الفهرس 
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Abstract
End-stage renal disease (ESRD) is a progressive decline in kidney function that is irreversible. In patients with ESRD, the most common treatment method is maintenance hemodialysis. Hemodialysis necessitates access to blood vessels that can provide rapid extracorporeal blood flow. CVCs provide hemodialysis patients with immediate access (non- tunneled catheter & tunneled catheter). A non-tunneled catheter can be used to initiation of acute hemodialysis. If dialysis will be required for more than a week, a cuffed, tunneled catheter can be placed or used. Hemodialysis nurses should be followed guidelines for preventing catheter-related bloodstream infection & the benchmark for all central venous catheter (CVC) care recommendations. Hand hygiene, maximum sterile personnel protection equipment, chlorhexidine for skin preparation, catheter site dressing regimens, and specific catheter placement sites are all recommended by the guidelines. Hemodialysis nursing is a specialized area of nursing practice focusing on the needs of patients with renal failure and their families across the lifespan
The aim of this study was:
To assess nurses’ knowledge and practices regarding tunneled catheter care among patients on maintenance hemodialysis.
Materials and method:
Research design:
A descriptive research design was utilized to meet the aim of the present study.
Setting:
The study was conducted at 3 hospitals (Benha teaching hospital,El-Humyat hospital &Benha university hospital) in hemodialysis units at Benha city.
Subjects:
All available hemodialysis nurses (A convenience sample) involved in providing care for tunneled catheter were included in the present study, they comprised of 70 nurses worked in the previous mentioned setting. The study subjects were distributed as follows:
• 40 nurses from BenhaTeaching Hospital.
• 20 nurses from Benha University Hospital.
• 10 nurses from El-Humyat Hospital.
Tools of the study:
In order to accomplish the aim of the study, two tools were used for data collection.
Tool I: Hemodialysis Nurses’ knowledge questionnaire concerning tunneled catheter care among patients on maintenance hemodialysis:
It consisted of two parts:
Part I: included:
- Hemodialysis nurses’ profileas: nurses’age, level of education, marital status, years of experience in hemodialysis unit, and previous attendance of training courses related to tunneled catheter care among patients on maintenance hemodialysis
Part II: Nurses’ knowledge questionnaire:
It included 40 questions (26 MCQ questions, 9 T or F questions, one question to arrange the steps & 4 matching questions). The questions covered the following:
- General knowledge about tunneled hemodialysis catheter
- Catheter insertion nursing care
- Catheter connection – disconnection nursing care
- Catheter exit site care, removal and documentation
- Catheter infection and complications
- Hemodialysis catheter discharge care plan.
Tool II: Nurses’ practices observational checklist regarding Tunneled Catheter Care among Patients on Maintenance Hemodialysis:
It was concerned with assessing hemodialysis nurses’ practices about tunneled catheter care which consisted of 64 domains of nursing practices on tunneled catheter care which includes:
1- Nursing care for catheter during connections.
2- Nursing care for catheter disconnections.
3- Nursing care for catheter exit site care.
4- Nursing care for catheter removal.
5- Discharge catheter plan.
Data collection:
All available hemodialysis samplesof 70nursesat the selected hemodialysis units, then each nurse was interviewed individually once from 20-25minutes by the researcher to collect the necessary data related to tunneled catheter care among patients on maintenance hemodialysis.
Statistical analysis of the data:
After completion of data collection, statistical tests were carried out using SPSS, version 20 for both data presentation and statistical analysis of the result. The number and percentage were used for describing and summarizing qualitative data. Mean and standard deviation used to present the quantitative data.
Limitation of the study
The catheter insertion and removal done in intensive care at vascular department by physician so observation of nurses’ practice during insertion & removal can’t be done by the researcher.
The main results of the study:
• More than half (62.9%) of them had a satisfactory overall knowledge about tunneled hemodialysis catheter care.
• All of the studied nurses (100%) hadan unsatisfactory practice level in relation to nursing management of tunneled hemodialysis catheter.
• There were statistical significant relations between nurses’ overall knowledge regarding nurses working place, qualification, and nurses received training courses from hospital protocol and policies.
• There were statistical significant relations betweenall, items of nurses’ profile and overall practice except ( sex, number of patients per on shift & numbers times of previous attendance of training courses)
• There wereno statistical significant correlation between nurses’ overall knowledge and overall practices.
The main recommendations based on the findings of the current study were as the following
o In-service education program for nurses to update their practices concerning hemodialysis catheter care.
o Continuing clinical and educational competency assessment should be carried out to nurses in all clinical settings.
o Replicate the study on a large probability sampling and on different geographical setting for generalization of the result.
o Impact of a training program on hemodialysis nurses’ knowledge and practices regarding tunneled hemodialysis catheter.
o Explore factors that affect nurses’ knowledge and practices regarding tunneled hemodialysis catheter.