Expenditure survey on continued veno-venous hemodialysis procedure in the intensive care unit

Abstract

Dialysis treatment has also developed greatly, due to scientific and technological advances, and it has happened more and more frequently at ICUs.Since the advent of dialysis treatments andICUs, a steady increase in the severity of baseline diseases has been observed, which present AcuteRenal Failure (ARF) as an associated complication (1) . ARF, which affects patients hospitalized atICUs, presents a particular mortality and epidemiological profile (2) . The Brazilian Society of Nephrology (BSN) informs that these patients' mortality is close to 50% and that the condition of current patients with ARF is more severe than formerly (3) .Despite efforts and investments in the area, the mortality of patients with ARF in ICUs remains high.Renal substitution therapy is a complex procedure, demands precise equipment, specific material and duly trained professionals. It involves the multiprofessional ICU and Dialysis teams so that they can work together; because the first attends the patient directly and the later fully masters the specialty. Thus, the association between these parts is necessary in order to increase the actions' effect and save resources.The limited availability of resources is a serious problem that affects not only public hospitals, which makes it necessary to identify the costs in care delivery. CASES AND METHODThis is an exploratory, descriptive, retrospective, Thus, to calculate the nurses' labor cost in each procedure, the hour cost of R$ 22.50 was multiplied by the total hours of each procedure. Input cost calculationIn the analysis of each procedure registered on the patients' files, the quantities of material, medication and volumes of solutions used were computed and, next, this information was registered in a worksheet.Unit cost data of the inputs were obtained by consulting the Material Administration System (MCS), an internal computer system. Some medications and solutions produced in the Institutions were consulted directly at the Pharmacy Division.Three kinds of solutions can be used at the institution. Two are industrialized (peritoneal dialysis and lactate-based dialysis) and the other is prepared at the unit itself by the nurse who performs the procedure. Two kinds of solutions can be used for the anticoagulation: citrate and heparine solutions or, due to the patients' clinical condition, only washing the system with physiological solution more intensely, according to the medical prescription.Some standards were set for the charge of some inputs, for example: the infusion pump is changed every 72 hours, according to institutional routine; a piece of 20cm of wide microporous adhesive tape used was considered in the turnoff for computation, and others.After finishing the cost calculation of each of the 93 procedures in the data collection instrument, amounts were transferred to an electronic worksheet for analysis with the study variables. RESULTS Socio-Demographic and Clinical Characterization of PatientsMen predominated (62%) in the sample. The ARF diagnosis was described for 76% of t...

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