Dialysis Technicians Research Articles

Bedside 3D ultrasound fistula maturation assessment by non-expert sonographers provides equivalent accuracy to formal duplex sonography: A prospective clinical trial.

EchoSure is an automated point-of-care 3D ultrasound (3DUS) designed to be used by dialysis technicians without advanced ultrasound training. The EchoMark/EchoSure System is a two-part system comprised of a bioresorbable implant, EchoMark, and a diagnostic ultrasound imaging platform, EchoSure. EchoSure was designed to enable any healthcare personnel in a dialysis clinic setting to obtain non-invasive, direct measurements of flow and vessel parameters that are critical quantifications used in the assessment of AVF maturation and readiness for hemodialysis cannulation. In this pilot feasibility study, we sought to explore whether use of an automated 3DUS could enable fistula assessment by non-experts and obtain measurement accuracy comparable to expert sonographer Duplex. This was a 20 subject prospective multicenter trial conducted at four sites in the United States. All subjects had an EchoMark implanted under their AVF during the fistula creation procedure. Subjects were evaluated at 2-weeks post-op with EchoSure and Duplex, followed by monthly assessments until either the 4-month visit or until radiographic maturation was achieved, whichever was longer. Beyond monthly ultrasound assessments, clinical follow-up continued every 6 months between months 6 and 24. Technical success of EchoMark implantation was demonstrated in 100% of subjects. Technical success of EchoSure was 99% across all scans. The mean percent difference in flow rate measurements between EchoSure and Duplex was -9.2% with a standard deviation of 38.1% compared to a mean percent difference of -15.7% with a standard deviation of 35.5% between Duplex measurements taken at the cannulation zone and brachial artery. Pearson correlation between EchoSure and Duplex was 0.708 versus 0.716 for the two Duplex measurements. Radiographic maturation was achieved in 70% of study subjects by 30 days and continued to rise to 90% through 90 days and 95% through 180 days after baseline. This study demonstrates the feasibility and accuracy of an automated 3D ultrasound system for assessment of maturation at the dialysis bedside by non sonographers.

Cardiac Arrest in Dialysis Units: A National Cross-Sectional Survey Evaluating the Experience of Dialysis Technicians

Cardiac Arrest in Dialysis Units: A National Cross-Sectional Survey Evaluating the Experience of Dialysis Technicians

Health-care Professionals' Perspectives on Ultrasound Evaluation of Arteriovenous Hemodialysis Fistula: A Narrative Review.

Arteriovenous hemodialysis fistulas play a critical role in maintaining life on hemodialysis. With the growing use of Doppler ultrasound in nephrology, its utility has expanded to improve the prognosis and quality of life of patients receiving hemodialysis. On a fistula care team, different health-care professionals, including nephrologists, dialysis technicians, and surgeons or vascular interventionalists, require different information. This review article comprehensively explains how Doppler ultrasound evaluation can be beneficial in the management of arteriovenous fistulas from different perspectives of health-care professionals. The article also introduces the pathophysiology of arteriovenous fistula disease and provides a thorough introduction to the use of Doppler ultrasound for the evaluation of arteriovenous fistulas and their associated diseases, addressing the need for a comprehensive understanding among ultrasound practitioners.

THE ROLE OF PSYCHOLOGICAL CAPITAL IN THE EFFECT OF EMOTIONAL LABOR ON BURNOUT

In this study, it was aimed to understand the emotional labor behaviors of health professionals working in dialysis units and to determine the relationship between emotional labor and burnout. Research on burnout shows that health professionals have high levels of burnout. Working conditions have become even more difficult, especially during the pandemic period. There are few studies on healthcare professionals working in dialysis units. This is a cross-sectional survey involving 215 healthcare professionals working in dialysis units. The sample of the study consisted of physicians, nurses and dialysis technicians working in dialysis units in different provinces of Turkey. In the research findings, it was determined that health professionals working in the dialysis unit had low levels of surface acting, moderate levels of deep acting, and high levels of natural feelings, burnout levels were low in all sub-dimensions and high level of psychological capital. A statistically significant relationship was found between emotional labor, burnout and psychological capital. This research shows that health workers with strong psychological capital can perform better emotional labor regulation and experience less burnout.

An Economic Approach to Human Resource Planning: Application of WISN for a Dialysis Centre Staffing

Background: By 2019, the estimated CKD prevalence in India was 7%–9%, and around 174,000 patients were on renal replacement therapy. India is likely to witness a rise in the number of patients with chronic kidney disease (CKD). Studies have identified that millions of people die of end-stage renal disease (ESRD) every year in the world, while poor infrastructure and deprived staffing are affecting dialysis access for patients. Inadequate staffing has proven to cause burnout and therapeutic errors which affect the quality of care and increase the financial burden of the illness. Optimal human resources planning is, hence, inescapable for healthcare quality, low attrition and economic viability to patients. With that premise, this study was carried out to ascertain the staffing of a dialysis centre. Methods: We have applied the workload indicator of staffing needs (WISN) method to estimate staffing for a six-bedded dialysis centre of a public sector hospital in Pune, India, with the aim to improve healthcare delivery. Results: The staffing requirement was conclusively calculated to be more than the current employment of two dialysis technicians. Conclusion: Additional employment would prevent staff fatigue and improve hospital operations, reducing the cost burden, enhancing patient safety and improving healthcare indices. The WISN method can be used to assess accurate healthcare staffing and is recommended for all healthcare facilities.

Work Experiences and Turnover Intention Among US Dialysis Technicians: A National Association of Nephrology Technicians/Technologists (NANT) Survey

Work Experiences and Turnover Intention Among US Dialysis Technicians: A National Association of Nephrology Technicians/Technologists (NANT) Survey

Professional Fulfillment and Burnout Among US Dialysis Technicians: A National Association of Nephrology Technicians/Technologists (NANT) Survey

Professional Fulfillment and Burnout Among US Dialysis Technicians: A National Association of Nephrology Technicians/Technologists (NANT) Survey

Accessibility and quality of haemodialysis services in an urban setting in South India: a qualitative multiperspective study

ObjectiveTo explore the accessibility and quality of existing haemodialysis services in an urban setting.SettingThe study was conducted in Bangalore city, India.ParticipantsA total of 28 stakeholders including 2 nephrologists, 7 duty...

Using Focus Groups to Understand Dialysis Staff Perspectives on Delivering Transplant Education.

Kidney transplant education in dialysis facilities could be optimized with internet resources, like videos, but most qualitative research predates widespread availability of online video education about kidney transplantation. To improve understanding of dialysis staff transplant education practices, as well as the potential value of video, we conducted focus groups of dialysis center staff members in Buffalo, NY. Seventeen focus groups (97 participants: 53 nurses, 10 dialysis technicians, 6 social workers, 6 dieticians, 7 administrative personnel, 2 trainees, and 1 insurance coordinator) from 8 dialysis facilities in Buffalo, NY, were conducted, audio-recorded, transcribed, and analyzed. After thematic data analysis, a diverse patient and caregiver community advisory board was invited to comment, and their voices were integrated. Findings: Five key themes were identified that captured barriers to transplant education delivery and how online video could be a facilitator: (1) delivery of transplant education was reliant on one person, (2) other dialysis staff had time to answer transplant questions but felt uninformed, (3) patient lack of interest in existing supplementary transplant education, (4) patient disinterest in transplantation education was due to education timing, feeling overwhelmed, and transplant fear/ambivalence, and (5) video education could be flexible, low effort, and spark transplant interest. Study limitations are potential selection bias and inclusion of English-speaking participants only. Dialysis staff barriers of time, insufficient knowledge, and limited resources to provide education to patients and their care partners may be mitigated with online educational videos without increasing staff workload.

Prevalence and Influencing Factors of Anxiety in Healthcare Professionals in Hemodialysis During the COVID-19 Pandemic

Objective: During the COVID-19 pandemic, working in hemodialysis (HD) can be a source of anxiety. In this study, the anxiety status of HD healthcare professionals (HCPs) during the COVID-19 pandemic and the associated factors were investigated. Materials and Methods: The data were collected through a web-based questionnaire. The questionnaire consisted of 3 parts: (1) demographic features, (2) questions about the causes and consequences of anxiety, and (3) general anxiety disorder-7 survey. Results: One hundred eighty-three HCPs completed the survey, mostly nurses and dialysis technicians (71.6%). Two-thirds of the participants stated that preventive measures increase workload and cause physical harm (68.3%, 62.3%). One-third of participants reported a lack of communication with the patients and a decrease in desire to work (31.1%, 35.6%). A-moderate-severe anxiety was detected in 24.6%. Physical contact with infected people, being physically harmed by -preventive measures, decreased desire to work, and a lack of communication with the patients were found to be -significantly more in participants with anxiety (P = .036, P < .001, P < .001, P < .001). In multivariate analyzes, being -physically harmed by preventive measures was the only risk factor for anxiety (OR = 7.423, CI: 2.050-26.877, P = .002). Conclusion: During the pandemic period, anxiety was observed in one-fourth of HCPs. Being physically harmed by preventive measures is the only risk factor for anxiety.

Skin Darkening in COVID-19 Patients: Case Series of Eight Patients in a Hemodialysis Unit.

The Pandemic of COVID-19 has grasped the whole world and changed dramatically, together with our social, occupational and personal life with high mortality and morbidity with other consequences since December 2019 started from Wuhan and then declared pandemic in March. It has been observed to involve every organ of the body including skin. Various skin manifestations, but most cases reported were like urticarial rash, xanthemas, chickenpox-like vesicle, vasculitidic type, pressure sores, contact dermatitis and a single case was reported in china with skin darkening. The COVID-19 and cutaneous manifestations are recognized by physicians and dermatologist treating COVID-19. We have observed around eight cases of COVID -19 who had skin darkening in our center Baluchistan Institute of Nephrology and Urology Quetta, among these included were six dialysis technicians one chronic maintenance dialysis patient and a physician. We present the representative cases and discuss the skin manifestations of COVID-19.

P1492HUMAN FACTORS TESTING OF THE QUANTA SC+: DEMONSTRATING EASE OF USE WITH MINIMAL UPFRONT TRAINING IN HEALTH CARE PRACTITIONERS AND PATIENTS

Abstract Background and Aims Quanta Dialysis Technologies has developed a compact, powerful personal haemodialysis system intended for home and self-care use designed in collaboration with patients and healthcare practitioners. Human factors testing is necessary to demonstrate ease of use with minimal up-front training. Method In compliance with FDA guidance and EU standards, the user interface of the system was evaluated through human factors testing to assess the safe and effective use of SC+. This included a series of user-based tasks whereby representative users independently setup SC+ into a simulated treatment, managed alarms to resolution and external SC+ cleaning/disinfection. All participants received an introduction to SC+ and completed a competency sign off at the end of training. 17 healthcare professionals (6 renal nurses, 8 dialysis technicians, 1 patient care technician) received up to 4 hours of structured training followed by a 1-day learning decay period. In addition, 10 lay users (8 dialysis patients, 2 caregivers) received between 5.5 and 7.5 hours training followed by a 2-day learning decay period. Results Between the two user groups, there were a total of 8,110 opportunities for use errors to occur. Despite minimal training and representative learning decay, only 4 significant use events were observed requiring some user manual enhancements. Other use errors captured were minor or could not be mitigated further due to clinical practices and shared inherent risks across all haemodialysis systems. Conclusion The results of the human factors testing demonstrated that healthcare practitioners, patients and caregivers successfully operated SC+ independently with a high level of use safety, despite minimal training and learning decay. The SC+ user interface is optimized for safe and effective use under FDA guidance and EU standards.

P1538AN EXPERIENCE OF FORCED SHUTDOWN OF HEMODIALYSIS UNIT IN SOUTHERN INDIA DUE TO FLOODS

Abstract Background and Aims The southern state of India, Kerala was hit by the worst flood in the last century on 16.08.18, due to unprecedented monsoon rains. The Indian government had declared it a Level 3 Calamity. According to the Kerala government, over 483 people died, about a million people were evacuated. This paper describes the experience of the Hemodialysis (HD) unit at Aster Medcity, which was forcibly closed due to floods. The Nephrology department does over 1100 dialysis treatments per month and about 60 kidney transplants per year. Aim To study unexpected shutdown of hemodialysis unit and its effect on maintenance hemodialysis patients. Method This is a descriptive study of forced closure of HD unit due to floods. The sequence of events till shut down after the decision of closure has been retrospectively studied by reviewing the minutes of meetings with chief of medical services and memory recall of the Nephrology team involved in the process. Role of HD nurses during the period of flood was also studied. HD patients were interviewed and impact of floods on them was recorded, including, ability to find an alternate HD unit, any missed HD sessions, access to medicines and admissions in hospital. The characteristics of HD patients was recorded. After reopening of our HD unit, 30days assessment was done for clinical consequences including, hospitalization, infections, vascular access problems and seroconversion. Results The services of HD unit were suspended from midnight 17.08.18 to 27.08.18. The HD unit is at the ground floor of the hospital. The HD unit has 13 HD machines, which were used for 77 maintenance HD patients (Males: 55; Females: 22). The mean age was 61 ±14 years and the median dialysis vintage was 2 years. Vascular access was a catheter (tunnelled and non-tunnelled) in 19 patients, arterio-venous fistula in 57 patients and arterio-venous graft in 1 patient. Patients known to have Diabetes were 77.7%, Hypertension 91%, Coronary artery disease were 26 in number and chronic liver disease were 5. Hospital authorities decided to evacuate the hospital 24 hours before the floods hit the hospital premises. The Nephrology team comprised of 4 consultants, 6 residents, 33 dialysis nurses and technicians and a social worker. The HD unit was closed after draining the reverse osmosis (RO) plant at 10pm on 16.08.18. The lead consultant contacted potentially safe HD units in other parts of the state; willingness for accepting HD patients and the surge capacity of each HD unit was recorded. The HD patients were informed over telephone the centers they can approach and HD summary (includes diagnosis and HD details) was sent to them via e-mail. All HD patients were reminded to comply with diet restrictions and inform the shelter camp regarding the same. Accordingly, 77 HD patients were accommodated in 25 HD units. 12 dialysis nurses provided their services voluntarily at other HD units unaffected by floods. 15 HD patients were displaced from their homes due to floods. 19 HD patients missed one HD session; 5 HD patients missed two HD sessions; 1 patient missed three HD sessions. Our HD unit reopened on 27.08.18 after complete disinfection of the RO plant and servicing of HD machines by the manufacturer. All patients returned to our HD unit. In the first 30 days after floods, 3 patients were admitted to intensive care unit with fluid overload, 3 patients were admitted with respiratory tract infection, 2 patients had an AV fistula dysfunction, 3 patients developed catheter related blood stream infection. There was no seroconversion. There was no mortality in HD patients during and one month after flood. Conclusion The timely decision to suspend dialysis services played a crucial role in preparing for HD unit closure, arranging alternate HD places for patients and providing treatment summaries. However, the increase in adverse clinical consequences heralds the drop in the quality of healthcare services during natural disasters.

Ultrasound-based simulation for cannulation in outpatient hemodialysis units: An educational protocol.

Portable ultrasounds are often referred to as the "new stethoscope." Their portability and affordability have led to improved diagnostic capabilities at the point of care in virtually every field of medicine, and hemodialysis access is no exception. However, though ultrasonography is increasingly used throughout the spectrum of hemodialysis access, its role in outpatient dialysis units in the United States has been limited so far. This may, in part, be due to limited ultrasound exposure, knowledge, and training of dialysis staff. This article details an educational protocol including hands-on simulation for training dialysis technicians and nurses in ultrasound-guided cannulation techniques.

Provider Attitudes and Support of Patients' Autonomy for Phosphate Binder Medication Adherence in ESRD.

This cross-sectional study of 56 dialysis providers from 3 dialysis clinics examined providers’ attitudes and perception of autonomy support for patients’ medication adherence behaviors. Respondents completed surveys assessing attitudes and perception of autonomy support. Compared to all other provider types, physicians and nurse practitioners (MD/NP) thought it was “less true” that phosphate binder medications are very important for dialysis patients (MD/NP vs others: 5.1 [1.4] vs 6.1 [1.1]; P = 0.02). More dialysis technicians (19%) offered the highest level of support. Attitudes and perception of autonomy support for medication adherence are suboptimal, vary by dialysis provider type, and are targets for quality improvement in dialysis care. This study addresses critical gap in existing knowledge about these two novel provider-based psychosocial factors and their potential impact on phosphate binder medication adherence.

Knowledge and practices about hemodialysis among dialysis technicians in western part of India

Introduction: Chronic kidney disease (CKD) is a global health burden with a high economic cost to health systems. Objectives: To determine the knowledge and practices regarding end-stage renal disease and hemodialysis (HD) among dialysis technicians. Patients and Methods: Total of 157 technicians participated in a study carried out at Ahmedabad city of Gujrat state. A validated written questionnaire was distributed among dialysis technicians who gave their consent to participate in the study and responded questionnaires were analyzed. Data entry was made in Excel software in codes and analysis was conducted by SPSS software version 17.0 Results: Out of 157, 113 participants were routinely using online clearance monitoring. Around, 19.1% carried out disinfection of water loop once per week, while 23.6% and 28% were doing it once in 15 days and 30 days respectively. Reverse osmosis (RO) plant parameters like pH, hardness of water, chlorine content were checked once daily by 46.5% of technicians while 17.8% and 24.2% technicians were doing it once a week and once a month respectively. About 87.3% of technicians said that dialyzer was reused at their center. Accordingly, 33.8% and 51.6% of technicians were using formalin and per-acetic based disinfectants for dialyzer reprocessing. Additionally 7.6% of technicians were using hypochlorite as disinfectant at their center. Around 63.7% of technicians said they were not reprocessing dialyzers of HCV positive patients. They preferred to use single dialyzers in these subsets of patients at their center. Around, 79.6% of technicians said that endotoxin filter was installed in their dialysis unit. Likewise, 45.9% knew correctly the permissible level of endotoxin in RO water used for HD. Only 15.3% of technicians had correct knowledge of permissible level of bacteria in treated RO water as per association for the advancement of medical instrumentation (AAMI) standards. Conclusion: Better knowledge and awareness about dialysis standards among dialysis technicians will help in better patient’s care. Effective dialysis education campaign needs to be driven at regular intervals with relevant information among dialysis technicians to address the knowledge gap.

IFT05. Outcomes of Basilic Vein Transposition: Challenges in an Indian Setting

Basilic vein transposition (BVT) is performed after other native access options are exhausted. Based on the numbers that we perform and vein maturation, we would expect good patency. The objective of this study was to understand the patency of BVT in our practice and the adequacy of surveillance. This was a retrospective study. All patients who underwent BVT between January 2015 and December 2016 were included. Patients who did not attend follow-up clinic were contacted by telephone. Data regarding patient demographics, previous vascular access, dialysis status, postoperative complications and patency (primary, primary assisted and secondary patency rates) at one year and two-year intervals were collected. There were 126 BVTs performed in 125 patients. Mean age of patients was 53 years (range, 16-82 years) and 78 patients (62.4%) were male. All patients had multiple failed native arterial fistulas before BVT. Two patients were in predialysis status and the others were on dialysis using tunneled central lines. BVT was performed as single-stage procedure in all patients. Three patients (2.4%) died and one patient underwent renal transplant within the first 30 days. Only 18% of the patients attended the scheduled follow-up visits. Of 122 procedures, 115 (94.3%) resulted in a mature fistula. At the 1-year follow-up, 38 patients were lost, 19 patients were dead, and 4 patients had renal transplant. At 1 year there were 65 (52%) eligible patients for analysis, of which 8 patients had ligation of the transposed basilic vein for pseudoaneurysm/bleeding complications and the primary patency was 49.2%, primary-assisted patency 56.9%, and secondary patency was 66.1%. At 2 years an additional 10 patients died and 3 patients had renal transplant. At 2 years there were 52 eligible patients (41%) for analysis, out of which the primary patency was 38.5%, primary-assisted patency was 42.3%, and secondary patency was 59.6%. Surveillance was inadequate because patients were being dialyzed at other centers and in other cities. Dialysis technicians and nurses often failed to recognize failing fistulas. BVT can be performed safely with good maturation in majority of the patients. However, inadequate surveillance and maintenance of fistulas can result in reduced 1- year and 2-year patency rates. A patient-centered approach with communication and education of patients, dialysis technicians, nephrologists and vascular surgeons could improve the patency rates.

Reflections on My Lifetime Teacher: Dr. Willem J. Kolff.

Reflections on My Lifetime Teacher: Dr. Willem J. Kolff.

My path as a clinical engineering technologist -On the conflict until one dialysis technician becomes the chief of the clinical engineering department of the university hospital-

My path as a clinical engineering technologist -On the conflict until one dialysis technician becomes the chief of the clinical engineering department of the university hospital-

Prediction of Arteriovenous Fistula Dysfunction: Can it be Taught?

Physical examination (PE) is an excellent means of predicting arteriovenous fistula (AVF) dysfunction. Although quick and inexpensive, PE is seldom used as a tool to assess stenosis by general nephrologists, dialysis nurses, and dialysis technicians. Previous studies have demonstrated that PE can be taught to interventional specialists, but the perception remains that it is too complex to be performed by other health care professionals. We hypothesized that the physical exam can be taught to a nonmedical professional, and that, with time, it would be comparable to the physical exam performed by a full-time interventional specialist. An undergraduate student and an interventional specialist (MD) examined AVF for dysfunction in a tertiary care hospital over a 6-month period. PE was performed on patients who were suspected of having dialysis access dysfunction and were referred for angiography and intervention (n=49). Physical exam findings were categorized blindly by each examiner into four categories of lesion location: inflow, outflow, both, or neither. Data were privately recorded and compared to the gold standard of angiographic results. Potential confounding variables, including age, gender, diabetic status, and location of AVF were recorded. Weighted Cohen's kappa value was used as a measurement of the level of agreement beyond chance between the diagnoses made by physical exam and angiography. The full-time interventional specialist demonstrated correct prediction of lesion location of 89.8% (kappa=0.850), while the undergraduate student had a correct prediction of 77.6% (kappa=0.625). The student's performance, however, differed significantly over time. The student correctly predicted the location of the lesion in 6 (42.9%) of the first 14 patients (kappa=0.082), compared to 32 (91.4%) of the last 35 patients (kappa=0.855). We suggest that physical exam of AVF can be taught to a nonmedical professional in a short duration of time and the predictive value of the exam can be similar to that of an interventional specialist.