Moderate clotting in the drip chamber was more frequently seen in the low- heparin group, as well as red patches in the dialyser at treatment end. However, massive clotting was similar in the two groups, with 1.4 events/ 1,000 sessions in the AN69ST/ low heparinised group versus 1.6 events/ 1,000 sessions in the control group. Haemoglobin levels and erythropoietin needs remained stable in both groups. Chanard J et al; Nephrol Dial Transplant 2008; 23: 2003- 9 ( http:// ndt. oxfordjournals. org/ cgi/ content/ abstract/ 23/ 6/ 2003) Better survival with short daily HD The five- centre experience of 415 patients from Europe and the USA starting a short daily HD programme between 1982 and 2005 has been reviewed. Approximately two thirds of the patients were treated at home or in a self- care unit, while the others were treated in- centre. Weekly StdKt/ V was 2.9± 0.6 and 2.6± 0.5 for the US and European patients respectively. The five- year survival in these patients was 68%. When compared to matched patients in the USRDS registry, this was 2- 3 times higher. The predicted time to 50% survival was 2- 11 years longer in the short daily group. Kjellstrand K et al; Nephrol Dial Transplant Advance Access May 5, 2008 Buttonhole cannulation practice reviewed Expert opinions and historical insights into vascular access techniques for chronic haemodialysis have been gathered in an email discussion club. Contributors with experience in the buttonhole technique for patients with native arterio- venous fistulas found benefits to be easier cannulation, reduced pain and reduced aneurysm formation. The paper discusses barriers to introducing the buttonhole technique and how to overcome these. Advice is provided on needling protocols, track formation and the preferred type of needle. Murcutt G; Buttonhole cannulation: should this become the default technique for dialysis patients with native fistulas? Summary of the EDTNA/ ERCA Journal Club discussion Autumn 2007. J Ren Care. 2008 Jun; 34( 2): 101- 8 Gambro's blunt AVF needles enable use of the button- hole technique for easier, gentle puncture for repeated and painless cannulation at the same site. For more information contact Samantha Ford 01480 444006 samantha. ford@ gambro. com 7 Here's the latest summary from our clinical specialists of the dialysis- related papers published recently. Shaun Hurlow reports positive feedback from MHRA and BSI inspectors Antibacterial catheter reduces the risk of infection Through its Dolphin Protect ® technology, Gambro offers an indwelling catheter that addresses the issue of catheter- related infection for haemodialysis patients. The integration of the antibacterial Bi additive into the catheter's surface coating reduces bacterial adhesion, inhibits proliferation and inhibits biofilm formation. Dolphin Protect is the first product on the market to use this coating system, rather than other methods which may release pharmaceuticals or other components like silver. The microdomain surface of the catheter reduces interaction between cells, plasma proteins and the surface of the catheter, significantly improving the catheter's biocompatibility. The coating also creates a stable and smooth surface which covers the catheter body, effectively reducing blood activation to help prevent catheter biodegradtion. It also prohibits the emission of X- ray contrast medium ( BaSO4) particles into the blood. ContactLloyd Buck 01480 444049 lloyd. buck@ gambro. com Dolphin Protect offers improved biocompatibility and reduced catheter biodegradtion " It was encouraging to hear government agencies and our notified body praise our working methods."

magazine highlights This paper is made from 55% recycled fibre content from both pre and post- consumer sources, together with 45% virgin ECF fibre from sustainable forests. 55% Highlights is a Gambro publication, produced four times a year for UK renal care and intensive care clinicians and technicians. We welcome your comments on Highlights, including ideas about the sort of information you would like us to feature. Please also let us know if you would like to subscribe to Highlights, notify us of a change of your contact details, receive our e- Magazine version instead of the hard copy edition, or tell us you no longer wish to receive a copy. Contact us at marketing. uk@ gambro. com Gambro, Lundia House, Ermine Business Park, Huntingdon, Cambridgeshire PE29 6XX Tel 01480 444000 Email marketing. uk@ gambro. com Web www. gambro. co. uk © Copyright Gambro 2008 8 Cardiff and Vale NHS Trust has expanded its home haemodialysis programme to supplement the renal unit at the University Hospital of Wales ( UHW). The expansion has delivered real benefits for the patients involved, and freed up access to the unit's 20 dialysis stations for newly diagnosed patients. Senior Sister Karen Welsh was involved in identifying the in- centre patients she felt would benefit from home haemodialysis ( HHD). These included patients in various situations who were looking for a more independent lifestyle. The programme began with trials of two patients and the results were encouraging, so a comprehensive HHD service was commissioned. Progress has been steady year on year, rising from seven patients recruited in 2002 to more than 15 last year. At the moment more than 40 patients are in the programme. The support patients receive starts with a two week induction, delivered by staff at the main renal unit. This induction includes training on procedures, products, equipment, safety and cleanliness. Additional training is later delivered at home to reflect the different environment. Supporting the medical team While the induction is happening the machine is installed in the home, with Gambro's technicians working in partnership with the hospital team. The AK 95 S dialysis machine is used, with its slimline configuration making it ideal where there is limited space and its low weight ensuring easy manoeuvrability. Most operating functions are automated or pre- set, while the logical user interface is straightforward to learn and operate. It is also quiet and unobtrusive during dialysis. The machine fits conveniently with the Gambro individual WRO water purification unit and hygiene standards are high, thanks to the Gambro CleanCart concept. While the machine is being installed, there is also a determination of the exact prescription, so that the requisite supplies can be ordered from Gambro's Home Care team. Once the patient is back at home they have either a fistula or permacath inserted and have ongoing six weekly bloods taken, along with EPO measurement and drug surveillance. Patients feel the benefits of home haemodialysis Sister Welsh says: " Our patients quickly get used to the AK 95 S and like the compactness and easy mobility. Our own technicians provide maintenance and servicing, but the support from Gambro is good should we need it. " Patients prefer having their control back through dialysing at home. HHD fits well into their different lifestyles and they feel less isolated from their family. They also become more involved in their renal dialysis treatment, which brings a higher compliance. Furthermore the elderly don't want a 7.30am ambulance start on a cold winter morning. " Research has shown that there is less risk of infection in the home compared to hospital dialysis, and our experience bears this out. Finally, HHD releases hospital in- centre slots, so that these are not depleted as our local dialysis demands still grow." ContactRob Fisher 01480 444000 rob. fisher@ gambro. com Dialysis in the home is expanded in Cardiff Gambro Bursary: financial support for advances in renal care Gambro's support for knowledge development across the renal community has been strengthened further with the launch of the Gambro Bursary. Under the scheme, a committee made up of Gambro employees and independent individuals assesses applications for funding from anyone working in renal care. For more information, download the Bursary rules and application form at www. gambro. co. ukor contact Julie Barclay 01480 444045 julie. barclay@ gambro. com