Actualización en técnicas continuas de reemplazo renal

Abstract

Carretera del Prat nº 32 5º 1ª 08038 Barcelona 2 RESUMEN El fracaso renal agudo afecta a un 25% de los pacientes hospitalizados en las Unidades de Cuidados Intensivos. A pesar de los avances tecnológicos, la mortalidad de estos pacientes sigue siendo elevada debido a las complicaciones asociadas. Uno de los tratamientos del fracaso renal agudo son las técnicas continuas de reemplazo renal ya que permiten tratar las complicaciones y disminuir la mortalidad. El conocimiento y la habilidad de la enfermera en relación a estas técnicas serán decisivos para el éxito de la terapia. Para ello, la formación y la experiencia de la enfermera son el componente clave. El presente artículo tiene como objetivo actualizar los conocimientos sobre las técnicas continuas de reemplazo renal. Para ello se realiza una revisión de los principios físico-químicos como la difusión y la convección, entre otros; una descripción de las modalidades de las técnicas continúas de reemplazo renal; una presentación de los principales accesos vasculares; y una descripción de los cuidados enfermeros y de las complicaciones relacionadas con las técnicas utilizadas.Palabras claves: cuidados intensivos, hemodiálisis, hemodiafiltración, hemofiltración, cuidados de enfermería, complicaciones, lesión renal aguda, acceso vascular ABSTRACTAcute renal failure affects 25% of patients hospitalized in intensive care units. Despite technological advances, the mortality of these patients is still high due to complications associated. One of the treatments of acute renal failure are continuous renal replacement techniques because they allow complications management and decrease mortality. Nurse's knowledge and skills in relation to these techniques will be critical for therapy success. Consequently, nurse experience and training are key components. The objective of this article is to update the knowledge about continuous renal replacement techniques. This is a review of phisical and chemical principles as difussion and convection, among others; description of different continuous renal replacement techniques; description of main vascular access; description of nursing cares and complications related to applied techniques.

Training of intensive care nurses to handle continuous hemodialysis: a latent condition for safety

“…The selected nurses who agreed to participate in the study were taken to a room at which the interviews were conducted, depending on their availability during the shift. A semi-structured script was constructed based on a review of literature, which pointed to the need for specialized knowledge and nurses' education; management of therapy; Nursing care with patients, the machine and the CH circuit; complications; and the use of protocols (7,15) .…”

“…Nurses contribute significantly to the application of CH in ICUs (6)(7) . One of the models adopted by some institutions to organize Nursing care in continuous hemodialysis is the collaborative one, which counts on the participation of a nephrologist nurse and an ICU nurse in the conduction of this therapy (6) .…”

“…In these cases, the importance of the preparation and continuous training of the ICU professional is highlighted, in view of the safety of critical patients. This is because, in this model, the professional prepares the circuit of the machine, connecting it to the vascular catheter of the patient and performs treatment maintenance tasks: adjustment in the fluid configurations to provide fluid balance; electrolyte monitoring and acid-base balance of the patient; alarm verification; diagnosis of circuit coagulation and its disconnection from the patient (7) . Nurses of the dialysis units are also in charge of this process.…”

Knowledge and Care Practice of Nurses of Intensive Care Units Regarding Acute Kidney Injury

“…The mortality rate ranges from 30 to 90% in patients who are in the ICU due to AKI, associated with these underlying disease: sepsis, respiratory failure and severe trauma. 7 Regarding the national literature, an incidence of 44.7% of AKI in ICU patients was found. 8 In this sense, this clinical condition should be treated with clinical measures and, if refractory to treatment, with dialysis therapy.…”

Experience of Nurses in the Management of Continuous Hemodialysis and Its Influences on Patient Safety

“…The nephrologist nurse is responsible for managing this process and providing problem solving assistance. [9][10] When establishing the counterpoint of the results of the knowledge production analysis with the researcher´s preliminary observations on the insertion of the intensive care nurse under this collaborative model, the need for investigations that discuss such insertion is strengthened, particularly the nexus regarding the professional experience of the nurses with continuous hemodialysis and patient safety. This is because, experience in the nursing profession generates expertise, which is the association between the theoretical knowledge and practice that distinguishes the nurses' performance.…”