Daily hemodialysis: a nursing perspective
Michaelene Ouwendyk, RN, BScN, CNephC
Synopsis: Ouwendyk M, Leitch R, Freitas T. Daily hemodialysis: a nursing perspective. Advances in Renal Replacement Therapy 2001; 8: 257-67.
Nursing literature on daily hemodialysis therapies is scarce. Experience with nocturnal and short daily home hemodialysis along with short daily treatments performed in-center are discussed in this article. Many nursing topics are addressed, including patient selection criteria and factors to consider when selecting the appropriate therapy for each patient. Success with fistulas, grafts and central venous catheters for daily hemodialysis are described, including the use and benefits of the buttonhole cannulation technique for native arterio-venous fistulas. Patient training is a key element to the success of a home hemodialysis program. A review of the nurse's role, nurse-to-patient ratio, the training schedule, tools and strategies, and discharge planning are presented. Safety is the primary focus for daily home hemodialysis patients. Remote monitoring of patient treatments is explored, the importance of patient annual recertification is stressed, and the various safety techniques used for the different vascular accesses are described in detail. To manage patients once discharged home, approaches for on-call support, strategies for patient follow-up, and the possibilities for respite care need to be considered.
Commentary by Todd S. Ing, MD
Ms. Ouwendyk et al., pioneers in the important nursing aspects of more frequent and more prolonged dialytic therapies, have described in detail what a dialysis center should do if it wishes to embark on a program encompassing these emerging therapies. Full nursing participation is the key to success!
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