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13.10.2021 | Original Article

Implementing a fluid volume management program to decrease intra-dialytic hypotensive events in a paediatric in-centre haemodialysis unit: a quality improvement project

verfasst von: Evelien Snauwaert, Stéphanie Wagner, Natasha A. Jawa, Valentina Bruno, Ashlene McKay, Amrit Kirpalani, Rosaleen Nemec, Chia Wei Teoh, Elizabeth A. Harvey, Michael Zappitelli, Christoph Licht, Damien G. Noone

Erschienen in: Pediatric Nephrology | Ausgabe 5/2022

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Abstract

Background

Intra-dialytic hypotension (IDH) is the most common serious adverse event in paediatric haemodialysis (HD). Repeated IDH results in chronic multi-organ damage and increased mortality. At the Hospital for Sick Children, Toronto, retrospective data from all in-centre HD sessions revealed frequently occurring IDH events (16.5 ± 5.6% of HD sessions per week). Based on literature review and clinical expertise, fluid volume management was selected as a potential modifiable risk factor to decrease IDH. Root causes identified as contributing to IDH were incorporated into a Paediatric haemodialysis fluid volume management (PedHDfluid) program using the Model for Improvement methodology including rapid cycles of change.

Methods

Multiple measures were evaluated including (i) Outcome: IDH events per number of HD sessions per week; (ii) Process: number of changes to estimated dry weight per number of HD sessions per week; (iii) Balancing: time spent on dry weight meeting per week. Data was analysed using statistical process control charts.

We aimed to decrease IDH in our dialysis unit to < 10% of HD sessions per week over a 6-month period by implementing a PedHDfluid program, including a multifaceted dry weight assessment protocol, multidisciplinary meetings and electronic health records “Dry Weight Evaluation flow sheet/synopsis”.

Results

The project resulted in a decline in IDH events from 16.5 ± 5.6% to 8.8 ± 3.3% of HD sessions per week. More frequent dry weight changes and increased awareness of fluid removal goals were noted.

Conclusions

A multidisciplinary approach including regular assessment, guidelines and systematic discussion, with an embedded electronic health record assessment and data gathering tool may sustainably reduce IDH events.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

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Titel: Implementing a fluid volume management program to decrease intra-dialytic hypotensive events in a paediatric in-centre haemodialysis unit: a quality improvement project
verfasst von: Evelien Snauwaert
Stéphanie Wagner
Natasha A. Jawa
Valentina Bruno
Ashlene McKay
Amrit Kirpalani
Rosaleen Nemec
Chia Wei Teoh
Elizabeth A. Harvey
Michael Zappitelli
Christoph Licht
Damien G. Noone
Publikationsdatum: 13.10.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 5/2022
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-021-05298-z

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Implementing a fluid volume management program to decrease intra-dialytic hypotensive events in a paediatric in-centre haemodialysis unit: a quality improvement project