Assessment of Nurses’ knowledge and Practices Concerning Hemodialysis Adequacy Guideline in Baghdad TeachingHospitals

Back ground :Kidney disease ranks third among life threatening diseases in the world, after cancer and heart disease, it goes about 200000.(1) aim: toAssessment of nurses’ knowledge and practices concerning hemodialysis adequacy guide line in Baghdad teaching hospitals . Methodology : An objective study involving 60 nurses was conducted from October 30, 2018 to June 4, 2019 on nurses working in dialysis centers at Baghdad Teaching

Teaching Hospital and Imam Ali (peace be upon him) Teaching Hospital to assess the knowledge and practices of nurses related to the work guide for the efficient blood enforcement program in Baghdad educational hospitals and the study sample was an unweight sample (a purposeful sample) that includes (60) nurses. A questionnaire study tool was used for the purpose of research and it consists of two parts, and these parts are the form of demographic data and the knowledge and practice elements index.Results:. . Data revealed that majority of the participants were within age between (20-29) years with job experience ( 1-5) years, majority were holding

INTRODUCTION:
Dialysis efficacy is one of the predominant factors determining survival in hemodialysis patients. The index kt/v urea, (which is a function of dialyzer urea clearance, treatment time, and urea distribution volume), is by far the most commonly used marker for dialysis adequacy (2).
In the past 20 years, despite major advances in medicine and the technology of hemodialysis, the morbidity, mortality and hospitalization of chronic kidney disease patients remain high (3). The annual mortality rate of hemodialysis patients is 18% and hospitalization is approximately 2 times greater than normal people (4).
End-stage renal disease (ESRD) causes irreversible, severe kidney failure (5). It is a major outcome of chronic kidney disease (CKD), with an important effect on the quality of life (QOL) (6).
There are about 1.8 million patients with end stage renal disease (ESRD) all over the world that need a kind of renal replacement therapy (RRT), including hemodialysis, peritoneal dialysis, or transplantation. Hemodialysis is one of the main modalities in RRT (7).
One of the most important criteria for the evaluation of hemodialysis process is to measure the dialysis adequacy (8).
Dialysis adequacy is the recommended quantity of hemodialysis delivered which is required for adequate treatment of end stage renal disease (ESRD), such that the patient receives full benefit of hemodialysis (9).
Consider kt/v gold standard for measuring the adequacy of dialysis, where k is the dialyzer urea clearance (expressed in liters per hour), t It is time on dialysis (expressed in hours), and v is the volume of distribution of urea (expressed in liters) (10).
Adequacy of hemodialysis increases patient survival, quality of life and biochemical outcomes and decrease disease complications and hospitalizations (11).
If hemodialysis does not possess necessary quality, blood toxin levels and clinical symptoms would not be well controlled and therefore the morbidity and mortality will be increased (12).
The nurses is an important link in the determination of adequate dialysis.
Whether by preventing shortened sessions, determining access problems, performing proper pre-and post-BUN sampling, or ensuring that the patient's treatment is done according to the patient's dialysis prescription, the dialysis Nurses plays an important role in ensuring adequate dialysis and decreasing patient morbidity and mortality (13). This table shows the demographic informationof the studied, the gender of the was equal between male and female , most were secondary nursing school graduate at (45) %, most of the sample were married (93.35), the had (1-5) years of service in the hemodialysis units (48.3) %, the not participate in the training session related to hemodialysis. To find out the size of the patient fluids we enter: 1.07 L 11 K LIMIT The minimum blood purification rate( ) per minute before the alarm is released usually (giving half the speed of the blood pump)

L 12
Continuous movement / movement of liquid inside the filter ( ) of the blood movement helps to transfer fluids and salts to and from the blood better: The high level of phosphorus may contribute to their injury: 1.31 L 20 The level of phosphorus in the blood ranges between (mg / dl): 1.41 M 21 The tube that carries the blood from the patient to the filter is: 1.07 L 22 The tube that returns the pure blood from the filter to the patient's body is:  Table 2 shows that nurses had a low level when response to all items except the items (Fourteen, fifteen, twenty andTwenty-eight) at the moderate level and the grand mean was (1.21) at low level. Preparing the patient's drum to be placed on the dialysis machine.

H 6
Ensure the integrity of A.V fistula.

H 7
Press the KT / V button located below the keyboard on the right. 1 L 8 Determine the value of Klimt and return to be two thirds of the blood speed. 1 L 9 Activate Scree n 1 L 10 Specify the time periods between each measurement and for example each (15 or 30) minutes.

L 11
Re-press the KT / V button.

L 12
Entering the total fluid volume of the patient's body.

L 13
Introducing the patient's sex.

L 14
Introducing the patient's age.

L 15
Insert the length of the patient.

L 16
Introducing patient weight.

L 17
Enter the desired Kt / v value target.

L 18
Enter the value of Limit.

L 19
Save the input information. 1 L 20 Learn to read the forecast screen from the beginning of the session to determine the efficiency of the session.

L 21
If the session is not efficient, we increase the time or blood speed.

L 22
Record the notes on the nursing notes form for the dialysis.

H 24
Destruction of disposable materials used in the hemodialysis.

H 25
Sterilization of dialysis device.  Table 3 shows that nurses had a low level when response to all items except the items (one andTwenty-Fiveat the moderate level and the items (Three, Four, Six, Twenty Two, Twenty Three, Twenty Four)and two at high level anditem the grand mean was (2.05) at moderate level. At the post test nurses had a high level of assessment for all items except the items (Ten, thirteen, fifteen seventeen) at the moderate level and the grand mean was (3.62) high level.