The document discusses the process of selecting patients for continuous peritoneal dialysis. It describes the process as involving 6 key steps:
1) Identifying all potential candidates for peritoneal dialysis.
2) Assessing patients' eligibility and any medical contraindications.
3) Offering eligible patients the choice of peritoneal dialysis.
4) Having patients choose their preferred modality.
5) Placing peritoneal dialysis catheters in patients who choose this modality.
6) Successfully initiating peritoneal dialysis treatment.
Problems at any step, such as delays or patients changing their minds, can reduce the number of patients who ultimately start peritoneal dial
خلاصه:
دیالیز صفاقی یکی از روش های درمانی جایگزین در کودکان با نارسایی مزمن و شدید کلیه می باشد . روش ساده ای است که بدون وابستگی به مرکز میتوان در منزل انجام داد و به فعالیتهای معمول ادامه داد. در این روش کاتتر دیالیز که تنکوف می باشد و معمولا انتهای پیچ خورده ای دارد و گردن خروجی ان به صورت خمیده می باشد به روش جراحی یا در کنار تخت بیمار کاتتر وارد شکم و به طرف پشت مثانه هدایت می شود. در کودکان به منظور جلوگیری ازانسداد کاتتر ، امنتکتومی صورت میگیرد. معمولا دوهفته بعد از کاتتر گذاری می توان دیالیز را شروع کرد. محلول دیالیز صفاقی خاصیت اسموتیک بالا دارد و عمدتا دارای قند بالا می باشد . قند موجود در مایع دیالیز کمک می کند تا آب و املاح براساس خاصیت اسموتیک از خون به حفره صفاق جابجا شوند، براساس خاصیت انتشار اوره و کراتینین ، فسفر و پتاسیم جابجا میشوند تا به تعادل برسند. حجم مایع دیالیز معمولا 1100 سی سی به ازای هر متر مربع در کودکان بالای یکسا ل و 600 سی سی به ازای هر متر مربع بدن در کودکان زیر یکسال می باشد. بهتر است دفعات تجویز مایع دیالیز با اندازه گیری تست تعادل پریتوئن صورت گیرد. به منظور جلوگیری از بروز فتق ویا نشت بهتر است حجم مایع تجویز شده با اندازه گیری فشارداخل شکم کنترل شود. وفشارداخل شکم کمتراز 18 سانتی متر آب نگهداشته شود. عوارض دیالیز صفاقی به عوارض عفونی ( پریتونیت ، عفونت محل خروج کاتتر و یا تونل) و حوادث غیر عفونی شامل بروز فتق ، نشت مایع دیالیز ، تجمع مایع د رفضای پریتونئال ، جابجایی کاتتر دیالیز صفاقی ، چسبندگی وانسداد ونهایتا فیبروز اسکلروزه پریتوئن می باشد. درکودکان توجه به دریافت مناسب کالری متناسب با سن برای رشد قدی و وزنی ضروری است.
خلاصه:
دیالیز صفاقی یکی از روش های درمانی جایگزین در کودکان با نارسایی مزمن و شدید کلیه می باشد . روش ساده ای است که بدون وابستگی به مرکز میتوان در منزل انجام داد و به فعالیتهای معمول ادامه داد. در این روش کاتتر دیالیز که تنکوف می باشد و معمولا انتهای پیچ خورده ای دارد و گردن خروجی ان به صورت خمیده می باشد به روش جراحی یا در کنار تخت بیمار کاتتر وارد شکم و به طرف پشت مثانه هدایت می شود. در کودکان به منظور جلوگیری ازانسداد کاتتر ، امنتکتومی صورت میگیرد. معمولا دوهفته بعد از کاتتر گذاری می توان دیالیز را شروع کرد. محلول دیالیز صفاقی خاصیت اسموتیک بالا دارد و عمدتا دارای قند بالا می باشد . قند موجود در مایع دیالیز کمک می کند تا آب و املاح براساس خاصیت اسموتیک از خون به حفره صفاق جابجا شوند، براساس خاصیت انتشار اوره و کراتینین ، فسفر و پتاسیم جابجا میشوند تا به تعادل برسند. حجم مایع دیالیز معمولا 1100 سی سی به ازای هر متر مربع در کودکان بالای یکسا ل و 600 سی سی به ازای هر متر مربع بدن در کودکان زیر یکسال می باشد. بهتر است دفعات تجویز مایع دیالیز با اندازه گیری تست تعادل پریتوئن صورت گیرد. به منظور جلوگیری از بروز فتق ویا نشت بهتر است حجم مایع تجویز شده با اندازه گیری فشارداخل شکم کنترل شود. وفشارداخل شکم کمتراز 18 سانتی متر آب نگهداشته شود. عوارض دیالیز صفاقی به عوارض عفونی ( پریتونیت ، عفونت محل خروج کاتتر و یا تونل) و حوادث غیر عفونی شامل بروز فتق ، نشت مایع دیالیز ، تجمع مایع د رفضای پریتونئال ، جابجایی کاتتر دیالیز صفاقی ، چسبندگی وانسداد ونهایتا فیبروز اسکلروزه پریتوئن می باشد. درکودکان توجه به دریافت مناسب کالری متناسب با سن برای رشد قدی و وزنی ضروری است.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/JQllk5Ad07E
Arabic Language version of this lecture is available at:
https://youtu.be/KXlJoMDi3ko
- Visit our website for more lectures: www.NephroTube.com
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Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
Peritoneal Dialysis – Procedure and Recovery.pdfMeghaSingh194
The kidney failure treatment known as Peritoneal Dialysis (PD) is a type of dialysis. The lining of the peritoneal cavity (the abdominal cavity) serves as the membrane through which excess fluid and waste are expelled. Let's explore more: https://www.southlakegeneralsurgery.com/peritoneal-dialysis-procedure-and-recovery/
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/JQllk5Ad07E
Arabic Language version of this lecture is available at:
https://youtu.be/KXlJoMDi3ko
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
Peritoneal Dialysis – Procedure and Recovery.pdfMeghaSingh194
The kidney failure treatment known as Peritoneal Dialysis (PD) is a type of dialysis. The lining of the peritoneal cavity (the abdominal cavity) serves as the membrane through which excess fluid and waste are expelled. Let's explore more: https://www.southlakegeneralsurgery.com/peritoneal-dialysis-procedure-and-recovery/
Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can no longer do the job adequately.
A cleansing fluid flows through a tube (catheter) into part of your abdomen and filters waste products from your blood. After a prescribed period of time, the fluid with filtered waste products flows out of your abdomen and is discarded.
Peritoneal dialysis differs from hemodialysis, a more commonly used blood-filtering procedure. With peritoneal dialysis, you can give yourself treatments at home, at work or while traveling.
Urgent-start peritoneal dialysis is generally reserved for patients who have no plan for dialysis modality, but are considered good candidates for peritoneal dialysis.
Sonia Journal club presentation (2).pptxpalsonia139
Title: Application of Checklist-Based Nursing Care Process in Patients Undergoing Intervention for Coronary Chronic Total Occlusion: A Quasi-Randomized Study
Presenter: Sonia Pal, M.Sc. Nursing 2nd Year
Journal: BMC Nursing (2023)
Authors: Xia Ge, Haiyang Wu, Zhe Zang, and Jiayi Xie
DOI: 10.1186/s12872-023-03627-8
Study Overview:
This presentation focuses on the effectiveness of a checklist-based nursing care process for patients undergoing interventions for coronary chronic total occlusion (CTO). The study employs a quasi-randomized design to assess improvements in patient care outcomes.
Key Points:
Background: CTO interventions are complex, and traditional nursing methods have not been highly effective, necessitating the exploration of new approaches.
Objective: To investigate the effectiveness of a checklist-based nursing care process in improving care quality, reducing patient anxiety, increasing patient satisfaction, and minimizing adverse events.
Methodology:
Design: Quasi-randomized study
Setting: Department of Cardiology, Shengjing Hospital, China Medical University, Shenyang, China
Participants: 120 patients undergoing CTO interventions
Groups: Intervention group (checklist-based care) and control group (standard care)
Tools: Preoperative and postoperative PCI nursing care checklists, Zung Self-Rating Anxiety Scale, satisfaction questionnaires for doctors and patients
Ethical Considerations: The study adhered to the Declaration of Helsinki, with informed consent obtained from all participants.
Results: The study aimed to demonstrate that checklist-based nursing care could enhance nursing efficiency and patient outcomes compared to conventional methods.
Quality Control: A quality control team ensured adherence to the checklist and study protocol, with regular training and supervision of nursing staff.
Conclusion:
The presentation concludes with findings supporting the effectiveness of checklist-based nursing care in CTO interventions, suggesting improvements in patient care processes and outcomes. The study highlights the importance of structured nursing protocols in complex medical procedures.
Part II: DCIS Research: De-escalating the Fear of Recurrencebkling
Ductal carcinoma in situ (DCIS) can be treated with surgery, or with Active Monitoring for low-risk DCIS. Chemotherapy is not needed, although sometimes radiation or hormone therapy are suggested. Most DCIS never develops into an invasive cancer. In part 2 of the DCIS webinar series, we discuss where research is taking us. For those who have already received treatment and surgery, this will be essential information to learn and share with family and friends so they know their level of risk too. You can also share this information with your medical team to help them keep up with the latest DCIS research and care.
Our panelists, Dr. Shelley Hwang and Deborah Collyar, discuss ways to de-escalate the fear of recurrence and ways to ensure decisions are made without fear.
Randomized Control Trials
Enigma of Blinding Unraveled
Introduction
RCT
Steps in a RCT
Allocation Concealment
Bias in RCT
Phases in RCT
Types of RCT
Study Designs of RCT
Blinding
Methods of Blinding in different trials
Assessment of Blinding
Un-blinding
Current Scenario of Blinding
CONSORT
Conclusion
References
Defibrillation strategy for refractory Ventricular fibrillation.pptxAhmed Lotfy
The objective of this trial (Double Sequential External Defibrillation for Refractory Ventricular Fibrillation [DOSE VF]) was to evaluate Double Sequential External Defibrillation (DSED) and Vector Change (VC) defibrillation as compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
1.4 modern child centered education - mahatma gandhi-2.pptx
peritoneal dialysis in children
1. ‘’ Selecting patients for continuous
peritoneal dialysis’’
Mitra Naseri
Associate professor
Pediatric nephrologist
Mashhad University of Medical Sciences
Mashhad, Iran
2. What is Peritoneal Dialysis?
❖ Peritoneal Dialysis (PD) is a treatment that utilizes the
peritoneum, as a filter to remove wastes from the
body. This type of dialysis requires a care partner to help
with the process.
❖ The peritoneum does a similar job as the dialyzer on a
dialysis machine during treatment or that the kidneys do
every day.
❖ Waste products and fluid pass through the membrane into
dialysate (dialysis fluid) and the fluid is drained with the
waste products.
3. ❖ To prepare for PD therapy, patients need to undergo a
small surgical procedure to have a catheter inserted into
the abdomen.
❖ The catheter is a small rubber tube that is placed into
the wall of the abdomen and secured using Dacron
cuffs.
❖ Generally, two cuffs are used in adults and they help
secure the catheter and prevent some forms of
infections.
Peritoneal Dialysis Catheter
4. ❖ The surgery can be done percutaneous, through a
laparoscopic surgery or an open surgical route.
❖ Laparoscopic surgery is a minimally invasive technique
when the operation is performed through a small incision.
A laparoscope (type of small camera) is used to view the
operation site and place the catheter.
Catheter placement
5. ❖ involves a guidewire being placed inside of tube. The
guidewire is then used to place the catheter into the
correct spot and a tunnel is made under the skin to the
exit site. This is also a less invasive technique, but
could have complications due to the nature of the
surgery.
Percutaneous surgery
6. ❖ A scalpel is used to make a tiny incision through
the skin and muscle of the abdomen. The “open”
area allows the surgeon to place the catheter and
the wound is stitched around it.
Open surgery
7. ❖ There are two types peritoneal dialysis:
Continuous-Cycler Assisted Peritoneal Dialysis
(CCPD)
Continuous Ambulatory Peritoneal Dialysis
(CAPD)
Types of Peritoneal Dialysis
8. CAPD
❖ CAPD is a method of performing peritoneal
dialysis exchanges using gravity to drain and fill
the peritoneal membrane with solutions four
times each day.
❖ It usually takes about 30 minutes to complete an
exchange. The patients are free to be active during
each dwell.
9. ❖ CCPD is a method of performing peritoneal dialysis
exchanges using a machine called a cycler during
the sleeping hours.
❖ Generally, three to five exchanges are done each
night.
❖ This program frees up your daytime hours.
❖ Each nightly session lasts at least eight to ten hours.
CCPD
10. 1) Adequate clean space to do the exchanges
❖ The room or area you choose shouldn’t have a lot of
traffic in or out, shouldn’t have open windows and
should if possible have enough room for your other
peritoneal dialysis (PD) supplies.
❖ You will need space for around 30 boxes of
supplies.
❖ The boxes do need to be kept in a dry space.
Equipment needed for PD
11. 2) Equipment needed for doing a clean dialysis
❖ A chair for doing exchanges.
❖ A table with a clean surface to perform an
exchange.
❖ Toilet: used to dispose of dwell waste products.
❖ I.V. pole: or any other surface used to hang your
dialysate bags from.
❖ Heating pad: to bring the dialysate up to body
temperature scale .
12. ❖ Disinfectant: used to keep patients and the
work surfaces clean.
❖ Masks: needed for patients and the partner to
minimize the risk of infection.
❖ Dialysis supplies (bags of dialysate, waste bags,
connection devices).
❖ Supplies for documenting the care such as
paper and pencil or a computer document.
19. ❖ The process of modality selection and how it works is
a critical determinant of peritoneal dialysis (PD)
utilization.
❖ This process can be break down into 6 steps and point
out how problems at each step can significantly reduce
the proportion of end-stage renal disease patients
initiating PD.
Perit Dial Int 2013; 33(3):233-241
Peritoneal dialysis and the
process of modality selection
20. ❖ All patients initiated on dialysis with a diagnosis
of ESRD.
❖ All patients receiving outpatient dialysis.
❖ All patients with more than 30 consecutive
days of dialysis dependence, even if they have a
presumed diagnosis of acute kidney injury
❖ All patients with a failed graft requiring dialysis
STEP 1:
Identification of all Potential candidates for PD
21. ❖ When patient defined as a potential PD candidate, the
medical team has to assess that patient’s eligibility to do
PD.
❖ Ideally, this assessment will have been made in the CKD
clinic, long before initiation of dialysis.
❖ It should be noted that this assessment is not an issue of
the patient choosing or not choosing to do PD, but rather
of whether the team has considered the patient to be
eligible for, or capable of doing PD.
STEP 2: assessment for PD eligibility
22. ❖ A contraindication is a factor that absolutely disqualifies
the patient from doing PD regardless of physician or patient
choice.
❖ This step requires an assessment of any contraindications
or barriers to the PD .
❖ Barrier can be overcome if sufficient supports are available
to the patient.
❖ In other words, barriers are really obstacles to self-care
rather than to PD per se.
23.
24.
25. Step 3:
Offer of modality choice to the PD-eligible patient
❖ Each eligible patient should be offered the
opportunity to do PD.
❖ Ideally, this “choice” is offered as part of a
modality education process that might include
group lectures, peer education, videos, and web
sites.
❖ Again, ideally, the choice and associated modality
education should have been presented before
dialysis initiation.
26. Step 4: patient choice
❖ Once eligible patients are offered a modality choice,
most studies suggest that approximately half will
select PD.
❖ Some patients in the CKD clinic may persistently
refuse to attend modality education classes or to make
a modality choice.
❖ Some may wish to defer that decision to the
nephrology team.
❖ Others may be in a state of denial and may feel too
overwhelmed to make any decision.
❖ In these situations, it might be best for the team to
make the decision for the patient, perhaps in
consultation with family members.
27. ❖ If less than a third of patients considered eligible
for PD eventually choose the modality, it suggests
that insufficient opportunity and encouragement to
do PD is being provided.
❖ Conversely, if more than two thirds choose PD, it
suggests that patients are being aggressively pushed
to choose the modality, which may be similarly
undesirable.
❖ A 50% choice for PD among eligible candidates is
typical of a center providing a balanced approach.
28. Step 5: PD Catheter Placement
❖ A significant proportion of patients who choose to do PD
after being offered an informed choice never undergo
catheter insertion and eventually start on HD.
❖ Long wait lists to see the surgeon who places PD catheters,
rapidly renal function deterioration than expected, and dialysis
must be initiated relatively urgently are responsible factors .
29. Step 6: Successful initiation of PD
❖ A significant proportion of patients who undergo a PD
catheter placement attempt do not succeed in
becoming successful home PD patients.
The major possibilities are :
1) Catheter insertion is unsuccessful
2) Catheter itself does not function adequately to allow
home PD. Catheter non-function rates of 10 – 15% are
not unusual, though good centers will report rates of
less than 5%.
❖ About half the cases of inadequate function will
respond to corrective measures, but the others will be
lost permanently to PD, either because the problem
persists or because the patient refuses the required
interventions.
30. 3) The training itself fails because the patient or family
member is found to be unable or unwilling to learn to carry
out the required procedures in a safe manner.
4) Patients change their mind or experience an unexpected
change in health status between catheter insertion and PD
training.
❖More than 85% of patients who have an attempted PD
catheter placement should eventually do home PD
successfully.
❖ Anything less reflects a problem with either catheter
placement or the original assessment of patient eligibility.
32. Process Summary
❖ Ideally, the 6 steps we have described should occur in
order, leading to elective initiation of the preferred
modality of dialysis. However, in patients starting
dialysis urgently, the sequence of steps may change.
❖ Identification as a candidate, assessment for eligibility,
and patient choice might follow rather than precede
initiation of dialysis.
❖ The initial modality will typically be HD because only
rarely do programs use PD in urgent dialysis starts.
❖ The “urgent start” group is a large proportion of all
ESRD cases, at least 20- 40% and more than 60% if the
definition is expanded to include all inpatient starts.