{"id":181,"date":"2018-04-23T11:54:26","date_gmt":"2018-04-23T11:54:26","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=181"},"modified":"2023-10-27T15:10:12","modified_gmt":"2023-10-27T15:10:12","slug":"preparing-patients-for-rrt","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/dialysis-handbook\/dialysis-information\/preparing-patients-for-rrt\/","title":{"rendered":"Preparing for Renal Replacement Therapy"},"content":{"rendered":"<h5><span style=\"font-family: arial, helvetica, sans-serif; font-size: 14pt;\"><strong><span style=\"color: #993300;\">General Advice<\/span><\/strong><\/span><\/h5>\n<p><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">The appropriate time to prepare someone for dialysis can be difficult to judge. It is essential that preparation should not be left until too late; it may, however, be inappropriate to burden people with too much information too early &#8211; this will vary patient to patient.<\/span><\/p>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">Advise patients (and appropriate others e.g., spouse) regarding the potential need for RRT<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">Introduce concepts of both haemo- and peritoneal dialysis early in conversation<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">Emphasise the importance of patients&#8217; preference in the decision making<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">Discuss transplantation where appropriate (including pre-emptive transplantation)<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">Remember that <a style=\"color: #000000;\" href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/not-for-rrt\/\">no RRT<\/a> is an appropriate option for some patients, this is called conservative management.<\/span><\/li>\n<\/ul>\n<h5><span style=\"font-family: arial, helvetica, sans-serif; font-size: 14pt;\"><strong><span style=\"color: #993300;\">Referrals<\/span><\/strong><\/span><\/h5>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt; color: #000000;\">About 6-12 months before the patient is expected to reach end-stage, refer to:<\/span><\/p>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Social Work Department: Download a proforma and send with copy of clinic letter (in Edinburgh)<\/span><\/li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Community Dialysis Team (CDT): Download proforma and send with copy clinic letter, including:<\/span>\n<ul style=\"list-style-type: circle;\">\n<li><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Relevant PMH<\/span><\/li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Any medical contraindications to PD\/HD<\/span><\/li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Very brief social history<\/span><\/li>\n<li><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Urgency of referral<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Transplant team (unless clearly contraindicated) &#8211; see below for additional investigations required<i>.<\/i><\/span><\/li>\n<li>Vascular Access Team<\/li>\n<\/ul>\n<p><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">The CDT will arrange visits to see patients who may be considering PD and HD (repeat visits, if necessary), and will arrange invitation to a Patients\u2019 Information Evening.\u00a0 They will see potential PD and home HD patients within their own home; those who are likely to do hospital HD can be seen at clinic visits. It is important to ensure that you get feedback from each of the above referrals and discuss this with the patient to ensure their understanding of the information shared with them.<\/span><\/p>\n<h5><span style=\"font-family: arial, helvetica, sans-serif; font-size: 14pt;\"><strong><span style=\"color: #993300;\">Vascular Access<\/span><\/strong><\/span><\/h5>\n<p><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">Aterio-venous fistulas should be created at least 6 months before starting haemodialysis to ensure that it is successful and mature prior to cannulation. Some patients may require multiple operations for fistula formation and so referral should be made well in advance where possible.<\/span><\/p>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif; font-size: 12pt;\">Refer to Vascular Access Coordinator (Ext 21199) and use specific referral performa.<\/span><\/li>\n<\/ul>\n<h5><span style=\"font-family: arial, helvetica, sans-serif; font-size: 14pt;\"><strong><span style=\"color: #993300;\">New Start Dialysis &#8220;SHAVE-PLUS&#8221; Checklist<\/span><\/strong><\/span><\/h5>\n<p><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">Click <a href=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2021\/04\/SHAVE-PLUS.pdf\">here<\/a>\u00a0for a checklist which may help when starting patients on dialysis. Consider also using the checklist whenever a tunnelled dialysis catheter (&#8220;Permcath&#8221;) is inserted, either into new patients or existing dialysis patients who require alternative vascular access.<\/span><\/p>\n<h5><span style=\"font-family: arial, helvetica, sans-serif; font-size: 14pt;\"><strong><span style=\"color: #993300;\">Hepatitis B and VZV immunizations<\/span><\/strong><\/span><\/h5>\n<p><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">We offer HepB immunisation to all patients preparing for dialysis.\u00a0 Our protocol is given here: <em><strong><a href=\"http:\/\/edren.org\/ren\/wp-content\/uploads\/2019\/06\/Hepatitis-B-immunisation.pdf\">Hepatitis B immunisation<\/a><\/strong><\/em>.\u00a0 Vaccinations are now requested through the <a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/publichealth\/Immunisation\/HSCPVaccinationService\/underlyingconditions\/Pages\/default.aspx\">NHS Lothian HSCP Vaccination Service<\/a>.\u00a0 Referrals are made using a <a href=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/04\/PSD_HBVaxPro_blank.docx\">PSD form<\/a>.\u00a0 If using an electronic signature on the PSD form, then the form must be sent from the prescriber&#8217;s own e-mail address.\u00a0 The appropriate e-mail address is at the bottom of the\u00a0unscheduled vaccination referral form (an excel file so unable to upload to Edren).\u00a0\u00a0<\/span><\/p>\n<p>We offer VZV immunisation to patients who test negative for VZV IgG prior to transplantation.\u00a0 Relevant <a href=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2023\/08\/Patient_specific_direction_Renal__Insufficiency_Planned-kidney-Transplant_Varivax_two_doses.docx\">PSD form here<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<h5><span style=\"font-family: arial, helvetica, sans-serif; font-size: 14pt;\"><strong><span style=\"color: #993300;\">MRSA Screening &amp; Eradication<\/span><\/strong><\/span><\/h5>\n<p><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">MRSA Screening and Eradication as per <a href=\"https:\/\/edren.org\/ren\/handbook\/prescribing-handbook\/renal-drugs-a-z\/\">Staph aureus eradication protocol<\/a>.\u00a0\u00a0<\/span><\/p>\n<h5><span style=\"font-family: arial, helvetica, sans-serif; font-size: 14pt;\"><strong><span style=\"color: #993300;\">PD catheter insertion<\/span><\/strong><\/span><\/h5>\n<p><span style=\"font-family: arial, helvetica, sans-serif; font-size: 12pt;\"><span style=\"color: #000000;\">Catheters for peritoneal dialysis should be inserted <strong>at least<\/strong> 2 weeks before starting PD. O<\/span><span style=\"color: #000000;\">peration dates are arranged through the transplant surgeons, Mr John Terrace and Mr Andrew Sutherland.<\/span><\/span><\/p>\n<h5><span style=\"font-size: 14pt;\"><strong><span style=\"font-family: arial, helvetica, sans-serif; color: #993300;\">Pre-Dialysis and Pre-Transplant Investigations<\/span><\/strong><\/span><\/h5>\n<p><span style=\"font-family: arial, helvetica, sans-serif; color: #000000; font-size: 12pt;\">You can download this proforma as a <span style=\"color: #0000ff;\"><a style=\"color: #0000ff;\" href=\"http:\/\/edren.org\/ren\/wp-content\/uploads\/2018\/10\/preRRTtests.pdf\">PDF file<\/a> <\/span>suitable for printing out and inserting into patient notes. The information should also be kept up to date on Vital Data. If you are uncertain where to record particular information, please seek advice from senior medical staff.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000; font-size: 12pt; font-family: arial, helvetica, sans-serif;\"><strong>Acknowledgements:\u00a0<\/strong>\u00a0 Neil Turner was the main author for this page. It was updated by Ashley Simpson in 2019. The &#8220;SHAVE-PLUS&#8221; checklist was written by Fiona Gifford and Mercedes Bugueno-Guerra in 2021.\u00a0 The last modified date is shown in the footer.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>General Advice The appropriate time to prepare someone for dialysis can be difficult to judge. It is essential that preparation should not be left until too late; it may, however, be inappropriate to burden people with too much information too early &#8211; this will vary patient to patient. Advise patients\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/dialysis-handbook\/dialysis-information\/preparing-patients-for-rrt\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":5958,"menu_order":33,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-181","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/181","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=181"}],"version-history":[{"count":31,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/181\/revisions"}],"predecessor-version":[{"id":6244,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/181\/revisions\/6244"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/5958"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=181"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}