Evaluación de la carga de trabajo sobre la enfermería nefrológica en la provisión de hemodiafiltración continua veno venosa en un hospital terciario

Abstract

The work load for nursing staff involved in the preparation and maintenance of continuous venovenous hemofitration techniques is very high. The objective of this study was to determine the work load that providing this technique implies for nephrology nursing personnel. A prospective study was performed using data from 62 patients and 396 filters over an 11 month period. Information was collected for the following variables: duration of filtration, benefit provided by the technique, frequency of filter change, reason for terminating treatment, and heparin dosage. Filters were changed according to protocol every 48 hours except in the case of coagulation, breakage or dropping of ultrafiltration for at least three consecutive hours. We concluded that because of the total hours employed and the activity's difficulty, it would be advisable to maintain a nephrology back-up nurse whose normal work description includes the provisión and supervisión of the technique. Additionally, the Nephrology Unit should centralize the technique's provisión so as to guarantee adequate management of stocks of hemofiltration materials, and to improve resource management. This would minimize filter losses of a non-clinical origin and premature ruptures due to faulty preparation. The greatest consumers of tilters are the General Intensive Care Units, while the unit generating greatest demand for nephrology nursing staff is the Pediatric ICU. Hematíe loss per patient was estimated to be high in this study, and requires the development of new protocols to avoid this oceurrence as much as possible. Although filters were changed according to protocol every 48 hours, almost three quarters of these did not reach this time limit, due primarily to coagulation. The survival rate of patients continued to be low at aboutone third. It is essential to increase the efrectiveness of this technique by improving the selection of patients who will undergo the treatment.