Background and objectives: Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmarkguided technique (ALT) for the femoral vein (FV).Design, setting, participants, & measurements: This was a randomized prospective study on 110 patients requiring FV DCs in a tertiary care hospital. Patients were randomized into two groups: USG and ALT. Data were collected on demography, operator experience, and side of insertion. The USG group had their catheters inserted under USG guidance, whereas the ALT group had their DC inserted by ALT. Outcome measures included successful insertion of DC, number of attempts, and complications.Results: Both groups were comparable regarding age and gender of patients, operator experience, and the side of catheterization. The overall success rate was 89.1%, with 80% using ALT and 98.2% under USG guidance (P ؍ 0.002). First attempt success rate was 54.5% in the ALT group as compared with 85.5% in the USG group (P ؍ 0.000). The complication rate was 18.2% in the ALT group and 5.5% in the USG group (P ؍ 0.039). The odds ratio (OR) for complications with two or more attempts was 10.73 with a relative risk (RR) of 3.2. The OR for successful insertion using USG was 13.5 (95% CI: 1.7 to 108.7).Conclusions: USG significantly improves success rate, reduces number of attempts, and decreases the incidence of complications related to FV DC insertion.
Background: Peritoneal dialysis (PD) affords patients increased independence and improved quality of life. However, the lack of more frequent monitoring may compromise outcomes and decrease wider uptake of this modality. This study uses a novel tablet computer-based interface to allow real-time monitoring and two-way communication to better link PD patients with a dialysis center and care providers. Methods: A tablet computer with an application that allows enhanced monitoring of all aspects of PD was given to patients to assess their usage in a pilot trial. The interface allows patients to review sterility techniques, enter vital signs and exchange data, upload media such as photos and video clips, synchronize data to be viewed by medical staff, and allow real-time adjustments to the PD prescription. Satisfaction with the interface and comments for enhancement were analyzed using a simple self-administered questionnaire. Results: Six continuous ambulatory PD patients were enrolled in this pilot study. A total number of 1,172 exchanges were recorded over a period of 251 days. Compliance with the applications ranged from 51 to 92%. No major adverse events were recorded. The overall impression of the interface was 5.2 out of 10. The major criticism was that the application needs to be adjusted depending upon the experience level of the patient and that data entry needs to be simplified and automated. Conclusion: A tablet computer platform is a feasible concept for continuous ambulatory PD. The major components include flexibility, advanced infrastructure, two-way communication, and real-time interaction. This may encourage more patients to take up PD as their preferred modality of therapy for end-stage renal disease. Modifications to enhance use will be incorporated in subsequent versions.
Background/Aims: Initiating renal replacement therapy in late referred patients with central venous catheter (CVC) hemodialysis (HD) causes serious complications. In urgent start peritoneal dialysis, initiating peritoneal dialysis (PD) within 14 days of catheter insertion still needs HD with CVC. We initiated Emergent start PD (ESPD) with Automated PD (APD) at our center within 48 h from the time of presentation. Methods: A prospective, case-controlled, intention-to-treat study with 56 patients was conducted between March 2016 and August 2017. Group A (24 patients) underwent conventional PD 14 days after catheter insertion. Group B (32 patients), underwent ESPD with APD. Exit site leak (ESL), catheter blockage, and peritonitis at 90 days were primary outcomes. Technique survival was secondary outcome. Results: Baseline characteristics were similar with 3 episodes of ESLs (9.4%) in the study group and none in the control group (p = 0.123). Catheter blockage (16.7%-Group A, 25%-Group B) and peritonitis (none vs. 9.4% in study group) were similar in terms of statistical details just as technique survival (95%-Group A, 88.2%-Group B at 90 days). Conclusion: ESPD with APD in the unplanned patient is an appropriate approach.
T elemedicine is the use of communication technology that may include a broad array of visual and audio platforms to allow the delivery of medical care at a distance from the healthcare provider. One of its goals and its greatest promise is the ability to deliver high-quality, affordable care to those individuals who, due to great distances or for other reasons, would not normally have access to such benefits (1). Such technology permits 2-way communication between the patient and medical staff over long distances with high fidelity and also allows the transmission of complex data such as medical records, images, audio, videos, and physical examination findings through devices such as electronic stethoscopes, ophthalmoscopes, and others. Over the last few decades, telemedicine platforms have become more widespread, and they now enable high-quality, cost-effective care in areas as diverse as cardiology, neurology, ophthalmology, dermatology, psychiatry, emergency medicine, etc. (2). This review describes telemedicine platforms used to support home dialysis therapies, specifically peritoneal dialysis (PD), which can support patients living in remote areas and help them maintain a good level of independence while ensuring good outcomes. As we have already learned from previous literature, PD has also been shown to be more affordable than hemodialysis (HD) in most parts of the world (3), especially in more developed countries like the USA and in European countries where HD is commonly reported to be 1.40-1.50 times the cost of PD. However, despite these advantages, PD is still quite underutilized. Published literature has indicated that lack of frequent nursing support, as there is in HD, less frequent interactions with the nephrologist, and lower levels of clinical oversight with PD than for in-center HD could be possible reasons for PD underutilization (4,5). We strongly believe that a well-designed telemedicine platform can help address these 'therapy gaps' by providing an improved level of 'virtual' support with embedded educational content that continually enforces proper technique. We speculate that such additions to a PD program can possibly lead to higher patient satisfaction, better comfort and, eventually, higher levels of acceptance of PD as a preferred form of renal replacement therapy (RRT). In fact, a few studies have already demonstrated that PD patients are willing to adopt such technology, with the belief that it could help simplify the therapy (6). BACKGROUND AN IDEAL TELEMEDICINE PLATFORM FOR PD An ideal telemedicine platform focused on PD would have several characteristics (Tables 1 and 2) (7). Firstly, the system
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