Patients suffering from long-term hemodialysis

Introduction, Analysis of Existing Evidence, and Quality Improvement Process

Hemodialysis patients are at high risks of infection due to their impaired immune defenses and repetitive access of the bloodstream via vascular access types. The treatment process of hemodialysis involves using different processes and equipment that sometimes worsen the patients’ conditions. For example, frequent antibiotics administration to these patients generates antimicrobial resistance and multidrug-resistant organisms. Central venous catheters (CVCs) are among the most commonly used vascular access types. While the use of CVCs is geared toward enhancing the health and wellbeing of hemodialysis patients, they enhance the risk of hospital-acquired infections. This paper provides a brief overview of the practice problem, analyzes existing evidence on this issue, and describes the quality improvement process and the Quality model that will be used to address this practice problem.

Don't use plagiarized sources. Get Your Custom Essay on
Patients suffering from long-term hemodialysis
Just from $9/Page
Order Essay

Practice Problem

The lifeline for patients suffering from long-term hemodialysis is a well-functioning vascular access. This is primarily because hemodialysis patients are at significantly high risk of developing vascular access-related blood stream infections (VRBSI) that could generate severe complications. According to Thompson et al. (2017), infection is regarded as the second leading cause of death among hemodialysis patients and the leading cause of hospitalization. Similarly, Nguyen et al. (2017) states that infections in hemodialysis patients increase hospitalization, mortality, need for antimicrobials, and healthcare costs. Nguyen et al. (2017) further states that hemodialysis patients are at high risks of infections due to their impaired immune defenses and repetitive access of the bloodstream using vascular access sites and types like central venous catheters (CVCs). Over the past 25 years, numerous efforts have been undertaken to lessen the number of bloodstream infections cause by the use of CVCs in hemodialysis and end-stage renal disease patients. These efforts have proven relatively ineffective since the use of CVCs for hemodialysis patients continues to be a major contributor of high bloodstream infection rates, increased healthcare costs, mortality, and morbidity (Hymes et al., 2017). Even though CVCs remain unavoidable for hemodialysis patients in need of immediate dialysis access, they continue to have undesirable side effects with regards to increasing infections. The undesirable side effects of CVCs contributes to a major practice problem in hemodialysis care settings.

Analysis of Existing Evidence

CVC infections have attracted considerable attention in existing literature since they are undesirable side effects of using central venous catheters in providing care to hemodialysis patients. Existing literature have examined various aspects relating to this issue with the aim of generating evidence that would promote practice change. Gahlot et al. (2014) states that intravascular catheters such as the central venous catheters are critical in modern clinical practices with regards to providing care to hemodialysis and end-stage renal disease patients. These catheters are inserted in critically-ill patients to help in administration of medication, fluids, nutritional solutions, blood products, and hemodynamic monitoring. While CVCs are among the integral catheters for critically-ill patients like hemodialysis patients, they pose a high risk of device-related infections. As compared to other kinds of catheters and medical device, CVCs are major causes of mortality and morbidity. The findings of prospective studies indicate that majority of bloodstream infections among hemodialysis patients are associated with CVCs. These studies estimate the relative risks for bloodstream infections to be approximately 64 times higher as compared to peripheral venous catheters (Gahlot et al., 2014).

Saxena, Panhotra & Al-Mulhim (2005) state that hemodialysis patients are at high risks of vascular access-related blood stream infections (VRBSI) that contribute to severe complications. Severe VRBSI infections are mostly associated with central venous catheters rather than arteriovenous fistula. These researchers contend that CVCs remain unavoidable for critically-ill patients in need of instant dialysis access. The unavoidability of CVCs in hemodialysis patients is linked to the unpredictable course of chronic renal disease. For hemodialysis patients, CVCs are used to help in ensuring a well-functioning vascular access. However, these patients are affected by dialysis access-related infections and subsequent hospitalization, which affect their overall well-being. The undesirable side effects of central venous catheters makes them undesirable though they are unavoidable. CVC infections among hemodialysis patients increase the cost of healthcare, mortality, morbidity, need for antimicrobials, and hospitalization (Nguyen et al., 2017; Gahlot et al., 2014; Thompson et al., 2017; Sexena, Panhotra & Al-Mulhim, 2005).

Hymes et al. (2017) suggests that the undesirable side effects of central venous catheters has resulted in numerous efforts over the past 25 years to lessen CVC infections among hemodialysis and end-stage renal disease patients. Some of these efforts include education and training of healthcare workers, Centers for Medicare and Medicaid Services Fistula initiative, use of antimicrobial locks, and development of guidelines like Scrub-the-Hub protocol by the Centers for Disease Control and Prevention (CDC). However, these researchers contend that there is a need for change in clinical practice relating to the use of CVCs for hemodialysis patients because these efforts have been relatively ineffective. Regardless of these numerous efforts, the use of central venous catheters in treatment and care for hemodialysis patients continues to be a major cause of high rates of hospitalization, bloodstream infections, increased healthcare costs, mortality, and morbidity. Therefore, the healthcare setting is faced with the need for a change in clinical practice that would help address the undesirable effects of using CVCs for hemodialysis patients while enhancing the general health and wellbeing.

Apata et al. (2017) argues that the use of chlorhexidine-impregnated transparent dressings as part of CVC maintenance helps to lessen CVC related infections among hemodialysis patients. Such dressings lessen CVC infections through allowing ongoing antimicrobial exposure and easy visibility of the insertion site for the intravascular catheter. The use of chlorhexidine-impregnated transparent dressings has been found to be more effective in lessening CVC infections among hemodialysis patients in comparison to adhesive dry gauge dressing. Therefore, existing evidence-based practice suggests that CVC infections among hemodialysis patients can be significantly reduced through the use of chlorhexidine-impregnated transparent dressings as part of CVC maintenance.

Quality Improvement Process and the Quality Model

The proposed quality improvement process for this project is promoting CVC maintenance care through chlorhexidine-impregnated transparent dressings (CHG-transparent dressing). In this regard, CHG-transparent dressing will be introduced in the hemodialysis unit as part of clinical practice on the use of CVCs for hemodialysis patients. This process will entail conducting clinician education and training on CHG-transparent dressing for CVC maintenance. The training will help enhance clinicians’ knowledge on this change in practice in order to enhance hemodialysis patient experiences and general wellbeing. To help in effective implementation of this quality improvement plan, the quality model that will be utilized is Plan-Do-Study-Act Cycle. The model will be utilized since it will allow for testing of the proposed change in clinical practice prior to full implementation. Once the change has been developed, a plan for testing it will be developed and carried out before its consequences are observed and modifications made prior to full implementation.


Apata et al. (2017, April 2). Chlorhexidine-Impregnated Transparent Dressings Decrease Catheter-related Infections in Hemodialysis Patients: A Quality Improvement Project. The Journal of Vascular Access, 18(2), 103-108.

Gahlot et al. (2014, Apr-Jun). Catheter-related Bloodstream Infections. International Journal of Critical Illness & Injury Science, 4(2), 162-167.

Hymes et al. (2017). Dialysis Catheter-Related Bloodstream Infections: A Cluster-Randomized Control Trial of the ClearGuard HD Antimicrobial Barrier Gap. American Journal of Kidney Diseases, 69(2), 220-227.

Nguyen et al. (2017, June 29). National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. Clinical Journal of the American Society of Nephrology, 12, 1-8.

Saxena, A.K., Panhotra, B.R. & Al-Mulhim, A.S. (2005). Vascular Access Related Infections in Hemodialysis Patients. Saudi Journal of Kidney Diseases and Transplantation, 16(1), 46-71.

Thompson et al. (2017, December). Catheter-related Blood Stream Infections in Hemodialysis Patients: A Prospective Cohort Study. BMC Nephrology. doi: 10.1186/s12882-017-0773-5

Get Professional Assignment Help Cheaply

Buy Custom Essay

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

  • Plagiarism free papers
  • Timely delivery
  • Any deadline
  • Skilled, Experienced Native English Writers
  • Subject-relevant academic writer
  • Adherence to paper instructions
  • Ability to tackle bulk assignments
  • Reasonable prices
  • 24/7 Customer Support
  • Get superb grades consistently

Online Academic Help With Different Subjects


Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.


Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!


While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.


Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.


In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.


Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.


We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!


We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.


Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment Help Service Works

1. Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2. Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3. Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4. Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

smile and order essay GET A PERFECT SCORE!!! smile and order essay Buy Custom Essay

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
error: Content is protected !!
Open chat
Need assignment help? You can contact our live agent via WhatsApp using +1 718 717 2861

Feel free to ask questions, clarifications, or discounts available when placing an order.
  +1 718 717 2861           + 44 161 818 7126           [email protected]
  +1 718 717 2861         [email protected]