CE: continuing education article. Integration of palliative care for patients with stage 5 chronic kidney disease.

Patients with advanced chronic kidney disease (Stage 5 CKD) have palliative care needs similar to patients with cancer. The decision not to commence dialysis or to withdraw from active treatment can have a profound impact upon all those closely involved in the patient's care. It is essential that every effort is made to minimise the physical and psycho-social symptoms experienced by patients who require palliative care.

Vascular access management III: central venous catheters.

This third article, the final part of a Continuing Education (CE) series on Vascular Access Management for patients with end stage renal disease (ESRD), focuses on central venous catheters. CVCs are considered the last choice in vascular access due to the numerous complications associated with their use. This CE article explores the incidence and prevalence of central venous catheters within the context of international guidelines, type and design of central venous catheters, insertion procedure, strategies for preventing infection and complications associated with their use.

Vascular Access Management II: AVF/AVG cannulation techniques and complications.

This second article, in a three-part Continuing Education (CE) series on Vascular Access Management, focuses on cannulation issues including complications relating to arteriovenous fistula and arteriovenous graft access. The first article (McCann et al. 2008) gave an overview of vascular access while the final article in this series will focus on central venous catheters (CVC).

Venous needle dislodgement: how to minimise the risks.

Although haemodialysis (HD) has become a routine treatment, adverse side effects, and occasionally life threatening clinical complications, still happen. Venous needle dislodgment (VND) is one of the most serious accidents that can occur during HD. If the blood pump is not stopped, either by activation of the protective system of the dialysis machine or manually, the patient can bleed to death within minutes.

Vascular access management 1: an overview.

Vascular access for renal replacement therapy (RRT) is seen as one of the most challenging areas confronting the nephrology multidisciplinary team. The vascular access of choice is the arterio-venous fistula (AVF) followed by the arterio-venous graft (AVG) and central venous catheter (CVC). A successful vascular access programme requires forward planning ensuring that enough time is available for the preservation of the access site, its creation and maturation.

EDTNA/ERCA vascular access recommendations for nephrology nurses.

In 1989, SJ. Schwab stated that providing satisfactory vascular access for haemodialysis remains one of the most challenging problems confronting the nephrology team (1). Successful long-term haemodialysis in patients with end-stage renal failure depends to a large extent upon a trouble-free vascular access.

Complications of vascular access: results of a European multi centre study of the EDTNA/ERCA Research Board.

The pilot project of the Research Board of EDTNA/ERCA handled the management of vascular accesses (VA) in European dialysis centres. In the first part of the study, centre policies related to VA management were investigated. In the second part of the study, individual patients were followed prospectively during one year.

Awareness of anaemia in diabetes patients.

Although the link between diabetes and anaemia has been firmly established in the renal world, patients with diabetes and healthcare workers in this field are clearly failing to recognise many of the common symptoms of anaemia, a key indicator for renal disease. By forging links and instigating an exchange of information, renal health care workers can work with their colleagues in diabetes to raise awareness of the important benefits arising from the early diagnosis and treatment of the anaemia related to kidney disease.

Identifying vascular access complications among ESRD patients in Europe. A prospective, multicenter study.

The pilot project of the Research Board of the EDTNA/ERCA was aimed at reviewing the management of vascular access (VA) in European dialysis centres (see August 1999 NN&I). In Part 1 of this study, centre policies related to VA management were investigated. In Part 2, detailed in this article, individual patients were prospectively followed for one year to identify VA-related complications.

Vascular access in acute renal failure.

Today, central venous access catheters play an important role in the treatment and management of many dialysis patients. Their use and care may influence the patient's overall outcome. Therefore, it is critical to have a thorough knowledge of the vascular anatomy, types of catheters, placement techniques and maintenance and management of complications.

Continuous quality improvement (CQI) in rhu-Epo management: the outcome.

The establishment of an adequate recombinant erythropoietin (epo) treatment for haemodialysis patients has challenged nephrology workers for the last 5 years. Starting with epo, it was quickly clear that its management was complex and a lot of conditions were involved in its effective application.

Effect of oxygen administration on the breathing pattern during haemodialysis in man.

During haemodialysis (HD), allowing important CO2- unloading, an irregular breathing pattern (BP) is frequently observed. This has been attributed to a decrease in central chemoreceptor firing, with a greater contribution of the peripheral chemoreceptors in the chemical drive to breathe. To provide further evidence for these findings we studied five patients with end-stage renal failure in chronic HD.

Development of nephrology nursing care in Europe: 1978-1988.

Nephrology nursing care in Europe has been accelerated by medical and technical advances. Nurses are becoming more and more involved in decision-making processes as opposed to the traditional serving role. This article analyzes some aspects responsible for these changes in Europe from 1978-1988 and how nephrology nurses adapted to these developments.

The effect of acetate on ventilation in haemodialysis patients.

This study evaluates the direct effect of acetate upon ventilation during acetate-haemodialysis. Eight patients with end-stage renal failure who were receiving chronic haemodialysis treatment underwent acetate infusion for 1 h on a day outside a haemodialysis session. Ventilation was continuously measured using respiratory inductance plethysmography, starting 20 min before the infusion.

Ventilation and breathing patterns during hemodialysis-induced carbon dioxide unloading.

Important CO2 unloading occurs during hemodialysis (HD) when acetate-buffered dialysate is used. This is accompanied by alveolar hypoventilation. To gain more insight into the mechanisms of this alveolar hypoventilation, breathing patterns were studied in 5 patients with end-stage renal failure during HD using acetate-buffered dialysate, which induces CO2 unloading, or bicarbonate without CO2 loss.

Biocompatibility of a polycarbonate membrane. A preliminary report.

In this preliminary study, the biocompatibility of a new dialysis membrane, polycarbonate, was studied. The bioincompatible effect of this membrane is less pronounced compared to cuprophane.