Advanced Practice Nurses: Roles in the Hemodialysis Unit

For example, utilization of the standardized
mortality ratio (SMR) in
dialysis units that employ APNs may
offer objective evidence supporting
the beneficial role of APN s .
A P N re s e a rcher scenario.
Problems with inadequate blood flow
rates and increased infection rates
were noted in patients requiring the
use of a permanent venous catheter
for vascular access in a chronic dialysis
unit. An effort was made by the
A PN to identify the cause of these
problems by retrospectively and
prospectively reviewing the dialysis
records of all patients using permanent
venous dialysis catheters in the
c e n t e r. The site of the placement of
the catheters (operating room by vascular
access surgeon versus interventional
radiology suite by radiologist)
was shown to have no effect on the
frequency of access related problems.
After 6 months of data collection, it
was concluded that the catheter per se
was the most likely problem, rather
than procedures concerning site care
or the place of catheter insertion. The
A PN reviewed product information
concerning recently marketed
catheters, which were reported to
have improved performance and
lower infection rates. The new
catheter was purchased and a policy
was instituted for catheters to be
placed by the interventional radiologist
unless circumstances existed that
warranted the patient being brought
to the operating room (e.g., general
anesthesia requirement). There was
an immediate reduction in catheter
infections and inadequate blood flows
documented with the use of the
improved dialysis catheter. The findings
of this small study were reported
to the hospital infectious disease committee
and tracking of catheter-related
problems continues to be a part of
this dialysis unit’s quality assurance
p r o g r a m .
Co n c l u s i o n
There are many different roles for
an APN within the specialty of
n e p h r o l o g y. This discussion was limited
to roles that may be found in the
hemodialysis unit. The integration of
A PNs into the ESRD team can
potentially decrease patient expenditures
by decreasing the need for hospitalization
and costly diagnostic and
therapeutic interventions related to
inadequate pre-ESRD care or to suboptimal
ESRD maintenance therapy.
The APN can build a network of
resources that will expedite delivery
of care. Utilization of nephrology
A PNs will help meet demands of outcome-based
dialysis initiatives.
Nephrology APNs are strategic members
of the renal team and allow for
provision of holistic patient care
d e l i v e r y.
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