Blood Purification Center Research Articles

Application effects of 5S management methods for management of first-aid articles in Blood Purification Center

Objective To explore the application effects of 5S management methods for management of first-aid articles in Blood Purification Center. Methods A total of 12 nurses were selected as objects of observation. Six months before and after the implementation of 5S management, we observed and compared the time to finish the first aid measures, the average time to look for articles during first aid, round-trip times from deposition room, the score of nurses′ behavior of the occupational safety and prevention in emergency, times of sound condition of emergency equipment, the score of first-aid articles returned to their original places after emergency, the score of management quality control of first-aid articles and the patients′ satisfaction with nursing. Results After the implementation of 5S management, the completion time of the rescue measures was shorter than before. At the same time, the rate of sound condition of emergency equipment and the score of first-aid articles returned their original places after emergency improved significantly. The average time to look for articles during first aid and round-trip times from deposition room all decreased significantly. The score of nurses′ behavior of the occupational safety and prevention in emergency increased significantly. The score of management quality control of first-aid articles and the patients′ satisfaction with nursing all improved significantly. Differences were all statistically significant (P<0.05). Conclusions The implementation of 5S management reduces the difficulty in preservation and management of first-aid articles, shortens the execution time of rescue measures, improves the working efficiency of rescue, enhances the quality of nursing and patients′ satisfaction, improves the quality of nursing staff, ensures the nurse occupational safety and prevention and promotes the continuous improvement of nursing quality. Key words: Blood purification; Nursing administration; 5S management methods; First aid articles

Clinical study of secondary relative hypoparathyroidism in the patients with maintenance hemodialysis

Objective To investigate the incidence and possible influencing factors of secondary relative hypoparathyroidism(SRHOP)in the patients with maintenance hemodialysis(MHD).Methods Totally 182stable chronic renal failure patients with MHD for more than 3 months were selected from the Blood Purification Center of Shanghai 7th People's Hospital from January 2012to December 2012.The status of plasma intact parathyroid hormone(iPTH)was analyzed according to the KDIGO(Kidney Disease:Improving Global Outcomes)guidelines.The patients were divided into two groups according to plasma iPTH concentrations:SRHOP group(iPTH150pg/mL,n=73)and non-SRHOP group(iPTH ≥150 pg/mL,n=109).The influencing factors for the SRHOP of MHD patients were investigated by Spearman correlation analysis and Logistic regression analysis.Results The average concentration of plasma iPTH of 182 MHD patients was(173.5± 114.3)pg/mL,and the concentration decreased gradually with age.According to KDIGO guidelines,the concentrations of plasma iPTH reached the standard in 83cases(45.6%),lower than the standard in 73cases(40.1%),and higher than the standard in 26cases(14.3%).The concentrations of plasma iPTH were not significantly different between the genders.The age, incidence of diabetes,and plasma corrected calcium concentration of the SRHOP patients were significantly higher,while the plasma phosphorus,albumin and normalized protein equivalent of nitrogen appearance(nPNA)levels were significantly lower than those of the non-SRHOP patients(P0.05).There were no significant differences in gender composition,duration of dialysis,blood pressure, plasma urea nitrogen,plasma creatinine,urea clearance index(Kt/V),numbers of patients with oral calcium or vitamin D,and hemoglobin between the two groups.Spearman analysis showed that age,diabetes,plasma corrected calcium,and phosphorus and albumin levels were associated with SRHOP,and Logistic regression analysis indicated that the age and plasma phosphorus level of MHD patients were independent risk factors for SRHOP.Conclusion SRHOP,rather than secondary hyperparathyroidism,often occurs in MHD patients.The patient age and plasma phosphorus level are the independent risk factors for SRHOP.

Application of nursing process optimization in blood purification center

Objective To discuss the impact on nursing quality and patients＇ satisfaction of nursing process optimization in blood purification center, in order to reduce the potential safety hazard and improve patients＇ satisfaction. Methods The patients with maintenance hemodialysis in our hospital were selected. The original blood purification process was analyzed, evaluated, reconstructed, optimized, and organized and implemented. Comparison of nursing quality and satisfaction was conducted between 106 cases before nursing process optimization and 115 cases after nursing process optimization. Results The overall patients＇ satisfaction before optimized nursing process was 83.9%. After optimized nursing process, the overall patients＇ satisfaction was 95.7%. The comparison difference was statistically significant （Z = -2. 585, P 〈 0.05 ）. After optimization of hemodialysis treatment processes, nursing quality improved. The rate of patients oozing or bleeding at the puncture was 13.92% and the rate of tube shed was 0. 87%, both lower than the rates before nursing process optimization. The differences were statistically significant （X^2 = 8. 594, 5. 198, respectively; P〈0.05）. Conclusions Nursing process optimization can improve the nursing quality and satisfaction in blood purification center. Key words: Blood purification center; Nursing process optimization; Nursing quality; Satisfaction

Effect of long intermittent hemodialysis on improving dialysis adequacy of maintenance hemodialysis patients

Background With the increase in hemodialysis (HD) patients, the blood dialysis patient’s quality of life (QoL) and long-term survival are still a challenge for clinicians. Recent studies have found that most of the HD patients have sleep disorders, which have a certain correlation with long-term survival and QoL. But there are few studies of Chinese in this field. This study aimed to investigate whether increasing the dialysis dose can improve sleep quality, so we treated HD patients on long intermittent hemodialysis (LIHD). Methods Forty patients who were treated by conventional HD at the Beijing Friendship Hospital Blood Purification Center were offered the option of LIHD. The patients’ laboratory data, medication use, and questionnaire answers were analyzed. Conventional HD was delivered thrice weekly with 4 hours per treatment, and LIHD was delivered thrice weekly with 8 hours per treatment. The study lasted 6 months. Questionnaires included sleep quality survey and QoL SF-36; the former includes the Athens Insomnia Scale, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Results After conversion to LIHD the dialysis efficiency (K t/V) significantly increased than before (P &lt;0.05) and clearance rate of urea nitrogen also increased from 67 to 78% (P &lt;0.01). After conversion, median values for Hb increased from 108.95 to 126.55 g/L (P &lt;0.01); albumin increased from 38.85 to 40.05 g/L (P &lt;0.01). Phosphorus decreased from 2.69 to 1.54 mmol/L (P &lt;0.01), but there was no alteration in blood calcium; phosphorus and calcium-phosphate product levels were under more control, but parathyroid hormone (iPTH) level did not change after conversion to LIHD. After conversion, blood pressure (BP) was better controlled than before and the mean number of antihypertensive drugs prescribed declined from 2.9 to 0.5 (P &lt;0.01). There was a significant reduction in the use of erythropoietin-stimulating agent of 5250 U/w (P &lt;0.01). Sleep quality significantly improved in the 2 months after conversion to LIHD, and the PSQI score decreased from 10.80 to 5.45 and the ESS score decreased from 12.05 to 5.30 (P &lt;0.01). However, sleep quality started to decline after 2 months on LIHD. QoL SF-36 score increased from 410.92 to 592.53 (P &lt;0.01). Conclusion LIHD offers an effective improvement in dialysis adequacy for Chinese maintenance HD patients, but it improves sleep quality only briefly which may be related to loss of serum calcium and parathyroid dysfunction.

Pulmonary hypertension as an independent predictor of cardiovascular mortality and events in hemodialysis patients

Hemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. Pulmonary hypertension (PH) has been recently reported as a new entity and unrecognized threat in maintenance hemodialysis (MHD) patients, whether PH predicts CV mortality and events in this population remains unknown. The aim of the present study was to determine the value of PH in predicting CV mortality and events in a prospective cohort of MHD patients. We studied 278 MHD patients (98 with and 180 without PH) in Guangdong General Hospital Blood Purification Center, Guangzhou, China. All patients had been followed up for 2 years, and in survival analysis, we considered time to death or first cardiovascular event. The endpoints were all-cause mortality, CV mortality and CV events. PH was defined as systolic pulmonary artery pressure (SPAP) ≥ 35 mmHg as determined by Doppler echocardiographic evaluation. Of the 278 MHD patients, 53 (19.1 %) died as a result of all causes, 28 (10.1 %) died from CV events (52.8 % of causes of death), and 87 (31.3 %) had new-onset CV events. The survival curve showed that all-cause and CV mortality and new-onset CV events were higher in PH group than the non-PH group. In a multivariate Cox proportional hazard model, the adjusted HR for all-cause mortality, CV mortality and CV events was 1.85 [95 % confidence interval (CI) 1.03-3.34], 2.36 (95 % CI 1.05-5.31) and 2.27 (95 % CI 1.44-3.58), respectively. Our study showed that PH was an independent predictor of all-cause mortality and CV mortality and events in MHD patients. We suggest to evaluate SPAP in MHD patients in order to stratify risk of death and CV events.

Influence of empowerment management on nursing quality in blood pnrification center

Objective To analyze the effect of empowerment management for nursing risk in blood purification center.Methods 16 nurses were chosen and nursing risk were authorized to six management groups,each group was respectively responsible for their share of nursing work.Before the implementation of empowerment management for nursing risk,100 patients undergoing maintenance hemodialysis were chosen,and after the implementation another 100 patients were also selected.The nursing effect was compared before and after the implementation.Results After the implementation,the score of nursing quality and patients' satisfaction degree were significantly improved.Conclusions The effective empowerment management for nursing risk can raise management effect of nurses continuously,and stir up the initiative and creativity of nursing staff,lower nursing risk occurrence.It is an effective management method that promotes nursing quality comprehensively. Key words: Blood purification center; Risk management; Empowerment management; Nursing quality

Practice and effect of nursing performance bonus distribution implementing in blood purification center

Objective To study the effect of bonus distribution based on the performance evaluation implementing in blood purification center.Methods Nursing performance bonus distribution based on the the quality of nursing,workload,nurses level and additional assessment issued.Results The highest assessment of nurses on the bonus distribution system was its fair and balanced,which score was (6.7 ± 1.7).After implemented the distribution system,the score of department management,disinfection isolation,emergency medical supplies and special nursing was(97.7 ± 0.96),(95.5 ± 1.91),(95.4 ±1.14),(97.0± 1.58)respectively,higher than that of before implemented this distribution system (90.5 ± 2.38 ),( 87.75 ± 2.50 ),( 88.6 ± 3.05 ),(90.2 ±1.30),and the difference was statistically significant (t=9.768,8.533,7.234,11.513,respectively;P ＜0.01 ).The times of nurses in broken medical ethics,regulations,nursing quality defective happend was significantly reduced after implemented the bonus distribution system ( x2=4.018,5.000,5.333,respectively; P ＜ 0.05 ).Conclusions Performance bonus distribution implementing fully embody the principles of “More pay for more work” and “Best pay for best work”,and improve the service and work quality. Key words: Blood purification center; Performance bonus distribution; Practice; Effect

Investigation and measures on the pressure of nurses in blood purification center

Objective To investigate work pressure of the nurses in blood purification center,and take measures to cope with it.Methods Interview was adopted to investigate 32 nurses.Results All of the 32 nurses believed that their work pressure in hemodialysis room derived from their job nature,overload duty,and lack of staff.Conclusions Nurses in hemopurification center are under work pressure and high risk of environment,which are dangerous to their health,so measures should be taken to reduce their pressure,and improve their health in body and mind. Key words: Blood purification center; Nurse; Pressure; Measure

Practice of continuous quality improvement in infection control of blood purification center

Infection control is important in quality management of blood purification center. Practice of Continuous Quality Improvement in infection control improves patients' living quality, and it is worth proceeding and generalization. Key words: Continuous quality improvement; Blood purification; Infection control

Successful treatment of patients with systemic lupus erythematosus complicated with autoimmune thyroid disease using double‐filtration plasmapheresis: A retrospective study

Systemic lupus erythematosus (SLE) associated with autoimmune thyroid disease (AITD) is a complex and well recognized autoimmune disorder. Careful monitoring/surveillance of thyroid gland functioning and active treatment of SLE patients with coexisting AITD, typically using medications, are critically important. The role of apheresis in this setting remains to be fully explored. Here we examine the use of double-filtration plasmapheresis (DFPP), as an adjuvant therapy in the treatment of patients with SLE complicated with AITD and report our experiences using this apheresis methodology. We performed a retrospective chart review of 11 patients with SLE complicated with AITD who had received DFPP in our blood purification center between 2004 and 2008. Levels of thyroid hormones, antithyroid autoantibodies, SLE disease activity, proteinuria, glomerular filtration rate (GFR), and response to therapy were analyzed. AITD, SLE, and lupus nephritis improved after DFPP. Except for one patient who died of severe pneumonia in the second month after completion of DFPP, all surviving patients continued to show clinical improvements or remained stable during the follow-up periods. DFPP can effectively remove autoantibodies and may have an important adjuvant role in therapeutic options in the treatment of SLE patients with AITD complications.

Effects of oxymatrine on microinflammatory state in patients undergoing continuous hemodialysis: a randomized controlled trial

Chronic microinflammatory state is common in the patients undergoing maintenance hemodialysis (MHD), which seriously affects the long-term survival rate of MHD patients. It is important to improve the microinflammatory state in MHD patients. To investigate the effects of oxymatrine on microinflammatory state in patients undergoing continuous hemodialysis. Sixty MHD patients in Blood Purification Center, Wuhan No.1 Hospital, from June to September 2008, were randomized into treatment group (30 cases) and control group (30 cases). Oxymatrine Capsule was orally administered to the patients in the treatment group 0.4 g once a day for 3 months, while the patients in the control group were not given oxymatrine. The serum concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), albumin (Alb), pre-albumin (PAB), total cholesterol (TC) and triglyceride (TG) were detected before and after 3-month treatment. Three patients in the treatment group had a stomachache on the first day of treatment, and two out of the three quitted the trial. The stomachache disappeared in one patient after stopping taking the drug, and did not recur after continuing to receive the intervention. Two patients in the treatment group had skin rash with pruritus on the second day of treatment. The rash disappeared after the patients stopped taking the drug, and did not recur after continuing to receive the intervention. A total of 58 cases accessed to the statistical analysis, while 2 cases were excluded. In the treatment group, the concentrations of hs-CRP, IL-1beta and TNF-alpha significantly decreased (P<0.01) and the mean values of Alb, PAB, TC and TG significantly increased after the treatment as compared with those before the treatment (P<0.01), but there were no significant differences in all parameters between before and after treatment in the control group. There were significant differences in all parameters between the treatment group and the control group after treatment (P<0.01, P<0.05). Oxymatrine can improve the microinflammatory state in the patients undergoing continuous hemodialysis.

Intravenous Iron Sucrose in Peritoneal Dialysis Patients with Renal Anemia

To explore the safety and efficacy of intravenous (IV) iron sucrose in maintenance peritoneal dialysis (PD). Randomized, controlled, parallel-group single-center trial. Blood Purification Center of Chaoyang, Beijing Capital University of Medical Science, China. 46 patients on PD were involved in this trial. 26 patients received IV iron sucrose (200 mg iron) once per week for 4 weeks then once every other week for a further 4 weeks. The other 20 patients received oral ferrous succinate, 200 mg three times per day, for 8 weeks. Hemoglobin, hematocrit, serum ferritin (SF) level, and transferrin saturation (TSAT) were assessed at baseline and then again after 2, 4, and 8 weeks of treatment. There were no differences between the IV and oral groups in terms of sex, age, duration of PD, mean dialysate dosage per day, erythropoietin dosage per week, or hematological parameters at baseline. After 4 and 8 weeks of treatment, mean Hb and Hct were significantly increased in the IV group and were also significantly higher than those in the oral group. Levels of SF and TSAT were also significantly increased in the IV group, and significantly higher than in the oral group. After 8 weeks, the response rate in the IV group was 94.8%, which was significantly higher than that in the oral group. The mean erythropoietin dose was significantly lower in the IV group than in the oral group. Hb, Hct, SF, and TSAT levels were maintained between 4 and 8 weeks in the IV group despite the decrease in dose frequency. There were no adverse events with IV iron. Eight patients in the oral group had adverse gastrointestinal effects. IV iron sucrose is safe in PD patients. It increases Hb levels and serum iron parameters more effectively than oral iron; it is well tolerated and can permit reductions in the required dose of erythropoietin.