Journal of Nursing Theory and Practice

[Advantages of the bevel down puncture technique]

SOMOSI László, KISS Szilvia, LADÁNYI Erzsébet

FEBRUARY 28, 2017

Journal of Nursing Theory and Practice - 2017;30(01)

[The arterio-venous fistula is also called the dialysis patient’s lifeline. The name lifeline stands for the essential connection between the body and the dialysis machine. Keeping it in good condition is very important, because fistulas play a keyrole in the successful dialysis treatment. Fistula care is indispensable both from the nurse and patient side. The dialysis team is responsible for the fistula puncture and care. We introduced the bevel down puncture technique in November of 2011 for better arterio-venous shunt care. Our dialysis nurses were trained on the correct position of the fistula needle. We emphasised the benefits and long-term effects. We use this technique for all patients, except for the first fistula puncture. The bevel down puncture technique reduces the patient’s fear of fistula puncture as it causes less pain. After removal of the needle, the bleeding time decreased from the approximate 6-7 minutes to less than 5 minutes and bleeding volume is also decreased. It also reduces the size of the scab and the aneurysm formation. In our dialysis unit we have had good experiences with the bevel down puncturing technique, as it kept our patients’ fistulas in good condition, this may prolong vascular accesses lifetime.]

COMMENTS

0 comments

Further articles in this publication

Journal of Nursing Theory and Practice

[Zsuzsanna Kossuth, the first head nurse in all of Hungary was born 200 years ago]

BALOGH Zoltán

Journal of Nursing Theory and Practice

[Investigation of nurses eating habits]

NÉMETH Anikó

[The aim of the study: was to assess the characteristics of diet among nurses in relation to socio-demographic and workplace related factors. Methods: The survey was conducted in 2015 through a self-constructed online questionnaire. Data were analyzed with SPSS 22.0 using chi square, Mann-Whitney and Kruskal-Wallis tests. Results: Sixty percent of the 548 involved nurses are overweight. Monthly overtime correlates negatively with the number of daily meals (p=0.003) with having hot meals (p=0.022) and with the opinion about dietary habits (p=0.001). Calm meals are typical for 30%, eating vegetables, fruits and whole grain bakery products for 20% and only 24.3% drinks two litres per day. Having children has beneficial effects on dietary habits. Conclusions: It can be concluded that the majority of the nurses included are overweight and they have dissatisfactory diet. The reasons for these might be rooted in the characteristics of the job and the Hungarian eating habits.]

Journal of Nursing Theory and Practice

[Community nurses’ challenges and occupational health hazards associated with home health care]

HIRDI Henriett Éva, LUKÁCS Miklós, BURCSEK Tóthné Ildikó, BALOGH Zoltán

[The aim of the study was to assess the occupational health hazards associated with the delivery of home health care among nurses in family practices. Methods: The cross-sectional survey was conducted between 20 January 2016 and 15 April among nurses working in general, child and family practices, selected using a random, sampling method (N=983). The data gathering took place using a web-based, anonymous, self-completion questionnaire. The authors analysed the gathered data with Microsoft Excel 2013 software, employing a descriptive statistical methods. Results: 99,59% of nurses were female with an average of 27,34 years experience. Nurses reported the following frequently health risks at their client’s homes: 71,4% handling sharp devices or equipment, 54,9% contact with human body fluids, 29,51% smoking in home, 13,7% patient handling without slings or handling devices, 8,9% agressive pets, 7,5% neighborhood violence/crime. Conclusions: Results demonstrated an increased biological health risk among nurses. Based on the results, the authors stress the importance of developing and conducting training programs concerning occupational health hazard issues for nurses working in family practices. ]

Journal of Nursing Theory and Practice

[Obstructive sleep apnea syndrome: how we screen and diagnose?]

ANNUS János, CSATLÓS Dalma, SZAKÁCS ZOLTÁN

[The obstructive sleep apnea syndrome (OSAS) is known to cause obstructive apneas and hypopneas mostly with desaturations and/or arousals caused by repetitive collapse of the upper airway system during sleep. The disorder negatively affects sleep efficacy and daytime neurocognitive functions as well as increases cardiovascular risks. The typical clinical presentation is excessive daytime sleepiness and loud snoring interrupted by brief pauses of breathing. Its prevalence is 2-4% in the general population. It may be a causative factor in some disorders such as therapy resistant hypertension, nocturnal cardiac arrhythmias, stroke, cognitive decline or depression. Significance of the disorder is highlighted by the fact that its risk must be evaluated by the family doctors during the examination of medical suitability for driving licence in Hungary. ]

Journal of Nursing Theory and Practice

[The opinion of parents with premature babies about information regarding homecoming and psychological support]

ADAMIK Ágnes, NÉMETH Anikó, TULKÁN Ibolya

All articles in the issue

Related contents

Hypertension and nephrology

[Study of attitude of dialysis patients to renal transplantation]

VÁMOS Eszter Panna, CSÉPÁNYI Gábor, MOLNÁR Miklós Zsolt, RÉTHELYI János, KOVÁCS Ágnes, MARTON Adrienn, NÉMETH Zsófia, NOVÁK Márta, MUCSI István

[Background: Treatment decisions made by patients with chronic kidney disease are crucial in the renal transplantation process. These decisions are influenced, amongst other factors, by attitudes towards different treatment options, which are modulated by knowledge and perceptions about the disease and its treatment and many other subjective factors. Here we study the attitude of dialysis patients to renal transplantation and the association of sociodemographic characteristics, patient perceptions, experiences with this attitude. Methods: In a cross-sectional study, all patients from eight dialysis units in Budapest, Hungary, who were on hemodialysis for at least three months were approached to complete a self-administered questionnaire. Data collected from 459 patients younger than 70 years were analyzed in this manuscript. Results: Mean age of the study population was 53±12 years, 54% was male, the prevalence of diabetes was 22%. Patients with positive attitude to renal transplantation were younger (51±11 vs. 58±11 years), better educated, more likely to be employed (11% vs. 4%) and had prior transplantation (15% vs. 7%) (p<0.05 for all). In a multivariate model negative patient perceptions about transplantation, negative expectations about health outcomes after transplantation, presence of fears about the transplant surgery were associated, in addition to increasing age, with unwillingness to consider transplantation. Conclusions: Negative attitudes to renal transplantation are associated with potentially modifiable factors. It would be necessary to develop standardized, comprehensible patient information systems and personalized decision support in order to facilitate modality selection and to enable patients to make fully informed treatment decisions.]

Hypertension and nephrology

[Managing medical quality and patient safety in an international dialysis network]

TÖRÖK Marietta, OROSZ Attila, CHARLOTTA Wollheim, JÖRGEN Hegbrant

[A dialysis provider’s core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence- based guidelines and clinical protocols and revising targets, guidelines and clinical protocols based on sound scientific data. Consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice. We point out the importance of auditing clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety]

Hypertension and nephrology

[Diabetology in dialysis]

MÁCSAI Emília, HALMAI Richárd, NEMERE Éva, BRASNYÓ Pál, KISS István

[According to epidemiological data, the number of diabetic patients requiring dialysis is increasing. Burnt-out diabetes, new onset diabetes during chronic dialysis treatment and new onset diabetes after transplantation diabetes are new types of diabetes compared to the traditional division forms. It is utmost important to evaluate education ability and acceptance the core values of lifestyle changes. Clear guidelines for oral anti-diabetic and insulin therapy have not yet been developed since this group of patients did not participate in previous major surveys. In order to formulate individualized therapeutic recommendations, it is imperative to perform regular glucose self-monitoring, which is also the cornerstone of solving unexpected situations. Both in hemodialysis and peritoneal dialysis, special considerations should be applied to the diabetic patient group, this review focuses on the current understanding of available relevant knowledge and summarizes presumably extrarenal diabetic complications as well.]

Hypertension and nephrology

[Hungarian Vasculitis Registry – results of the first five years]

HARIS Ágnes, TISLÉR András, ONDRIK Zoltán, FILE Ibolya, MÁTYUS János, ZSARGÓ Eszter, DEÁK György, AMBRUS Csaba

[Launching the Hungarian Vasculitis Registry aimed to collect information about prevalence and outcome of our patients with ANCA-associated vasculitis, and treatment protocols of the disease. The on-line data collection has been developing dynamically since its initiation five years ago, presently 278 patients’ files are available. Patients’ mean age is 58.2±14.5 years, 62% are women; their disease is associated with c-ANCA positivity in 51% and p-ANCA in 49%. At diagnosis GFR was 24.6±21.6 ml/min/1,73 m2, that time 29%, during the total follow up 39% of the registered subjects needed dialysis. Renal replacement therapy could be discontinued in 23% of them. In cases with focal histological changes, also with upper respiratory tract and skin involvement dialysis was significantly less frequently necessary, which underlines the importance of early diagnosis. In induction therapy steroid was administered for 94% of the patients, 85% of them got cyclophosphamide, 59% was treated by plasmapheresis, 11% got rituximab. Maintenance treat ment contained steroid in 80%, per os cyclophosphamide in 23%, parenteral cyclophosphamide in 22%, furthermore 40% of the patients got azathioprin, 8 subjects got mycophenolate and 6 got methotrexate. Median follow up was 30 months (IQR 6-78), during which period 20% of the patients died, 5% got kidney transplantation, and 5% were lost to follow up. Median survival was 14.8 years, five years survival was 85%, and ten years survival was 70%. Long term survival in patients with c-ANCA vasculitis seemed better comparing to p-ANCA vasculitis, but when correcting by age this difference disappeared. Predictors of death were age and dialysis dependent renal failure. Relapses developed in 27% of patients, 28% of them presented in the first year, 21% suffered it after five years of care. Collected data by the Hungarian Vasculitis Registry shows our society’s successful professional activity. Our results are comparable to the published data in the literature, yet there are several areas in our care where further improvements are warranted in order to increase our patient’s survival and quality of life.]

Hypertension and nephrology

[Stroke is a common, severe, but preventable cardiovascular disease in chronic kidney disease]

NAGY Judit, KOVÁCS Tibor, KÉSŐI István, TÓTH Péter, SÁGI Balázs, SZAPÁRY László, VAS Tibor, KOMOLY Sámuel, KOLLER Ákos, WITTMANN István, BERECZKI Dániel, KISS István

[In chronic kidney disease (CKD) patients the high risk for cardiovascular events represents the major cause for morbidity and mortality. Stroke is the third most common manifestation of cardiovascular diseases and cause of death. The risk of cerebrovascular diseases persists in CKD patient in predialysis increases by 1.5-3 times whereas in patients on dialysis is increases by 4-10 times. The combination of classical cardiovascular risk factors and the pathomechanisms present in CKD and activated by dialysis treatment may explain the increased risk. The outcome of stroke is more severe in CKD, than in other populations. There are only a few data regarding early identification, primary and secondary prevention. and proper treatment of stroke in CKD patients with and without dialysis. In this review we summarize the diagnostic and treatment strategies that are based on the existing state of knowledge. However, additional studies are needed to address the poor prognosis through early identification of risk developing potential preventions and treatments of stroke in CKD.]