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RATIONALE & OBJECTIVE: The incidence of left ventricular assist device (LVAD) implantation as destination therapy for heart failure is increasing and kidney failure requiring maintenance hemodialysis is a common complication. Because little is known about the safety or efficacy of outpatient hemodialysis among patients with LVADs, this study sought to describe their clinical course. STUDY DESIGN: Case series of patients with an LVAD undergoing maintenance outpatient hemodialysis whose clinical data were obtained from an electronic medical record. SETTING & PARTICIPANTS: Adults who received an LVAD, survived to hospital discharge, and were subsequently treated with maintenance hemodialysis by a not-for-profit dialysis provider between 2011 and 2019. RESULTS: 11 patients were included. 6 had a known history of chronic kidney disease. Patients underwent outpatient hemodialysis for a mean duration of 165.2 (range, 31-542) days, during which they were treated with 544 total dialysis sessions. 6 of these sessions were stopped early due to dialysis-related adverse events (1.1%). More than 80% of follow-up time was spent out of the hospital; however, 55% of patients were rehospitalized within 1 month of starting outpatient hemodialysis. The most common reason for hospitalization was infection (32%), followed by hypervolemia (14%), and cerebrovascular accident or transient ischemic attack (11%). 4 patients recovered kidney function, 1 underwent combined heart and kidney transplantation, 2 continued treatment, 2 died, and 2 were lost to follow-up. LIMITATIONS: Retrospective design, small number of cases, and lack of complete follow-up data. CONCLUSIONS: Approximately half the patients with complete follow-up either recovered kidney function or underwent combined heart and kidney transplantation. This case series demonstrates that outpatient hemodialysis centers, in partnership with LVAD treatment teams, can successfully provide hemodialysis to patients on LVAD support.

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OBJECTIVE: The aim of this study was to find an effective and simple method by which outpatient hemodialysis can be performed using diffusion and ultrafiltration methods with different procedures on a model. METHODS: A solution containing high-level urea and creatinine similar to the blood values of patients with chronic renal failure was used, with the expectation of clearing it as in hemodialysis using a model with the designed system. The product values at the beginning and end of the process were determined, and the cleaning rates were calculated. RESULTS: The clearance rates obtained in the serum were 79.2% for urea and 93.7% for creatinine. Greater than 65% clearance rates were detected in all products except calcium and magnesium. Statistical significance was found in all products (P < 0.05) except magnesium (P = 0.065). CONCLUSIONS: Using this method, we achieved a clearance rate greater than the desired clearance rates (65%) in hemodialysis.

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Antimicrobial resistance is a major growing problem fueled by inappropriate use of antimicrobials. Patients requiring maintenance hemodialysis are at especially high risk for infections caused by antimicrobial-resistant bacteria. The Centers for Disease Control and Prevention has recommended development and implementation of antimicrobial stewardship programs to combat the spread of resistant pathogens. This article describes in detail a multifaceted antimicrobial stewardship intervention that featured staff education and a behavioral change process, Positive Deviance, and its implementation in six outpatient hemodialysis units. Results of the intervention demonstrated a 6% month-to-month reduction in antimicrobial doses/100 patient months over the course of the 12 months intervention, with a decrease in mean antimicrobial doses from 22.6/100 to 10.5/100 patient months from the beginning to the end of the intervention period. These results demonstrate the effectiveness of this multifaceted intervention in engaging staff and improving antimicrobial prescribing patterns.

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BACKGROUND: Infections among hemodialysis patients continues to be major causes of morbidity and mortality despite advances in the science of infection prevention. Many infections are potentially preventable, yet research suggests that evidence-based interventions are not uniformly practiced in dialysis settings. The purpose of the project was to reduce the risk of infection among hemodialysis patients in an outpatient dialysis clinic in upstate New York through the development of an enhanced patient safety culture. METHODS: A survey was used to assess the safety culture of a large outpatient dialysis program. A Comprehensive Unit-based Safety Program was instituted to enhance infection prevention practices. Evidence-based checklists and audit tools were used to track staff adherence to protocols. RESULTS: Scores on the survey were strongly correlated with bloodstream infection rates. Adherence to infection control standards improved when the End Stage Renal Disease Safety Program was implemented, with audits improving from 27%-82% of procedures performed correctly. Bloodstream infection rates decreased from 2.33-1.07 events per 100 patient months, and the standardized infection ratios decreased from 1.960-0.985 in the 12-months after implementation. CONCLUSIONS: The Comprehensive Unit-based Safety Program model and implementation of the safety program may be effective in improving the culture of safety and adherence to evidence-based practices in hemodialysis. Enhanced patient safety culture is correlated with improved patient outcomes.

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Competent nurse managers of outpatient hemodialysis (HD) units are invaluable in enhancing patient safety, creating a culture of safety, and preventing adverse events. Yet little is known regarding the characteristics of a professional work environment that supports their important managerial role. The purpose of this qualitative study was to identify those organizational characteristics that outpatient HD unit nurse managers describe as important to a supportive managerial work environment. A total of six major themes with descriptive categories and exemplars emerged from the analysis. Findings from this study can inform HD administrators in their efforts to create and sustain work environments that support the professional practice of outpatient HD unit nurse managers. Notably, findings can also provide guidelines for nurse managers considering employment opportunities in that they can be used to assess and compare the work environments of outpatient HD facilities and organizations.

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