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Education

Edited by Dr. Marisa Pegoraro, a nurse specializing in haemodialysis at the Niguarda Ca’ Granda Hospital, a member of the EDTNA / ERCA scientific association, former President of the SIAN scientific association. It should never happen, but unfortunately arteriovenous fistulas sometimes become infected or aneurysms form. Dr. Pegoraro explains very clearly what to do in these cases and, in general, how to keep this important access in good condition. A fistula is a communication between an artery and a vein, usually on the forearm, sometimes on the arm. The connected vein becomes larger, more palpable and stronger. It changes very...

Education

Edited by Dr. Marisa Pegoraro Another interesting article on a central theme for those undergoing haemodialysis: proper vascular access maintenance. Below, Dr. Pegoraro helps us to understand the procedures to followed, both from the point of view of the patient and the health care professional and offers some useful advice on how to prevent infections. For a patient undergoing haemodialysis treatment, the vascular access is THE essential component that allows him to enjoy a certain level of well-being and have a good quality of life. Whether it is an arteriovenous fistula (AVF) or a catheter, it should be thought of as...

Education

Edited by Dr. Maurizio Alberto Gallieni, Associate Professor of Nephrology at the University of Milan. Since 2018 Director of the Complex Operational Unit of Nephrology and Dialysis of the ASST (Local healthcare area) Fatebenefratelli Sacco of Milan. Author of over 200 scientific publications, indexed in the PubMed database of the National Library of Medicine. He is a member of various Scientific Societies, also has coordination positions and is the Editor for Italian and foreign journals of Nephrology.   Before talking about dialysis, you need to know that this therapy requires a venous vascular access to be created in order to...

Education

Edited by Dr. Maurizio Alberto Gallieni, Associate Professor of Nephrology at the University of Milan. Since 2018 Director of the Complex Operational Unit of Nephrology and Dialysis of the ASST (Local healthcare area) Fatebenefratelli Sacco of Milan. Author of over 200 scientific publications, indexed in the PubMed database of the National Library of Medicine. He is a member of various Scientific Societies, also has coordination positions and is the Editor for Italian and foreign journals of Nephrology. The risk of healthcare associated infections exists both in hospital and in out-of-hospital settings and is increasing dangerously. The number of HAI associated...

Education

Edited by Marisa Pegoraro In our Hospitals and Dialysis Centres there is a growing tendency to use the so-called Buttonhole technique, also and above all for those who choose home dialysis. It is important to understand what it consists of, when it can be used and how to maintain its fistula. Marisa Pegoraro talks about it below. The Buttonhole technique – literally an eyelet, buttonhole – requires the needles to be placed in exactly the same point and with the same inclination and position for each dialysis session. Before inserting the needles, the area must be washed, disinfected and the...

Stories

“My relationship with kidney disease started at the prime of my life in my twenties”. This is how Serena’s story began, a young woman, a mother, who was diagnosed with immunological glomerulonephritis: her immune system no-longer recognizes her kidneys and tries to reject them. Today, Serena talks about her kidney disease from the blog she started to share her experience with others, to exchange information, suggestions and to share feelings. Because “together is better”, says Serena, and fortunately she had her family and her husband always by her side. After the initial treatment based on cortisone and immunosuppressants, which changed...

Education

Edited by: Dr. Matthias Rudolf Hermann Zeiler, since 2004 Medical Director of the Nephrology and Dialysis Unit of the Carlo Urbani Hospital in Jesi in the Marche region, with a managerial role in coordinating clinical research activities since 2008. Member of the Italian Society of Nephrology and the Gesellschaft für Nephrologie (German Society of Nephrology) and reviewer for the Peritoneal Dialysis International, Clinics and Practice and Nephrology Dialysis Transplantation journals. WHEN WE SPEAK ABOUT HOME DIALYSIS, WE REFER TO TWO TYPES OF DIALYSIS: HOME HAEMODIALYSIS AND PERITONEAL DIALYSIS.   In this guide, Dr. Zeiler summarizes the characteristics that are common...

Education

Edited by: Dr. Maurizio Alberto Gallieni, Associate Professor of Nephrology at the University of Milan. Since 2018 Director of the Complex Operational Unit of Nephrology and Dialysis of the ASST (Local healthcare area) Fatebenefratelli Sacco of Milan. Author of over 200 scientific publications, indexed in the PubMed database of the National Library of Medicine. He is a member of various Scientific Societies, also has coordination positions and is the Editor for Italian and foreign journals of Nephrology. In another article by Prof. Gallieni, we talked about venous vascular accesses and the diseases for which they are carried out. CVCs are...

Case Study

Silver dressings with an antimicrobial action can be used as a barrier against microorganisms in wounds that have a high risk of infection or re-infection. We used photographic monitoring to observe the development of some complications that occurred in patients using the FAV (AterioVenous Fistula) buttonhole method. The critical issues were treated, until they were completely resolved, using an ionic silver dressing placed at the needle insertion points at the end of the dialysis treatment. READ MORE

Sector studies

The main clinical problems related to CVC exit-site management are complications due to infection, in particular CRBSI, which impact negatively on hospitalization, survival and the incidence of mortality, thereby increasing hospital and care costs. Understanding the sequence of clinical and care events that lead to infections allows us to develop rational preventive strategies. As has already been demonstrated, keeping to strict vascular access management protocols can lead to a reduction in the incidence of CRBSI, but the unity of the nursing team and the supervision by the person responsible for vascular access is also necessary and important. Find out about...

Sector studies

Peritoneal catheter exit-site infections are still frequent complications for patients doing peritoneal dialysis. Not only are they risk factors for the development of tunnel infections, but also peritonitis due to the infection developing in the peritoneal cavity. Advances made over the past two decades in the prevention and treatment of peritonitis and technical improvements in materials have significantly reduced the incidence of these infections. For several years, an advanced medication, EXIT-PAD Ag by Emodial, has been available, designed for the exit-sites of peritoneal dialysis catheters and CVCs for haemodialysis. EXIT-PAD Ag is a dressing consisting of a mesh with the...

Sector studies

When looking for sources of inspiration for developing a CVC management protocol, we realized that international guidelines often encourage the use of chlorhexidine for skin antisepsis. These guidelines are not always clear regarding its use, its concentration, the type of solution, whether aqueous or alcoholic etc. In addition, any interaction and the safety of this substance with the materials that make up the CVC are not taken into account. These unanswered questions prompted us to verify the efficacy of alternative products to Chlorhexidine in alcohol, and their tolerability by the materials in order to create an ad hoc protocol for...

Sector studies

The buttonhole fistula puncture method appears to be less traumatic for both the vessel and the patient in the long term. This atraumatic technique however, has the disadvantage of a higher frequency of fistula and subcutis infections. Disinfection of the skin and careful crust removal are very important for preventing complications and, thanks to the use of an advanced silver-based dressing, there is a greater antibacterial action that reduces the risk of infection. The purpose of this study was to analyse the macroscopic effect of an advanced silver ion dressing at the cannulation site with a “buttonhole”. Find out about...

Sector studies

In Italy, 15% of patients undergoing haemodialysis use a long-term central venous catheter as the vascular access, which can lead to a risk of local and systemic infections. Over the last few decades, the spread of multi-ethnic populations throughout Europe has forced health professionals to pay greater attention to the recognition of dermatological diseases that have clinical aspects different from those of Caucasian skin that we are normally used to. There is a wide variety of phototypes in the various populations of the planet, which depends on the amount and type of melanin they contain. The anatomical, structural and physiological...

Sector studies

The access route to the peritoneum continues to be a significant problem in the management and survival of peritoneal dialysis. Exit-site infections are serious complications during the course of peritoneal dialysis. In addition to causing a local logistic process, these infections can spread and cause peritonitis. A healthy exit site is dry, without traces of blood or pus and shows no redness, swelling or crusts. There is no universally accepted definition of exit-site infection. This, together with the tendency for the infection to become chronic, makes an epidemiological assessment and comparison of the various preventive approaches very difficult. However, assuming...

Sector studies

Our skin is alive and constantly renews itself. It performs several very important functions for the human body such as protection, temperature regulation, electrolyte balance, metabolism and tactile perception. This is why, when skin integrity is compromised, dialysis patients or those with vascular accesses feel pain and are more vulnerable to infections. MARSI are complications that occur in some patients on dialysis or other therapies that use vascular accesses, due to the use of devices with adhesives. This is where Emodial’s research into new, gentler, but extremely effective solutions to prevent MARSI started. Read the full report on how to...

Sector studies

Preventing catheter site infections is essential for proper peritoneal dialysis maintenance. These infections can have serious consequences for the patient such as peritonitis, loss of the catheter and drop-out from this dialysis method. In addition to proper catheter management, which is the basic approach for preventing infections, numerous experiences have been reported in literature that use advanced dressings with silver ions that aim to stabilize the exit-site through “continuous” disinfection, in order to reduce the incidence of catheter site infections and improve management of patients on dialysis. See all the results related to the study on infection prevention using silver...

Sector studies

The first choice of vascular access for haemodialysis patients is usually an arteriovenous fistula. When an AVF access is difficult to implement or there are contraindications, the most common alternative is a central venous catheter. This however, poses a greater risk of infection for the patient and a relative increase in hospital costs. The best way to reduce the risk of infection is, without doubt, to develop a series of prevention measures that involve both patients and healthcare professionals. Another ally in the prevention of infections are CVC dressings that release silver ions, such as EXIT-PAD®AG, which when applied to...

Sector studies

For those doing peritoneal dialysis, it is very important that the exit site heals properly because it provides greater resistance against local vascular access infections. Clinical studies have demonstrated the effectiveness of advanced dressings containing silver ions, their antibacterial and almost physiological function that helps heal the exit-site in the post-operative period. Find out about exit-site healing results obtained using EXIT-PAD®AG with silver ions. READ MORE

Sector studies

A very large number of patients undergo anticoagulant therapy following dialysis. Because of these high numbers, Emodial decided to find a solution that could speed up post dialysis haemostasis. The use of calcium alginate in our dressings has led to improvements and faster post-dialysis haemostasis, providing significant benefits for patients, but also for healthcare professionals. Discover the benefits of calcium alginate dressings READ MORE

Sector studies

It is not uncommon for patients undergoing fistula dialysis to have haemostasis related issues. The incidence of these problems prompted us to find a calcium alginate-based solution to speed up post dialysis haemostasis. BETAFIX is an elastic compression bandage with a multilayer calcium alginate pad that has been specially designed to overcome haemostasis problems in patients who bleed profusely or who have coagulation difficulties. Discover all the features of BETAFIX READ MORE

Sector studies

In hospitalized patients, the implantation of an intravascular device is one of the main causes of nosocomial infections; this is why Emodial has developed a new type of advanced antiseptic dressing based on the controlled release of silver ions. The advantages of these silver-releasing dressings in the management of intravascular devices have been shown by their anti-bacterial activity, anti-fungal activity, low toxicity, no bacterial resistance and a broad spectrum of action. Discover the features of our silver range READ MORE

Sector studies

The onset of MARSI and managing the patient’s relationship with water can be problematic for those on dialysis treatment or undergoing therapies that involve vascular accesses. Emodial has developed two effective products that help to improve the life of dialysis patients: with SOFT-TOUCH technology we have created devices that use a delicate hypoallergenic silicone adhesive to eliminate the effects of repeated removal of adhesive, which in the long run causes mechanical damage, both in patients with normal skin and in patients with delicate skin or skin that is prone to sensitization. EXIT-POCKET WP is our solution for managing the interaction...

Sector studies

If dressings with a suitable adhesive technology are not used in dialysis patients, there is a risk of creating physical injury, resulting in the onset of MARSI, which not only affects the health and quality of life of the patient, but also hospital costs. The new hydrophobic silicone based SOFT-TOUCH adhesive technology eliminates the effects of the repeated removal of adhesive, which in the long run causes mechanical damage, both in patients with normal skin and in patients with delicate skin or skin that is prone to sensitization. Find out more about SOFT-TOUCH technology READ MORE

Sector studies

The survival of a native arteriovenous fistula (AVF) not only depends on the vessels chosen and the technique used, but also on the method of cannulation. However, there is no generally effective method for the various types of AVFs. Each dialysis centre should adopt its own puncture protocol. In the proposed Guidelines for Vascular Access for Haemodialysis, one of the puncture techniques we refer to is the so-called “Buttonhole” method, i.e. the continuous puncturing of a skin site to form a precise subcutaneous path. The advantage of this technique is that it causes less pain and accurately identifies the best...

Sector studies

Emodial’s experience, working together with the main dialysis centres in Italy and abroad, has shown an increasingly large number of patients with difficulties in haemostasis or with specific coagulation related disorders. This condition, combined with nephrological diseases, stimulated the search for medications capable of containing the effects of the two pathologies which, when acting simultaneously in a patient, often result in a particularly complicated clinical picture. READ MORE

Sector studies

Healthcare associated infections (HAIs) are acquired infections. They are the most frequent and most serious complication to healthcare that can occur in any care setting, including acute care hospitals, day-hospitals/day-surgery, long term healthcare facilities, clinics, home care and territorial residential structures. HAIs include infections transmitted from the outside (exogenous), from person to person or through care operators and the environment, and infections caused by bacteria present in the body (endogenous). There are many causes: the gradual introduction of new health technologies, with the prolonged use of invasive medical devices and complex surgical interventions, which, while improving therapeutic possibilities and the...

Sector studies

The prevention and control of HAIs in all care facilities is essential for reducing their impact and, more generally, for limiting the spread of antibiotic-resistant microorganisms. One of the crucial points for combating HAIs is to define and implement good care practices and other measures that follow an integrated program that should be customised for each care setting. Some of the main measures include the correct washing of hands (which is one of the most important and effective), a reduction in unnecessary diagnostic and therapeutic procedures, the correct use of antibiotics and disinfectants, the sterilization of equipment, asepsis during invasive...

Sector studies

Hand hygiene is our first ally against infections, a simple but essential action that ensures protection and prevention in both the home and healthcare settings. According to the US CDC, hand hygiene is the most effective way of fighting infections. The most common infections are care related, i.e. those that occur during healthcare procedures in hospitals or at home and in therapies that take place at home with the support of a caregiver. In addition to contact infections, infections from the spread of antibiotic-resistant bacteria are also a source of risk. The World Health Organization has recognized the importance of...

Sector studies

Over the last few decades, the spread of multi-ethnic populations throughout Europe has forced health professionals to pay greater attention to the recognition of dermatological diseases that have clinical aspects different from those of Caucasian skin that we are normally used to. There is a wide variety of skin “colours” (Phototypes I-V) in the various populations of the world, which depends on the amount and type of melanin they contain. The phototypes range from I for populations with very light/reddish skin to V for those having black skin, including intermediate phototypes with slightly dark or olive coloured skin. (e.g. Indians,...

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