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Patient safety in dialysis access
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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
End-stage renal disease (ESRD) is a public health problem affecting approximately 2.9 million of the world's population. Of these, 60 per cent are on maintenance dialysis, haemodialysis and continuous ambulatory peritoneal dialysis (CAPD). Quality assessment and performance improvement process (QAPI) is essential for the achievement of high-quality outcomes in dialysis centers. A dialysis center is responsible for the quality, safety, and care provided to the patients. Of all, safety of dialysis access is one of the key parameters affecting the outcome. Proper dialysis access care requires integration of different professionals to create an access team. This team should include a nephrologist, radiologist, surgeon, infectious disease consultant, and members of the dialysis staff utilizing their experience to give the best options to uremic patients and the best care for their dialysis access.
For most of the non-nephrologist physicians, dialysis is viewed as a mechanical process, which can be performed without much attention. This book has retreated that not only dialysis as such, but access to dialysis is also a risk factor for safety issues potentially affecting the patients outcome. It discusses important aspects of safety of access to both haemodialysis and CAPD. The first chapter is appropriately written providing a concept of safety in relation to patient care, an area which is often not given as much importance as it deserves. Rest of the chapters discuss topics such as maintenance of vessels, pre-operative care, operative/procedural issues, postoperative and maintenance care.
Though the chapters and topics included are important, certain lacunae of the book cannot be overlooked. There is only one chapter on CAPD, depicts there being a scope for other areas in CAPD access which could have also been included. If not, then the term term “haemodialysis vascular access” should have been used rather than ‘dialysis access’. Further, there are many initial chapters, where the text included is not related to access to dialysis and could have been avoided like care of patients of CKD, drug safety in CKD, contrast agents in CKD, contrast ionization in CKD and safe anaesthesia in CKD. These are important topics but not relevant to vascular access in dialysis per se. Another issue, which though has been clarified in the first chapter i.e., the patients’ safety issue, is debatable since, some of the aspects included in the book are actually related to access survival rather than safety of patients. Cannulation techniques for prolonging vascular access life in haemodialysis setting is an important issue, and should have been discussed in more detail.
Colourful diagrams and the flow of content are good for the reader to cover large number of pages in short time, even in topics like surgical techniques. Tables and pictures are appropriately chosen to explain the issues. Overall, this book will be useful for nephrologists and dialysis staff, who wish to understand haemodialysis vascular access, an Achilles’ heel of maintenance dialysis programme of patients with ESRD.
