الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic Renal Failure is considered life threatening disorder if not properly treated. It refers to a condition related to irreversible kidney damage in which the body ability to maintain metabolic, fluid and electrolytes balance fails. It can progress to ESRD which require RRT to sustain life.
Hemodialysis is the most common method used to treat advanced and permanent CRF in pediatric population. It is the process of removing metabolic waste and water from blood by a machine.Children undergoing HD require critical nursing care. This has created the need for high skilled nurses trained in the application of guidelines for management of children undergoing HD to achieve an optimal care.
The aim of current study was to assess the nurses’ application of guidelines for management of children undergoing HD. The study was conducted at the Kidney Dialysis Unit at Smouha University Children’s Hospital. All nurses who are responsible for providing direct care for children undergoing HD admitted to the previously mentioned setting during a period of four months comprised the study subjects regardless to their level of education or years of experience. Their number was 21 nurses.
One tool was used to collect the necessary data. Nurses’ Application of Guidelines for Management of Children Undergoing Hemodialysis Observational Checklist which was developed by the researcher guided the Egyptian Society of Nephrology and Transplantation Hemodialysis Guidelines (2019)and relevant literatureIt was used to assess nurses’ application of guidelines regarding to the management of children undergoing HD. Every nurse was observed four times while providing care for those children during the morning and afternoon shifts (two observations in the morning and two observations in the afternoon shifts).
Results
The main finding of this study indicated the following:
• Almost half of the studied nurses (52.4%) were from 25 to less than 35 years old.
• Slightly more than two thirds of nurses had Technical Institute of Nursing Diploma (66.7%).
• Forty-two-point nine percent of nurses had less than one year of experience in the HD.
• All nurses kept horizontal surfacesandfloor ofroom clean (100% of observations for each) and all of them had satisfactory score in the application of guidelinesconcerning preparation of environment before HD procedure.
• All nurses prepared all equipment and supplies needed for performing HD procedure (100% of observations for each) except plastic apron which was prepared by nurses in 97.6% of their observations.
• Allnurses had satisfactory score in the application of guidelines for preparation of equipment and supplies before HD procedure.
• All nursesprimedalllinesanddialyzerwiththeprescribedsolutionand checkedthemforairbubbles(100% of observations for each).
• All nurses set temperature, dialysate flow, heparin infusion time and rate as well as session length (100% of observations for each). Allof them had satisfactory score in the application of guidelines for preparation of HD machine before HD procedure.
• All nursesmeasured the children’sbody weight and placed themin comfortable position(100% of observations for each).
• All nurses assessedaccesssitefor signsofinfection and performed the prescribed laboratoryinvestigations(100% of observations for each). All of them had satisfactory score in the application of guidelines for preparation of children before HD procedure.
• All nurses cleansedcatheterexitwith70%alcoholor10%povidone iodine and applied semipermeable dressing tocover theexitsite(100% of observations for each).
• All nurses withdraw previously injected heparin from each catheterlumen and primed them with 10 ml normal saline 0.9%(100% of observations for each).Allof them had satisfactory score in the application of guidelines for initiation of HD procedure.
• All nurses measured temperature, pulse and blood pressure hourly, gave prescribed medication as well as observed andreportedforoccurrenceofcomplications during HD procedure.
• All nurses neither measured respiration nor checked clotting time in 100% of their observations and all of them had satisfactory score in the application of guidelinesregarding intradialytic children’s assessment and machine monitoring during HD procedure.
• All nurses in 100% of their observations gavefoodandfluidsfollowingtherapeutic regimen and initiated diversionalactivities.All nurses had satisfactory score in the application of guidelines regardingphysical and psychological care for children during HD procedure.
• All nurses instilled heparinintocatheter lumens and attached new sterile cap toeachcatheter lumen in 100% of their observations after HD procedure.
• All nurses measured pulse, blood pressure and body weight in 100% of their observations after HD procedure.
• The nurses provided educationaboutdiet,vascularaccesscareandmedication in 25.0% of their observations. Moreover, all of them had satisfactory score in the application of guidelines regarding termination of HD procedure concerning children.
• All nurses performedchemicaldisinfectionusing citricacidaftereachsession in 100% of their observations.Also, all of them had satisfactory score in the application of guidelines regarding termination of HD procedure concerning HD machine.
• All nurses discarded tubing and dialyzersin aleak-proofcontainer and discarded sharpitemsinan appropriatesharp’s container in 100% of their observations.
• All nurses washed non-disposableequipmentwithsoapandwaterandsent them forsterilization in 100% of their observations.All of them had satisfactory score in the application of guidelines regarding termination of HD procedure concerning equipment and supplies.
• All nurses cleaned any spills of blood or body fluids immediately usingchloridesolutionafter eachsession in 100% of their observations.All of them had satisfactory score in the application of guidelines regarding termination of HD procedure concerning environment.
• All nurses washed their hands before performing as well as before and after terminatingHD procedure in addition to after removal of gloves in 100% of their observations.
• All nurses dialyzedthe childrenwith HBV orHCVin aseparate room, witha separate machine and with a dedicated nurse (100% of observations for each).
• All nurses woresterilegloves before performingand terminating HD procedure in 100% of their observations. All nurses obtained satisfactory score in the application of guidelines regarding infection control precautions before, during and after HD procedure.
• All nurses documented temperature, pulse and blood pressure before, during and after HD procedure. Furthermore, all of them documented body weight before and after HD procedure(100% of observations for each).
• None of nurses documented clotting time during HD procedure in 100% of their observations.All nurses obtained satisfactory score in the application of guidelines regarding documentation before, during and after HD procedure.
• All nurses attained satisfactory score in the application of guidelines for management of children undergoing HD.
• There was statistical significant difference between the nurses’ total mean score in the application of guidelines for management of children undergoing HD and their years of experience.