist guide-wire measurements (p < .01; r = 0.65) and concluded to be a useful method for determining appropriate cuffed catheter length.
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Optimizing i.v. iron management is essential to the overall health of hemodialysis patients. Establishing an i.v. iron protocol, administering a safe and effective i.v. iron supplement, and developing a strong nurse/patient relationship are all indispensable to an effective and efficient hemodialysis program.
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Review
Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: pathophysiology and management.
Pathogenic mechanisms of renal injury by thrombotic microangiopathies present a challenge to the multidisciplinary team caring for a patient with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS). First recognized 77 years ago as a rare disorder characterized by reversible platelet aggregation in the microcirculation causing ischemia in various organs, the prognosis was always fatal. In the past 20 years, due to effective treatment with plasma exchange therapy, there has been a decline in the mortality rate to 10-20%. ⋯ Frequency of TTP-HUS appears to be increasing. Due to the urgent need for a diagnosis, sufficient diagnostic criteria for TTP-HUS are currently thrombocytopenia and microangiopathic hemolytic anemia in the absence of another apparent cause. It is imperative to have a solid understanding of the pathophysiology and current standards of practice of TTP-HUS in order to facilitate positive patient outcomes in this unique group of patients.
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The more frequent introduction of new drugs and devices to the marketplace, including an increase in the number of trials, requires nephrology nurses to better understand the process and the implications for their practice. This article explains the pre- and post-marketing phases of drug development and describes the post-marketing safety surveillance of all FDA-approved drugs.
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Comparative Study
Comparison of sampling methods for obtaining accurate coagulation values in hemodialysis patients with heparinized central venous catheters.
Monitoring coagulation values in hemodialysis (HD) is integral to the care of patients with central venous catheters (CVCs) to maintain catheter patency. HD patients can have problems providing blood samples and may experience discomfort with venipuncture, but no consensus in the literature is available to identify a reliable and efficient method of obtaining an international normalization ratio (INR) value from a heparinized CVC line. This was a comparative study of three different methods of blood sampling for INR values. ⋯ Results revealed that both alternative methods are suitable for taking INR samples. As a result of this study, the arterial bloodline sample port method for INR sampling was introduced into the HD unit at this hospital. This method has proven to be simple, quick, accurate, and noninvasive to renal patients.