Measurement and mobilisation of localised oedema in haemodialysis

IF 1.5 4区医学 Q3 NURSING

Journal of renal care Pub Date : 2022-07-03 DOI:10.1111/jorc.12438

Ryan Longley, David F. Keane MSc, PhD

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引用次数: 0

Abstract

Background

The presence of localised oedema can make measurement and removal of excess fluid in haemodialysis challenging.

Objectives

To evaluate (i) the effectiveness of intermittent pneumatic compression and neuromuscular electrical stimulation at mobilising oedema and (ii) the impact of localised fluid on bioimpedance measured fluid status.

Design

A single centre, cross-over study design. Participants were monitored weekly during mid-week dialysis sessions. Four sessions with each of the interventions and no interventions, with washout periods between, were included.

Participants

Six participants with lower limb oedema and established on haemodialysis for at least 3 months.

Measurements

The effectiveness of mobilising oedema and improving haemodynamic stability was assessed by: reduction in ankle circumference; ultrafiltration volume achieved; blood pressure changes; participant symptoms and achievement of target weight. The impact of localised fluid on bioimpedance measurements was assessed by comparing measurements across affected tissue with measurements avoiding the site of oedema.

Results

There were no differences in ultrafiltration volumes, achievement of target weight, participant symptoms or reductions in ankle circumference and systolic blood pressure between intermittent pneumatic compression and neuromuscular electrical stimulation sessions compared to control sessions. Measurements of fluid overload with bioimpedance were 1.7 and 1.8 L higher when measuring across oedematous tissue compared to non-oedematous tissue.

Conclusions

We were unable to demonstrate improved mobilisation of fluid in the participant's lower limb, though there was a low number of study participants and notable interindividual variation observed. Bioimpedance offers potential for monitoring fluid management in individuals with lower limb oedema but specific protocols are necessary.

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血液透析中局部水肿的测量和动员

背景:局部水肿的存在使血液透析中过量液体的测量和清除具有挑战性。目的:评估(i)间歇性气动压缩和神经肌肉电刺激对水肿动员的有效性，以及(ii)局部液体对生物阻抗测量的液体状态的影响。设计单中心交叉研究设计。参与者每周在周中透析期间接受监测。每种干预措施和不干预措施的四次会议，中间有洗脱期。受试者:6名下肢水肿且接受血液透析至少3个月的受试者。通过以下方法评估活动性水肿和改善血流动力学稳定性的有效性:减小踝关节围度;实现超滤体积;血压变化;参与者症状和达到目标体重。局部液体对生物阻抗测量的影响是通过比较受影响组织的测量和避免水肿部位的测量来评估的。结果与对照组相比，间歇气动压缩和神经肌肉电刺激组在超滤量、达到目标体重、参与者症状或踝关节围度和收缩压的降低方面没有差异。与非水肿组织相比，在肿胀组织中测量生物阻抗的液体过载测量值高出1.7和1.8升。结论:我们无法证明参与者下肢液体活动的改善，尽管研究参与者数量较少，并且观察到显著的个体间差异。生物阻抗为监测下肢水肿患者的体液管理提供了潜力，但需要具体的方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of renal care Nursing-Advanced and Specialized Nursing

CiteScore

3.50

自引率

5.30%

发文量

期刊介绍： The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA). The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given. The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.