Hospital-Based Nocturnal Hemodialysis—A Novel Approach to Solving Old Problems

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Abstract:

It is unlikely that there is a solitary hospital-based dialysis unit that can claim an unlimited amount of available chronic spots. Many units, in fact, constantly face a problem of overcrowding, long patient waiting lists, and ongoing shortages of nurses trained in highly specialized areas such as dialysis. In addition, conventional dialysis does not afford the best outcomes to patients with lifestyle, fluid control, hypotension, or hypertension issues. Objective: 

We developed an in-hospital nocturnal program with the goal of solving some of these issues related to wait lists, overcrowding, and shortages of trained hemodialysis nurses. Method: 

In the first year, a four-bed room was converted into a 4 station unit. Nurses from the 24 bed in-patient Nephrology/Urology/Ophthalmology unit were trained to perform hemodialysis. Stable, hospitalized dialysis patients or in-center dialysis patients were selected if they met criteria drawn up by the medical director. Staffing for the unit was established at 3 : 1 or 4 : 1 patient to nurse ratio. Support staff included a hemodialysis-trained ward nurse with an assignment of 5–6 hospitalized patients. Back-up support included assistance with trouble-shooting and break coverage for the nocturnal nurse. Results: 

We currently have 12 nurses from the ward trained to do hemodialysis. The nocturnal unit has been operating 3 nights/week, with plans to expand to 6 nights/week within the year. We have 3 patients on the program with plans to increase to 6–8 patients as more nurses are trained. Initiation of hospital-based nocturnal hemodialysis has led to the opening of in-center dialysis spots as well as shortening wait periods for patients in the Pre-Renal Clinic, awaiting initiation of chronic dialysis. This model has also provided the in-center dialysis unit with a greater pool of skilled hemodialysis nurses to draw from during shortages. Anecdotal reports from patients indicate that they feel much better, and 1 patient no longer requires antihypertensives for their blood pressure control. Conclusion: 

We conclude that hospital-based nocturnal hemodialysis is a novel and extremely viable solution for many of the issues facing dialysis units today.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1492-7535.2004.0085bq.x

Affiliations: St. Michael's Hospital, Toronto, Ontario, Canada.

Publication date: January 1, 2004

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