Coming Soon!

1. Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“A joint EDTNA/ERCA & Gambro project to define multidisciplinary clinical guide for haemodialysis Coming Soon!

2. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ Project Background by Jitka Pancirova & Anki Davidson EDTNA/ERCA Project Coordinators EDTNA/ERCA & Gambro are proud to present our joint project aiming to define multidisciplinary Clinical Guide for Haemodialysis. Together we will launch this project results on November 29, 2013. Why do we need Clinical Guide for Haemodialysis? Renal patients are older and suffer from various co-morbidities There is higher demand for individualised treatments Patient numbers continue to increase Outcomes are not improving, considering application of modern technology, treatment regimes and medicine

3. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ Overview of Chapters by Jitka Pancirova & Anki Davidson EDTNA/ERCA Project Coordinators 0. Introduction & Use of Guide 1. Individualisation of treatment 2. How to achieve the prescribed dialysis dose 3. Water for dialysis and dialysis fluid 4. Fluid management 5. Anticoagulation strategy 6. Vascular Access Management 7. Anaemia Management 8. Nutrition 9. Infection & Hygiene

4. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ Firstly, patient needs differ from individual to individual. The end-stage renal disease population consists of multiple patient groups with different diagnoses and clinical characteristics. The Clinical Guide for Haemodialysis lets clinicians/medical staff/care providers choose the right treatment modality and dialysis prescription for each and every patient and their individual needs. Secondly, dialysis care differs from session to session. For example, variability in the delivered dialysis dose exists between countries, between units, between patients and within individual patients over time. The Clinical Guide for Haemodialysis gives care providers confidence that targets are consistently reached and that every session is easily and effectively delivered in daily practice. This includes dialysis technology for simplified treatment delivery and quality control. Introduction by Anki Davidson

5. Decisions regarding treatment prescription based on physical as well as social and emotional needs of patients • Prescription parameters individualised to each patient needs(hours, frequency, Qb, Qd, membrane SA, etc) • Dialysate composition individualised to patient needs (cardiac status, medications, blood pressure, thrombogenicity, blood levels, weight gains) • Use of machine modes as per individual prescription (isolated UF, profiling of Na, K+, Bicarb & UF, HDF, HF, AFBK) • Use machine monitoring to individualise each session (blood volume, online clearance, biofeedback) • Adherence to biocompatibility principles as per patient needs The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ Chapter 1. Individualisation of treatment by Lorraine Burchell

6. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ • Methods and procedures of routine monitoring of dialysis dose • Measures and procedures to ensure that delivered dose meets the dose prescribed • Identification of cause(s) of insufficient dialysis dose • Attention on too high(unexpectedly high) dialysis dose cases Chapter 2. HD/HDF adequacy, delivered dialysis dose by František Lopot

7. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ • Chemical dialysis water quality monitoring • Water purification components • Optimal water purification and distribution loop configuration • Acute and Home HD • Dialysis concentrates • Disinfection and bacterial/endotoxin monitoring • Emergency situations and sustainability Chapter 3. Water for Dialysis Fluids by André Stragier

8. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ • Assessment of hydration and fluid status in the haemodialysis patient • Dry (target) weight • Obtaining and managing Dry weight • Treatment strategies and treatment monitoring • Tools and technologies to strengthen the assessment of patients target weight • Management of intra-dialytic complications related to fluid management • Stratified Clinical Approach to prevent IHD Chapter 4. Fluid Managementby Karen Wilson

9. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ • Individually assess patients risk factors in regards to coagulation/ bleeding • Determine when variations are required in anticoagulation regimes • Machine preparation, anticoagulant administration and monitoring are an essential part of nursing care • Understanding the various methods to review/prevent coagulation of the dialysis circuit is essential • Various medications are available to maintain anticoagulation • Medication need to be assessed for benefits and risk relative to each patient’s condition Chapter 5. Anticoagulationby Angela Henson, Franta Lopot & James Tattersall

10. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ • An accurate pre-cannulation assessment of vascular access is vital • Understanding key principles for cannulating haemodialysis vascular access is imperative for accurateness and vessel longevity • Understanding principles in utilising and care of HD central venous catheters maintains patency and minimises risks to patient care • Undertaking problem-solving of complications related to vascular access is an essential part of nursing care • Staff awareness of patient safety and risk factors related to invasive HD treatments is vital Chapter 6. Vascular Accessby Angela Henson & Waltraud Kuentzle

11. The goal of an anaemia management programme is: • to get as many patients as possible into the desired range for Hb, • with the most cost-effective use of ESAs and iron supplements • and without exposing the patients to unnecessary risks • Your unit can optimise anaemia management by using: • a systematic approach based on well-defined protocols, • ensuring that the protocols respect the life cycle of the red blood cell and allow the desired Hb range to be adjusted for individual needs • and carrying out audits to assess the impact of any changes • The chapter includes flowcharts that can be adaptedto work with locally agreed guidelines / regulations The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ 7. How to manage anaemia in HD patientsby Elizabeth Lindley

12. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ • Preventing malnutrition • Nutritional needs • Macronutrients • Micronutrients • Fluids • Nutritional support • Oral Nutritional Support/ Enteral Nutrition • IDPN Chapter 8. Nutritionby Dr Kalliopi-Anna Poulia

13. The Clinical Guide“A Guide to Implementing Renal Best Practice in Haemodialysis“ • Raise awareness about importance of the role of management and staff infection control • Support assessment of local hygiene standard and practice • Leadership and Quality Management - vital for good hygiene practice • The Patient - Epidemiological aspects, prevention of infection, treatment • Staff, basic hygiene and adherence, occupational health • Others Chapter 9:Hygiene in Haemodialysis by Waltraud Küntzle

14. The Launch – November 29A Guide to Implementing Renal Best Practicein Haemodialysis