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Evolved care of neuropathic bladder from birth
ESPUN Meeting 2007
S99
From 14:00 to 14:10 # S3-4 (O)
NURSING EXPERIENCES OF LAPARSCOPIC INSERTION OF PERITONEAL DIALYSIS CATHETERS IN CHILDREN ENTERING THE END STAGE RENAL FAILURE PROGRAMME Juila HOLDING and Ramnath SUBRAMANIAM St.James University Hospital, Paediatric Urology, Leeds, UNITED KINGDOM
PURPOSE
RESULTS
To present the Clinical Nurse Specialist’s (CNS) experience of Laparoscopic peritoneal catheters between September 2005 and September 2006.
Ten peritoneal dialysis catheters were placed laparoscopically in nine patients, (one child had a reinsertion due to complications). Seven children have been successfully established on peritoneal dialysis, with no ongoing complications. One child was transplanted within days of insertion; therefore the catheter was not used. One child unfortunately developed a rare reaction to the catheter and on both insertions the catheter failed to work. This was due to fibrous tissue growing around the catheter, with S.aureus around her exit site. She is now managed on haemodialysis. We have not had any leakage from catheters. All catheters were flushed on return to the ward until the dialysate clear. Only one of
MATERIAL AND METHODS Nine patients in end stage renal failure, aged between 18 months and 19 years were referred to a single surgeon for peritoneal dialysis catheters. An audit form was completed prospectively by the CNS which looked at complications and outcomes.
the catheters was used straight away because it was clinically indicated, whilst the others were rested up to three weeks, allowing training to begin. Our children and care givers were happy with the cosmetic outcome from the procedure.
CONCLUSIONS Overall, we have had good success with our dialysis catheters inserted laparscopically and we will continue to audit our practice. This approach allows early use of catheters within hours if required especially in acute situations. The laparoscopic approach provides good cosmesis for our young patients
From 14:10 to 14:20 # S3-5 (O)
EVOLVED CARE OF NEUROPATHIC BLADDER FROM BIRTH Kath SHAVA, Brid CARR, Divyesh DESAI, Patrick DUFFY, Dominic THOMPSON and Ciaran BRADY Great Ormond Street Hospital for Sick Children NHS Trust, Department of Paediatric Urodynamics, London, UNITED KINGDOM
PURPOSE Management of patients with bladder dysfunction resulting from a primary diagnosis of spina bifida/spinal dysphraism remain a challenge. Our experience at this institution was that despite usual modes of management a small number patients were still presenting with episodes of infection and renal scarring. These findings have led us to focus on and to conduct a retrospective study of all patients seen between 2000-2005 to identify common risk factors. From the study our multidisciplinary model of care/ practice was clarified and altered and the
effect and impact on nursing practice changed.
RESULTS Reliable assessment of risk has tailored investigations and management. Incidence of renal scarring has been reduced.
MATERIAL AND METHODS CONCLUSIONS Initially data was collected on children in whom renal scarring had occurred to identify common risk factors (9 patients). 7 possible risk factors were identified and then applied to a further 66 patients born in the same time frame. Current management and risk factors will be discussed.
Early assessment using the devised protocol has resulted in a clear model of care with less unnecessary invasive investigations and better outcome for the patients. A consistent multidisciplinary approach to care with clear risk factors and management direction identified.
S99
From 14:00 to 14:10 # S3-4 (O)
NURSING EXPERIENCES OF LAPARSCOPIC INSERTION OF PERITONEAL DIALYSIS CATHETERS IN CHILDREN ENTERING THE END STAGE RENAL FAILURE PROGRAMME Juila HOLDING and Ramnath SUBRAMANIAM St.James University Hospital, Paediatric Urology, Leeds, UNITED KINGDOM
PURPOSE
RESULTS
To present the Clinical Nurse Specialist’s (CNS) experience of Laparoscopic peritoneal catheters between September 2005 and September 2006.
Ten peritoneal dialysis catheters were placed laparoscopically in nine patients, (one child had a reinsertion due to complications). Seven children have been successfully established on peritoneal dialysis, with no ongoing complications. One child was transplanted within days of insertion; therefore the catheter was not used. One child unfortunately developed a rare reaction to the catheter and on both insertions the catheter failed to work. This was due to fibrous tissue growing around the catheter, with S.aureus around her exit site. She is now managed on haemodialysis. We have not had any leakage from catheters. All catheters were flushed on return to the ward until the dialysate clear. Only one of
MATERIAL AND METHODS Nine patients in end stage renal failure, aged between 18 months and 19 years were referred to a single surgeon for peritoneal dialysis catheters. An audit form was completed prospectively by the CNS which looked at complications and outcomes.
the catheters was used straight away because it was clinically indicated, whilst the others were rested up to three weeks, allowing training to begin. Our children and care givers were happy with the cosmetic outcome from the procedure.
CONCLUSIONS Overall, we have had good success with our dialysis catheters inserted laparscopically and we will continue to audit our practice. This approach allows early use of catheters within hours if required especially in acute situations. The laparoscopic approach provides good cosmesis for our young patients
From 14:10 to 14:20 # S3-5 (O)
EVOLVED CARE OF NEUROPATHIC BLADDER FROM BIRTH Kath SHAVA, Brid CARR, Divyesh DESAI, Patrick DUFFY, Dominic THOMPSON and Ciaran BRADY Great Ormond Street Hospital for Sick Children NHS Trust, Department of Paediatric Urodynamics, London, UNITED KINGDOM
PURPOSE Management of patients with bladder dysfunction resulting from a primary diagnosis of spina bifida/spinal dysphraism remain a challenge. Our experience at this institution was that despite usual modes of management a small number patients were still presenting with episodes of infection and renal scarring. These findings have led us to focus on and to conduct a retrospective study of all patients seen between 2000-2005 to identify common risk factors. From the study our multidisciplinary model of care/ practice was clarified and altered and the
effect and impact on nursing practice changed.
RESULTS Reliable assessment of risk has tailored investigations and management. Incidence of renal scarring has been reduced.
MATERIAL AND METHODS CONCLUSIONS Initially data was collected on children in whom renal scarring had occurred to identify common risk factors (9 patients). 7 possible risk factors were identified and then applied to a further 66 patients born in the same time frame. Current management and risk factors will be discussed.
Early assessment using the devised protocol has resulted in a clear model of care with less unnecessary invasive investigations and better outcome for the patients. A consistent multidisciplinary approach to care with clear risk factors and management direction identified.