High-Flux and Low-Flux Membranes: Efficacy in Hemodialysis

Background: Inadequacy of dialysis is one of the main causes of death in hemodialysis patients. Some studies have suggested that high‐flux membrane improves the removal of moderate-sized molecules while other studies indicate no significant effect on them. Objectives: This study aimed to investigate the dialysis efficacy of low-flux versus high-flux membranes in hemodialysis patients. Patients and Methods: Forty hemodialysis patients participated in this cross-over clinical trial. Two sessions of low-flux and high-flux membrane dialysis were performed consecutively, in the first and second stage of the trial. In both stages, blood samples before and after the dialysis were taken and sent to the laboratory for assessment. Blood urea nitrogen (BUN), KT/V and the urea reduction ratio (URR) indexes were used to determine dialysis efficacy. Data were analyzed using t test and paired t test. Results: The mean KT/V was 1.27 ± 0.28 in high-flux and 1.10 ± 0.32 in low-flux membrane which, these differences were statistically significant (P = 0.017). The mean of URR was 0.65 ± 0.09 in high-flux and 0.61 ± 0.14 in low-flux membrane, which these differences were not statistically significant (P = 0.221). Conclusions: The high-flux membrane had better dialysis adequacy, so we suggest using high-flux membrane in hemodialysis centers

The Effect of the Open and Closed System Suctions on Cardiopulmonary Parameters: Time and Costs in Patients Under Mechanical Ventilation

Background: One of the measures to keep the airway open is suctioning of endotracheal tube in patients under ventilation. This procedure can be accompanied with some complications. Selection of appropriate method of suctioning can prevent incidence of acute complications. Objectives: This study aimed to compare the effects of the open and closed system suctioning methods on blood pressure, mean arterial pressure, heart rate, percentage of arterial oxygen saturation, time, and costs in patients under mechanical ventilation. Patients and Methods: This clinical trial study was conducted on 40 patients in ICU. Patients’ blood pressure, heart rate, arterial oxygen saturation, related costs, and length of suctioning procedure were measured and recorded immediately before and one, five, ten, and fifteen minutes after suctioning. Data were analyzed using paired t test and repeated measure analysis of variance. Results: No significant differences were observed between the two suctioning methods in terms of mean systolic blood pressure (P = 0.075), diastolic blood pressure (P = 0.405), and mean arterial pressure (P = 0.257) in the five consecutive measurements. However, significant changes were observed in heart rate (P = 0.025) and percentage of arterial oxygen saturation (P < 0.001). The mean lengths of time in open and closed suctioning methods were 5.59 ± 0.211 and 4.34 ± 0.039 seconds, respectively (P < 0.001). The cost of the closed system was lower than the open method for the patients who were admitted to ICU for longer than two days. Conclusions: Closed suction caused fewer disturbances in patients’ hemodynamic condition, took shorter time, and is more economical. Therefore, this method can replace open suction method in caring of severely critically ill patients

Effects of Small Group Education on Interdialytic Weight Gain, and Blood Pressures in Hemodialysis Patients

Background: One of the most common problems in patients undergoing hemodialysis is interdialytic weight gain due to high liquid intake. Many patients are not fully aware of the fluid restriction. Group educations, such as small-group education, are among powerful methods to enable patients correct their behaviors, and enhance their capabilities, knowledge, and awareness. Objectives: The purpose of this study was to determine the effect of small-group education on interdialytic weight gain, and blood pressures in patients undergoing hemodialysis. Patients and Methods: This is a quasi-experimental study. Data collected from 42 patients undergoing hemodialysis. Before education, the mean of interdialytic weight gain during one week, and blood pressure were recorded. Then small-group education performed in 4 sessions. One week, and one month after the education, the mentioned parameters were recorded again. Repeated measure analysis of variances was conducted and pair-wise comparison was done using the Bonferroni test. Descriptive statistics were calculated for demographic variables. Results: The mean, and standard deviation of interdialytic weight gain of participants was 3.64 ± 0.88 kg, before the education, and significantly decreased to 1.34 ± 0.61 kg, and 1.71 ± 0.72 kg one week, and one month after the education, respectively (P = 0.001). Also, the mean and standard deviation of participants' systolic blood pressure was 139.7 ± 16.45 mmHg before the education, and significantly decreased to 129.6 ± 12.16, and 129.5 ± 11.51 mmHg one week, and one month after the education, respectively (P = 0.001). But, the mean and standard deviation of diastolic blood pressure of the participants was 81.4 ± 6.07 mmHg before the education, and decreased to 79.7 ± 5.51 and 81.7 ± 5.27 mmHg one week, and one month after the education respectively. However, no statistically significant difference was observed between the diastolic blood pressure in the three phases (P = 0.061). Conclusions: Small-group education in patients undergoing hemodialysis leads to a decrease in interdialytic weight gain, and systolic blood pressure, but has no effect on diastolic blood pressure

Effect of pre-warmed intravenous fluid therapy on prevention of postoperative shivering after caesarean section

Background & Aim: Hypothermia is a main side effect during surgery in which blood pressure, heart rate, intra cranial pressure, oxygen consumption, pain and discomfort increase. The rate of cesarean section in Iran is three times more than global standard. This study aimed to investigate effect of pre-warmed intravenous fluid therapy on prevention of shivering after general anesthesia in cesarean section. Methods & Materials: A total of 62 women undergoing general anesthesia for elective cesarean section were randomly allocated into two intervention and control groups. In the intervention group, patients received pre-warmed serum (37°C) and in the control group, patients received serum at room temperature (25.5°C). The postoperative shivering and some homodynamic parameters of the participants were assessed in recovery room. Results: The mean of body temperature in the intervention and control groups were 35.9°C±0.48 and 35.42°C±0.6, respectively (P<0.05). The incidence of post operative shivering in the intervention and control groups were 13 and 35, respectively (P<0.05). Conclusion: Infusion of pre-warmed serum (37°C) would prevent postoperative shivering and could improve nursing care for women underwent general anesthesia in cesarean section