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Abstract
Introduction: Patient safety in intensive care units with intermittent renal replacement therapy is influenced by different factors; including patient-related, human, and technical factors.
Objective: Identify risk factors and major incidences present in clinical practice affecting the patient safety on intermittent renal replacement therapy.
Material and Method: Descriptive and retrospective study of 413 sessions of intermittent renal replacement therapy. Demographic and clinical data, clinical and technical complications, monitor controls, corrective measures, and nurse-related risk factors were obtained using a dialysis expert questionnaire.
Results: Out of the 413 sessions, 52.1% were intermittent hemodialysis. Patients had a mean age of 65 years and 78.7% were male. 35.1% were admitted by septic shock. Incidences include error in modality assignment (33.2%), outdated protocols (30.5%) and vascular access dysfunction (15.7%). As clinical complications found 47.6% in intermittent hemodialysis and 41.2% had hypotension. Technical complications in 37.7% of sessions, with total or partial extracorporeal circuit coagulation (16.7%). As personnel related factors highlighted the lack of standardized training program (57.1%), personnel variability (81%), and not attending scheduled training (52.4%).
Conclusions: Patient safety with renal replacement therapy in intensive care units is a multifactorial process involving non-modifiable patient-related aspects, incidences during the procedure, and complications. Although no major adverse effects were produced in the patient’s clinical evolution, risk factors are considered potential and some of them predictable, controllable, and avoidable.
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Copyright (c) 2023 Maria del Transito Suarez Plata, Lida Rodas Marín, Marta Quíntela Martinez, Adriana Patricia Mejía Díaz
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References
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- Sociedad Española de Nefrología (SEN). Guías SEN. Actuación en el fracaso renal agudo Nefrología. Nefrología 2007;27(Supl 3):S3-13.
- Tsagalis G. Update of acute kidney injury: Intensive care nephrology. Hippokratia 2011;15(Supl 1):S53-68.
- Wang AY, Bellomo R. Renal replacement therapy in the ICU: intermittent hemodialysis, sustained low-efficiency dialysis or continuous renal replacement therapy? Curr Opin Crit Care 2018;24(6):437-42. DOI: https://doi.org/10.1097/MCC.0000000000000541
- Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007;18(3):CD003773. DOI: https://doi.org/10.1002/14651858.CD003773.pub3
- Terol E, Agra Y. Estrategia en seguridad del paciente del Sistema Nacional de Salud [The National Health System patient safety strategy]. Med Clin (Barc) 2008;131(Suppl 3):S1-3. DOI: https://doi.org/10.1016/S0025-7753(08)76454-6
- Arenas Jiménez MD, Macía-Heras M. Safety on haemodialysis: Team work paradigm. Nefrologia (Engl) 2018;38(1):1-3. DOI: https://doi.org/10.1016/j.nefroe.2018.01.005
- Rylance P. Improving patient safety and avoiding incidents in renal units. Journal of renal nursing 2014;6(1):24-9. DOI: https://doi.org/10.12968/jorn.2014.6.1.24
- Cuevas Budhart MÁ, Saucedo García RP, García Larumbe JA, Álvarez Bolaños E, Pacheco del Cerro E, Meneses Monroy A, et al. Factores asociados al desarrollo de eventos adversos en pacientes con hemodiálisis en Guerrero, México TT. Enfermería Nefrológica [Internet]. 2019; [consultado 12 Abr 2020] 22(1):42–50. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2254-28842019000100007&lang=pt%0Ahttp://scielo.isciii.es/pdf/enefro/v22n1/2255-3517-enefro-22-01-42.pdf. DOI: https://doi.org/10.4321/S2254-28842019000100007
- Gómez López VE, Muñoz Macías C, Casas Cuestas R, Álvarez de Lara MA, Crespo Montero R. Análisis de las medidas correctoras para la disminución de los eventos adversos en una unidad de hemodiálisis hospitalaria. Enferm Nefrol 2019;22(1):27–33. DOI: https://doi.org/10.4321/S2254-28842019000100005
- Thomas-Hawkins C, Flynn L. Patient safety culture and nurse-reported adverse events in outpatient hemodialysis units. Res Theory Nurs Pract 2015;29(1):53-65. DOI: https://doi.org/10.1891/1541-6577.29.1.53
- Ulrich B, Kear T. Patient Safety Culture in Nephrology Nurse Practice Settings: Results by Primary Work Unit, Organizational Work Setting, and Primary Role. Nephrol Nurs J 2015;42(3):221-37. 1.
- Arenas Jiménez MD, Ferre G, Álvarez-Ude F. Estrategias para aumentar la seguridad del paciente en hemodiálisis: Aplicación del sistema de análisis modal de fallos y efectos (sistema AMFE). Nefrología (Madr.) [Internet]. 2017 [consultado 12 Abr 2020]; 37(6): 608-21. Disponible en: https://dx.doi.org/10.1016/j.nefro.2017.04.007. DOI: https://doi.org/10.1016/j.nefro.2017.04.007
- World Health Organization. Marco Conceptual de la Clasificación Internacional para la Seguridad del Paciente. Inf Técnico - 2009 [Internet]. 2009;16–23. Disponible en: http://www.who.int/patientsafety/implementation/icps/icps_full_report_es.pdf.
- Rechene JB, Douthat W. Fallo Renal agudo en unidades criticas. Factores de riesgo y Mortalidad. Rev Nefrol Dial Traspl 2018;38(3)170-8.
- Tejera D, Varela F, Acosta D, Figueroa S, Benencio S, Verdaguer C, et al. Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit. Rev Bras Ter Intensiva 2017;29(4):444-52. DOI: https://doi.org/10.5935/0103-507X.20170061
- Aranaz Andrés Jesús Ma, Aibar Remón C, Vitaller Burillo J RLP. Estudio Nacional sobre los Efectos Adversos ligados a la Hospitalización. ENEAS 2005 Minist Sanid y Consum [Internet]. 2006;170. [consultado 1 de Abr 2022]. Disponible en: http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/pdf/excelencia/opsc_sp2.pdf.
- Aguirre-Bermeo H, Tomasa T, Navas A, Xirgu J, Catalán-Ibars RM, Morillas J, et al. Utilización de las terapias de depuración extracorpórea en los Servicios de Medicina Intensiva de Cataluña (España) [Renal replacement therapy in Intensive Care Units in Catalonia (Spain)]. Med Intensiva 2015;39(5):272-8. DOI: https://doi.org/10.1016/j.medin.2014.07.001
- Ronco C, Ricci Z, De Backer D, Kellum JA, Taccone FS, Joannidis M, Pickkers P, Cantaluppi V, Turani F, Saudan P, Bellomo R, Joannes-Boyau O, Antonelli M, Payen D, Prowle JR, Vincent JL. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care 2015;19(1):146. DOI: https://doi.org/10.1186/s13054-015-0850-8
- Molina-Andújar A, Blasco M, Poch E. Role of sustained low efficiency dialysis in the intensive care unit Nefrologia (Engl) 2019;39(1):88-9. DOI: https://doi.org/10.1016/j.nefroe.2018.06.015
- Rosa-diez G, Greloni G, Crucelegui M, Bedini-roca M, Heredia-martínez A, Coli ML, et al. Factores determinantes de una baja dosis de hemodiálisis establecida por dialisancia iónica en pacientes críticos con insuficiencia renal aguda. Rev Nefrol 2012;32(3):359-66.
- Cornelis T, van der Sande FM, Eloot S, Cardinaels E, Bekers O, Damoiseaux J, Leunissen KM, Kooman JP. Acute hemodynamic response and uremic toxin removal in conventional and extended hemodialysis and hemodiafiltration: a randomized crossover study. Am J Kidney Dis 2014; 64(2):247-56. DOI: https://doi.org/10.1053/j.ajkd.2014.02.016
- Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al. Guía Clínica Española del Acceso Vascular para Hemodiálisis. Nefrología [Internet]. 2017 [consultado 1 Nov 2022]; 37:1–191.Disponible en: http://dx.doi.org/10.1016/j.nefro.2017.11.004. DOI: https://doi.org/10.1016/j.nefro.2017.11.004
- El Marnissi, S., Khomsi, Z., Kassy Raymond S A., El Harti, J., Taoufik, J., Chaibi, A, et al . Analysis of the infectious risk around the patient in the hemodialysis unit of Ibn Sina Rabat hospital using the failure modes, effects and criticality analysis method. Nephrol Ther [Internet]. 2020 [consultado 12 Ene 2020];16(2):105-17.Disponible en http://doi: 10.1016/j.nephro.2019.09. DOI: https://doi.org/10.1016/j.nephro.2019.09.005
- Kear T, Ulrich B. Patient Safety and Patient Safety Culture in Nephrology Nurse Practice Settings: Issues, Solutions, and Best Practices. Nephrol Nurs J 2015;42(2):113-22.
References
Ávalos-López M, Pérez-López MJ, Aguilar-Martínez C, Díaz-Franco AMC, Esquivel-Chávez A, Baltazar-Torres JA. Pronóstico de lesión renal aguda en pacientes críticamente enfermos tratados con hemodiálisis intermitente frente a TRRC [Prediction of acute kidney injury in critically ill patients treated with intermittent hemodialysis versus CRRT]. Rev Med Inst Mex Seguro Soc 2017;55(6):696-703.
Sociedad Española de Nefrología (SEN). Guías SEN. Actuación en el fracaso renal agudo Nefrología. Nefrología 2007;27(Supl 3):S3-13.
Tsagalis G. Update of acute kidney injury: Intensive care nephrology. Hippokratia 2011;15(Supl 1):S53-68.
Wang AY, Bellomo R. Renal replacement therapy in the ICU: intermittent hemodialysis, sustained low-efficiency dialysis or continuous renal replacement therapy? Curr Opin Crit Care 2018;24(6):437-42. DOI: https://doi.org/10.1097/MCC.0000000000000541
Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007;18(3):CD003773. DOI: https://doi.org/10.1002/14651858.CD003773.pub3
Terol E, Agra Y. Estrategia en seguridad del paciente del Sistema Nacional de Salud [The National Health System patient safety strategy]. Med Clin (Barc) 2008;131(Suppl 3):S1-3. DOI: https://doi.org/10.1016/S0025-7753(08)76454-6
Arenas Jiménez MD, Macía-Heras M. Safety on haemodialysis: Team work paradigm. Nefrologia (Engl) 2018;38(1):1-3. DOI: https://doi.org/10.1016/j.nefroe.2018.01.005
Rylance P. Improving patient safety and avoiding incidents in renal units. Journal of renal nursing 2014;6(1):24-9. DOI: https://doi.org/10.12968/jorn.2014.6.1.24
Cuevas Budhart MÁ, Saucedo García RP, García Larumbe JA, Álvarez Bolaños E, Pacheco del Cerro E, Meneses Monroy A, et al. Factores asociados al desarrollo de eventos adversos en pacientes con hemodiálisis en Guerrero, México TT. Enfermería Nefrológica [Internet]. 2019; [consultado 12 Abr 2020] 22(1):42–50. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2254-28842019000100007&lang=pt%0Ahttp://scielo.isciii.es/pdf/enefro/v22n1/2255-3517-enefro-22-01-42.pdf. DOI: https://doi.org/10.4321/S2254-28842019000100007
Gómez López VE, Muñoz Macías C, Casas Cuestas R, Álvarez de Lara MA, Crespo Montero R. Análisis de las medidas correctoras para la disminución de los eventos adversos en una unidad de hemodiálisis hospitalaria. Enferm Nefrol 2019;22(1):27–33. DOI: https://doi.org/10.4321/S2254-28842019000100005
Thomas-Hawkins C, Flynn L. Patient safety culture and nurse-reported adverse events in outpatient hemodialysis units. Res Theory Nurs Pract 2015;29(1):53-65. DOI: https://doi.org/10.1891/1541-6577.29.1.53
Ulrich B, Kear T. Patient Safety Culture in Nephrology Nurse Practice Settings: Results by Primary Work Unit, Organizational Work Setting, and Primary Role. Nephrol Nurs J 2015;42(3):221-37. 1.
Arenas Jiménez MD, Ferre G, Álvarez-Ude F. Estrategias para aumentar la seguridad del paciente en hemodiálisis: Aplicación del sistema de análisis modal de fallos y efectos (sistema AMFE). Nefrología (Madr.) [Internet]. 2017 [consultado 12 Abr 2020]; 37(6): 608-21. Disponible en: https://dx.doi.org/10.1016/j.nefro.2017.04.007. DOI: https://doi.org/10.1016/j.nefro.2017.04.007
World Health Organization. Marco Conceptual de la Clasificación Internacional para la Seguridad del Paciente. Inf Técnico - 2009 [Internet]. 2009;16–23. Disponible en: http://www.who.int/patientsafety/implementation/icps/icps_full_report_es.pdf.
Rechene JB, Douthat W. Fallo Renal agudo en unidades criticas. Factores de riesgo y Mortalidad. Rev Nefrol Dial Traspl 2018;38(3)170-8.
Tejera D, Varela F, Acosta D, Figueroa S, Benencio S, Verdaguer C, et al. Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit. Rev Bras Ter Intensiva 2017;29(4):444-52. DOI: https://doi.org/10.5935/0103-507X.20170061
Aranaz Andrés Jesús Ma, Aibar Remón C, Vitaller Burillo J RLP. Estudio Nacional sobre los Efectos Adversos ligados a la Hospitalización. ENEAS 2005 Minist Sanid y Consum [Internet]. 2006;170. [consultado 1 de Abr 2022]. Disponible en: http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/pdf/excelencia/opsc_sp2.pdf.
Aguirre-Bermeo H, Tomasa T, Navas A, Xirgu J, Catalán-Ibars RM, Morillas J, et al. Utilización de las terapias de depuración extracorpórea en los Servicios de Medicina Intensiva de Cataluña (España) [Renal replacement therapy in Intensive Care Units in Catalonia (Spain)]. Med Intensiva 2015;39(5):272-8. DOI: https://doi.org/10.1016/j.medin.2014.07.001
Ronco C, Ricci Z, De Backer D, Kellum JA, Taccone FS, Joannidis M, Pickkers P, Cantaluppi V, Turani F, Saudan P, Bellomo R, Joannes-Boyau O, Antonelli M, Payen D, Prowle JR, Vincent JL. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care 2015;19(1):146. DOI: https://doi.org/10.1186/s13054-015-0850-8
Molina-Andújar A, Blasco M, Poch E. Role of sustained low efficiency dialysis in the intensive care unit Nefrologia (Engl) 2019;39(1):88-9. DOI: https://doi.org/10.1016/j.nefroe.2018.06.015
Rosa-diez G, Greloni G, Crucelegui M, Bedini-roca M, Heredia-martínez A, Coli ML, et al. Factores determinantes de una baja dosis de hemodiálisis establecida por dialisancia iónica en pacientes críticos con insuficiencia renal aguda. Rev Nefrol 2012;32(3):359-66.
Cornelis T, van der Sande FM, Eloot S, Cardinaels E, Bekers O, Damoiseaux J, Leunissen KM, Kooman JP. Acute hemodynamic response and uremic toxin removal in conventional and extended hemodialysis and hemodiafiltration: a randomized crossover study. Am J Kidney Dis 2014; 64(2):247-56. DOI: https://doi.org/10.1053/j.ajkd.2014.02.016
Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al. Guía Clínica Española del Acceso Vascular para Hemodiálisis. Nefrología [Internet]. 2017 [consultado 1 Nov 2022]; 37:1–191.Disponible en: http://dx.doi.org/10.1016/j.nefro.2017.11.004. DOI: https://doi.org/10.1016/j.nefro.2017.11.004
El Marnissi, S., Khomsi, Z., Kassy Raymond S A., El Harti, J., Taoufik, J., Chaibi, A, et al . Analysis of the infectious risk around the patient in the hemodialysis unit of Ibn Sina Rabat hospital using the failure modes, effects and criticality analysis method. Nephrol Ther [Internet]. 2020 [consultado 12 Ene 2020];16(2):105-17.Disponible en http://doi: 10.1016/j.nephro.2019.09. DOI: https://doi.org/10.1016/j.nephro.2019.09.005
Kear T, Ulrich B. Patient Safety and Patient Safety Culture in Nephrology Nurse Practice Settings: Issues, Solutions, and Best Practices. Nephrol Nurs J 2015;42(2):113-22.