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...7,288 children with chronic kidney disease (CKD) Stage 5 in 2005. Of those, 1292 were on hemodialysis, 892 on peritoneal dialysis, and 5104 were transplanted. Currently, in the U.S., there are 354 adult and pediatric dialysis units providing incenter hemodialysis to pediatric patients.
We currently provide maintenance dialysis to 68 patients at Texas Children's Hospital in Houston, Texas. Thirty-three children receive hemodialysis and 35 children receive peritoneal dialysis. While our center cares for children from as far away as 541 miles, many patients cannot be cared for effectively at great distances due to family constraints. In the event that a family does not have the resources for long, frequent commutes or relocation, these children must be followed in an adult program. This article is focused at assisting nurses in adult facilities with the care required for a child or adolescent receiving hemodialysis. Included are some of the fundamental differences encountered when providing care to children.
Assessment
The pre/post-treatment assessment of a child or adolescent resembles that of the adult with some modifications. Details on comprehensive physical assessment for children with CKD are available in the ANNA Core Curriculum for Nephrology Nurses (Currier, McCarley, & Brewer, 2001; McAfee, Richards & Smith, 2008). Pre/posttreatment weight is supervised by staff at the scale to ensure accurate measurement. Height is measured at least quarterly and plotted on a growth chart. Temperature is taken pre/posttreatment and during treatment if an infection is suspected. Children weighing less than 20 kg are placed on an electrocardiogram (EKG) monitor prior to initiation of hemodialysis treatment. Ranges for heart and respiratory rates are shown in Table 1.
Blood pressures (BP) should be measured with an appropriately sized cuff. The cuff bladder should cover 80%-100% of the arm circumference and length should cover approximately two-thirds of the upper arm. Pediatric blood pressure standards based on gender and height can be found at: http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.pdf (National Heart Lung and Blood Institute [NHLBI], 2004).
The dialysis facility should ensure that children are current on their childhood immunizations. These immunizations are in addition to the dialysis specific hepatitis B and pneumococcal pneumonia and influenza vaccines. A complete vaccination schedule can be found at http:// www.cdc.gov/vaccines/recs/schedules/default.htm (Centers for Disease Control and Prevention [CDC], 2007).
Target Dry Weight
Assessment of target dry weight in pediatric patients on hemodialysis is difficult. Small fluid shifts may result in symptoms associated with ultrafiltration, such as cramping and nausea, but children may not verbalize complaints. Achieving dry weight is critical since chronic fluid overload can result in hypertension and left ventricular hypertrophy (Jain, Smith, Brewer, & Goldstein, 2001).
Accurate determination involves clinical assessment as well as the use of new technologies. Assessment should include: pre/postreplacement treatment weight, pre/intradialytic/post...
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ANNA chapter presidents.(American Nephrology Nurses' Association), March 01, 2008
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