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Volume 7, Issue 4 (Suppl) J Nephrol Ther 2017
ISSN: 2161-0959 JNT, an open access journal Nephrology & Urology 2017
July 06-07, 2017
JULY 06-07, 2017 KUALA LUMPUR, MALAYSIA
12TH ANNUAL CONFERENCE ON
Nephrology & Urology
J Nephrol Ther 2017, 7:4 (Suppl)
DOI: 10.4172/2161-0959-C1-043
Elements of dialysis nursing practice associated with successful cannulation: Result of a survey
Maria Teresa Parisotto, Francesco Pelliccia, Aileen Grassmann and Daniele Marcelli Fresenius
Fresenius Medical Care, Germany
Introduction: Vascular Access (VA) cannulation is an essential skill for dialysis nurses: Failure to correctly repeat this operation
day after day may result in serious complications for the patients.
Aim: The aim of this study was to investigate if the different aspects of Arteriovenous Fistula (AVF) and Graft (AVG) cannulation
have an effect on the development of acute access complications which may, in the medium-long term, affect the survival of the
vascular access.
Methods: In April 2009, a cross-sectional survey was conducted in 171 dialysis units located in Europe, the Middle East, and
Africa to collect details on VA cannulation practices. Information on cannulation retrieved from the survey comprised fistula
type and location, cannulation technique, needle size, application of arm compression at the time of cannulation, needle and bevel
direction, needle rotation and needle fixation.
Results: In total, 10,807 cannulation procedures of an equivalent number of patients were observed and included in the current
evaluation. Out of all observed cannulation procedures, 367 showed some kind of complication, the most frequent (33.8%)
being the need for multiple cannulations. In summary, the following were associated with a significantly higher odds ratio for
acute complication: prescription of 16-17 gauge needles, of back-eye needles, the use of rope-ladder cannulation technique, the
insertion of the venous needle as first needle and the rotation of the arterial needle.
Conclusions: This study highlights critical steps in the process of cannulation potentially affecting the lifespan of the vascular
access and stressing the need for additional research aimed to improve the practice.
Impact of diuretic therapy on renal outcomes of Chronic Kidney Disease patients
Yusra Habib Khan, Azmi Sarrif, Azreen Syazril Adnan, Amer Hayat Khan and Tauqeer Hussain Mallhi
University Sains Malaysia, Malaysia
Diuretic therapy has been mainstay of treatment in Chronic Kidney Disease (CKD) patients, primarily for hypertension and
fluid overload. Apart from their beneficial effects, diuretic use is associated with adverse renal outcomes. Current study
aimed to determine outcomes of diuretic therapy. A prospective observational study was conducted by inviting pre-dialysis
CKD patients. Fluid overload was assessed by Bioimpedance Analysis (BIA). A total 312 patients (mean age 64.5±6.43) were
enrolled. Among 144 (46.1%) diuretic users, furosemide and hydrochlorothiazide (HCTZ) were prescribed in 69 (48%) and 39
(27%) patients respectively, while 36 (25%) prescribed with combination therapy (furosemide plus HCTZ). Changes in BP, fluid
compartments, eGFR decline and progression to RRT were assessed over a follow-up period of 1 year. Maximum BP control
was observed with combination therapy (-19.3 mmHg, p<0.001) followed by furosemide (-10.6 mmHg with 80 mg thrice daily
(p<0.001)), -9.3 mmHg with 40-60 mg (p<0.001) & -5.9 mmHg with 20-40 mg (p=0.02) while HCTZ offeredminimal SBP control
(-3.7 mmHg with 12.5-25 mg (p=0.04)). Decline in extracellular water (ECW) ranged from -1.5 L (p=0.01) with thiazide diuretics
to -3.8 L (p<0.001) with combination diuretics. Decline in eGFR was maximum (-3.4 ml/min/1.73 m2, p=0.01) with combination
diuretics and least with thiazide diuretics (-1.6 ml/min/1.73 m2, p=0.04). Progression to RRT was observed in 36 patients. It is
cautiously suggested to discourage the use of diuretic combination therapy and high doses of single diuretic therapy. Prescribing
of diuretics should be done by keeping in view benefit versus harm for each patient.