Self- locating catheters give excellent access to the peritoneum Gambro PDCATH- Self locating has been developed in response to the fact that the success of a PD programme depends largely on the quality of the peritoneal access by avoiding catheter dislocation. " The consequences of dislocation are many," says Gambro's Home Care Team Leader, Sally Oldroyd. " It can increase infusion time and drainage difficulties, leading to a breakdown or slowing down of the dialysis process. There can also be considerable discomfort for the patient. " The new catheter increases weight at the tip, creating gentle gravitation towards the Douglas pouch to counter the external forces that cause cuff extension at the exit site." Some highlights include: • Biocampatible. The catheter is made of implant- grade silicone for superior flexibility to avoid any outgrow or rejection. • Worry- free peritoneal access. It's compatible with Gambro's titanium adapter for a sealed connection and the radiopaque marker allows easy identification on plain radiography during use. An accurate hole positioning technique avoids any holes on the radiopaque stripe and prevents the catheter from splitting. • Selected for patient compliance. The bevelled tip avoids discomfort on abdominal tissues. Different designs are available to fit with your patients' needs and your implementation technique. Precision holes also provide improved dialysate flow. In a two- year study, self- locating catheters had higher long- term survival rate than traditional Tenckhoff catheters and there were fewer episodes of peritonitis, tunnel infection, cuff extrusion, catheter malfunction, obstruction and leakage. 1 ContactRob Fisher 01480 444000 rob. fisher@ gambro. com 1Di Paolo N et al. The self- locating catheter: clinical experience and follow up. Perit Dial Int 2004; 24( 4): 359- 64. Overall, the quality of dialysis individuals with a fistula receive is better and this may also, in part, explain the better outcomes in those who start dialysis via a fistula rather than line. The national service framework for renal services guarantees that ' renal services are to ensure the delivery of high quality, clinically appropriate forms of dialysis which are designed around individual needs and preferences and are available to patients of all ages throughout their lives' ( standard 4). It goes on to state that ' all dialysis methods should be available for all patients interchangeably including home haemodialysis'. Home dialysis has many advantages - not least no travelling, but more about transport later. One of the main advantages of home haemodialysis, for many people, is often the independence that it gives. With that comes the opportunity to really tailor the prescription around the preferences of the individual. At the recent British Renal Society - Renal Association joint conference in Glasgow, there was much talk about home haemodialysis. Quotidian, or daily - meaning five or more times per week - and nocturnal, slow overnight dialysis, are options that are being increasingly made available to people on home haemodialysis. There were fantastic presentations from the Manchester team led by Dr. Sandip Mitra and from Dr. Cormac Breen's team at Guy's on these topics. The words of patients are however most powerful - one of the Guy's patients said: " Dialysing six nights a week for eight hours each time has made an amazing difference to my health. The toxins in my blood are really low, I'm taking no medication, my blood pressure is normal and my haemoglobin levels have stabilised without injections." In recognition of the importance of quotidian dialysis we have built more frequent dialysis into the Payment by Results modelling of the proposed tariff for home haemodialysis. This form of therapy should be available now for any patient who is suitable for home haemodialysis. Technical advances, quieter reverse osmosis machines, routine blood volume monitoring and infusion pumps for heprin and bicarbonate designed for easy home use need to keep pace with the aspirations of our service users - people on dialysis. Transplantation and dialysis So the ' chronic kidney disease' agenda will increase renal replacement therapy demand. Paradoxically, the focus on transplantation is also increasing dialysis 4 continued from front cover... The growing need for home haemodialysis Gambro's home, in- centre and acute care machines and water plant systems are all covered by the new Partnership Support Agreements

demand. Since the NSF recommended that all patients suitable for transplant should be listed prior to dialysis - within six months of the predicted date of starting dialysis or when the GFR falls below 15 mls per minute - we have seen that the national transplant list has grown at a much faster rate than prior to 2005. In addition the change in the organ allocation rules that have benefited long waiters has also meant that people awaiting a deceased donor kidney are now on average waiting over a year longer than at the turn of the century. So the need for high quality dialysis is not going to go away! National renal audits Everyone reading this, I am sure, will be aware of the importance of monitoring and measuring to improve safety and drive up quality. The wider kidney community also shares this ethos. We are fortunate to have the UK Renal Registry that allows comparative audit between centres. To that we have recently added a programme of national renal audits. The first two national renal audits both concern haemodialysis. For the next three years these programmes will concentrate on vascular access for haemodialysis and transport for in- centre dialysis. These aren't the only important topics in dialysis but together do represent substantial components of safety, quality and patient experience. The audits will of course cover all units - main, satellite, general practice based, commercial and independent sector treatment centres in England. I hope they can be extended to cover the whole of the United Kingdom and that they become embedded into our routine data collection for the Registry and our commissioners. Finally, companies like Gambro, through their commitment to innovation and customer service, have a vital role to play in improving the experiences and outcomes of people on dialysis. I am pleased therefore that ' Highlights' has given me an opportunity to speak to you directly and I hope to do this again in future editions. If you have questions or queries, check things out on my blog at www. renaltsar. blogspot. com, or please don't hesitate to contact me directly: ContactDonal O'Donoghue, National Clinical Director for Kidney Care donal. o'donoghue@ srft. nhs. uk 5 " Home dialysis brings the opportunity to tailor the prescription around the individual." Technical training schedule Here's a breakdown of what's available from our technical training team over the next few months. AK 200 S Basic course 11- 15 August This course enables participants to handle simple maintenance and trouble shooting. WRO 300 H and WSF 300 course 19- 20 August This two- day course gives service engineers a deeper knowledge of these systems. AK 95 S Basic course 14- 17 October Any service engineer working with the AK 95 S should attend this four- day course as it provides participants with a thorough grounding in the relevant systems. Prismaflex Technical course 21- 22 October and 25- 26 November This two- day course provides Prismaflex technicians and engineers with the ability to perform basic calibration, fault finding and simple maintenance. Prismaflex Study Days Monthly during September- December These study days are for anyone in the clinical environment and provide further knowledge on the principles of CRRT therapies and an understanding of using and trouble shooting the Prismaflex machine more effectively. The schedule is: • 4 September - Bristol. • 28 October - Manchester. • 18 November - London. • 16 December - Huntingdon. To book a place on a course or for more information please contact Louise Young 01480 444033 louise. young@ gambro. com Complete peace of mind for your renal equipment Our new Partnership Support Agreements ensure you have guaranteed access to the services you need to support your own resources. There are four levels of Agreement to choose from, each one bringing you support from Gambro's service technicians. Support starts with the entry- level Basic Agreement, which provides technical telephone support and preventative maintenance kits. At the other end of the scale, the Full Agreement gives you inclusive service and repair visits, including spare parts and labour time. In addition to the core services within each Agreement level, a number of extra options are available. These include additional technical training vouchers, spare parts, a repair service with 24- hour response time and holiday cover for when your technicians are absent. " We are receiving a very positive response to the new Agreements," says Richard Dixon, Technician Team Leader, North Region. " Hospitals welcome the fact that we can provide essential cover to suit their individual requirements when their resources require additional support." Call our sales and marketing department on 01480 444000 to discuss your service needs, or e- mail us at TSAgreements@ gambro. com