Kidney transplantation; retained foreign objects; perceptions of quality of care; older nurses' experiences - Evidence For Practice

AORN Journal,  March, 2004  by Kathryn Schroeter

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This information is intended for general use only. The clinical implications are specific to the abstracted article only. Individuals intending to put these findings into practice are strongly encouraged to review the original article to determine its applicability to their setting.

Kidney donation after cardiac death

The New England Journal of Medicine July 25, 2002

The number of patients awaiting donor organs and the length of waiting periods before transplantation have increased dramatically during the past decade; thus, it is important to examine ways in which a greater number of patients can receive organs for transplantation. Transplanting kidneys from patients who do not have a heartbeat (ie, donation after cardiac death) is one way to achieve this goal.

Researchers conducted a matched, single-center study of 244 kidney transplants, half obtained from donors with a heartbeat and half from donors without a heartbeat, during a 15-year period. (1) The sample included transplant recipients who were matched according to age, gender, number of transplantations, and calendar period of transplantation. The transplantations were performed at the University of Zurich, and, as such, this study was not a randomized trial.

Findings. The results revealed that the characteristics of the recipients did not differ significantly between the two groups. A significantly higher incidence (48.4%) of delayed graft function among the patients who received kidneys from donors without a heartbeat was observed compared to 23.8% of patients who received kidneys from donors with a heartbeat (P < 0.001). The long-term rate of graft survival was similar between the two groups, however (P = 0.98). When the two groups were compared again at 10 years posttransplantation, the rate of graft survival was 78.7% for kidneys from donors without a heartbeat and 76.7% for kidneys from donors with a heartbeat.

Clinical implications. The results of this study may provide a basis for reevaluation of this source of organs by transplantation centers and by legislative bodies that thus far have proscribed the use of organs from donors without a heartbeat. Numerous issues revolve around this practice. One is the lack of research data that support the practice, and this study serves to add to the database that will support donation after cardiac death now and in the future.

Transplantation protocols must be developed that are consistent with ethics and rights of individuals in this country. Practice issues, such as in situ cooling of organs before the consent of the family has been obtained, have evoked serious ethical concerns and this will be problematic in the future unless these concerns are addressed. All aspects of consent must be addressed and education of perioperative staff members and the public must occur if this practice is to become widespread.

KATHRYN SCHROETER

RN, MS, MA, CNOR

CHAIR, NURSING RESEARCH COMMITTEE

Retained surgical instruments and sponges

The New England Journal of Medicine Jan 16, 2003

According to the literature, several risk factors are associated with retained foreign bodies. Among these are changes in nursing personnel during a surgical procedure, excessive loss of blood, lack of a complete count of sponges and instruments, surgical team member fatigue, and the urgency of the surgery. Anecdotal data collected from surgeon interviews has suggested other risk factors, such as patient obesity, unexpected intraoperative developments, procedures that involve multiple teams, and the performance of more than one major procedure at a time.

This study used a retrospective case control design whereby medical records associated with incident reports or claims of a retained sponge or instrument were reviewed. (2) The sample was composed of 54 patients who had incurred a retained foreign body and 235 control group patients who had undergone the same procedures during the same six-month period but did not experience this complication.

Findings. The results of this study indicated that the risk of a foreign object being left behind significantly increased in procedures that were considered emergencies, when unplanned changes in the procedure occurred, and in patients with a higher body mass index. The retention of a foreign object was nine times more likely when a procedure was performed as an emergency and four times more likely when a procedure involved an unexpected change. The findings further suggested that emergency procedures and those involving unexpected changes were significantly more likely to involve a failure to perform counts.

Clinical implications. Perioperative nurses must be proactive in identifying risk factors for retained objects, recognizing those times when the risk of a retained foreign body may be increased. They also should monitor compliance with existing policies and procedures.

ROBIN CHARD

RN, MSN, CNOR

NURSING RESEARCH COMMITTEE

Perceptions of the quality of perioperative care

Applied Nursing Research February 2003