Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic manag
Background: Adolescent’s perception of nurse care imparted in the hemodialysis unit and the needs that they do not always express are an important starting point to optimize attention and care given by nurse professional;the goal is to reach the holistic focus characteristic of the discipline, and then generate scientific evidence that will help other health professionals, regarding given attention to patients in this step of their lives suffering chronic renal damage subjected to hemodialysis. Objective: To analyze the perception of adolescents with chronic kidney disease about nurse care in a hemodialysis unit. Methods: Qualitative and phenomenological study under the philosophic scope of Merleau Ponty, with a descriptive design;the information collection was through semi-structured interviews, field notes, and participants’ observation from three adolescents’ informers subjected to renal substitution by hemodialysis three times per week, in a high specialty medical unit in Mexico City. Selection of informers was by convenience and their previous authorization was requested by signed informed consent. The analysis of qualitative data was according to Rodríguez et al. Results: Four categories with seven subcategories emerged: Category 1, Adolescent’s perception regarding nursing care on hemodialysis;Category 2, Care during hemodialysis process;Category 3, The world of hemodialysis;Category 4, Corporeity from adolescent’s look. Conclusion: Nursing care to adolescents during hemodialysis must be accompanied by comprehension, communication, and knowledge of patients, regarding their needs perceived to know the way they live their chronic kidney illness, through their body, their world and the way they see themselves. The main characteristics of nurse care are communication and constant interaction with nurse-adolescent, this openness to an unknown world for them is seen as a pleasant interaction, perceived as necessary and it helps them to feel good in their hemodialysis treatment.
Karla Pamela Jesús Martínez-CoronaDiana Andrea Hernández-TapiaDiana Cecilia Tapia-Pancardo
