Developing Nursing Practice Guidelines to Prevent Delayed Graft Function in Patients Undergoing Kidney Transplantation Under Anesthesia
Keywords:
kidney transplant patients, nursing practice guidelines, delayed graft function, anesthesiaAbstract
This action research aimed to develop and evaluate the outcomes of nursing practice guidelines (NPG) for preventing delayed graft function in patients undergoing kidney transplantation under anesthesia. Data was collected from 17 kidney transplant patients and 16 nurse anesthetists between August 2023 and July 2024. The research instruments included 1) Patient Record Forms, 2) Process Evaluation and Post-Transplant Outcome Forms, and 3) Satisfaction Assessment Forms for Nurse Anesthetists. The research intervention tool was the preventing delayed graft function NPG. The content validity of the research instruments was verified by five experts, yielding a validity score of 0.89. The nursing practice guidelines were pilot tested with three patients whose characteristics were similar to the study sample and three nurse anesthetists. A feasibility study was also conducted before the guidelines were implemented in practice. Data analysis involved comparing demographic information, delayed graft function rates, and average length of hospital stay with previous studies using descriptive statistics. Post kidney transplant creatinine levels (at 24 hours, 72 hours, and 1 week) were compared using the Friedman test.
The nursing practice guidelines for preventing delayed kidney function consisted of three phases, including: 1) Pre-Anesthesia Nursing Care 2) Peri-Anesthesia Nursing Care, and 3) Post-Anesthesia Nursing Care. The guidelines' quality assessment, conducted using the AGREE-II instrument, scored as follows across the six domains: 91.11%, 86.67%, 82.45%, 82.22%, 81.67%, and 98.33%, respectively, with an overall quality score of 85.22%. The incidence of delayed graft function was 5.88% and the average hospital stay was 12.88 days (S.D. = 3.43). Nurse anesthetists' evaluations of the guidelines across all aspects indicated the highest levels of agreement and satisfaction. The guidelines demonstrated potential for preventing delayed graft function and reducing hospital stay durations in post-kidney transplant patients.
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Information and Technology Center, Ministry of Public Health. HDC - Report [Internet]. 2024 [cited 4 Mar 2025]. Available from: https://hdcservice.moph. go.th/hdc/reports/ report. php?flag_kpi_ level=1&flag_kpi_year=2024&source=pformated/format1.php&id=7ac059f4e4e3d08750d2ee23600556af&cat_id=39fd60c25235db479930db85a0e97dd3 (in Thai).
Kurniawaty J, Ancilla C, Arovah NI. Anesthesia in renal transplant. Jurnal Komplikasi Anestesi. 2023;10(3):62–70.
Li MT, Ramakrishnan A, Yu M, Daniel E, Sandra V, Sanichar N, et al. Effects of delayed graft function on transplant outcomes: A meta-analysis. Transplant Direct. 2023;9(2):1433.
Chutipongtanate A, Kantain A, Inksathit A, Kantachuvesiri S, Sumethkul V, Jirasiritham S, et al. Perioperative hemoglobin decrement as an independent risk of poor early graft function in kidney transplantation. BMC Res Notes. 2020;13:1–7.
Thai Transplant Society. Registry Book 2023 update [Internet]. 2024 [cited 2025 Mar 10]. Available from: https://www.transplantthai.org/?page=annual-report
Ratanasunthorn P, Prommool S, Kurathong P, Kurathong S. Posttransplantation Anemia: Etiology, Diagnosis and Management. Vajira Medical Journal: Journal of Urban Medicine. 2013;57(3):171–8. (in Thai).
Mendez NV, Raveh Y, Livingstone JJ, Ciancio G, Guerra G, Burke GW, et al. Perioperative risk factors associated with delayed graft function following deceased donor kidney transplantation: A retrospective, single center study. World J Transplant. 2021;11(4):114.
De Gasperi A, Narcisi S, Mazza E, Bettinelli L, Pavani M, Perrone L, et al. Perioperative fluid management in kidney transplantation: is volume overload still mandatory for graft function? In: Transplantation proceedings. Elsevier; 2006. p. 807–9.
American Association of Nurse Anesthesiology. AANA | Enhanced Recovery After Surgery [Internet]. 2024 [cited 2025 Mar 12]. Available from: https://www.aana.com/practice/clinical-practice/clinical-practice-resources/enhanced-recovery-after-surgery/
Dias BH, Rana AAM, Olakkengil SA, Russell CH, Coates PTH, Clayton PA, et al. Development and implementation of an enhanced recovery after surgery protocol for renal transplantation. ANZ J Surg. 2019 Oct 1;89(10):1319–23.
Shoskes DA, Halloran PF. Delayed graft function in renal transplantation: etiology, management and long-term significance. J Urol. 1996;155(6):1831–40.
Budhiraja P, Reddy KS, Butterfield RJ, Jadlowiec CC, Moss AA, Khamash HA, et al. Duration of delayed graft function and its impact on graft outcomes in deceased donor kidney transplantation. BMC Nephrol. 2022;23(1):1–12.
Management of delayed graft function – edren.org [Internet]. 2023 [cited 2025 Mar 11]. Available from: https://edren.org/ren/handbook/transplant-handbook/management-of-delayed-graft-function/?form=MG0AV3
Calixto Fernandes MH, Schricker T, Magder S, Hatzakorzian R. Perioperative fluid management in kidney transplantation: a black box. Crit Care. 2018;22:1–10.
Wagener G, Bezinover D, Wang C, Kroepfl E, Diaz G, Giordano C, et al. Fluid management during kidney transplantation: a consensus statement of the Committee on Transplant Anesthesia of the American Society of Anesthesiologists. Transplantation. 2021;105(8):1677–84.
Soukup SM. The center for advanced nursing practice evidence-based practice model: promoting the scholarship of practice. Nursing Clinics of North America. 2000;35(2):301–9.
Joanna Briggs Institute. JBI Critical Appraisal ToolsJBI [Internet]. 2021 [cited 2025 Mar 6]. Available from: https://jbi.global/critical-appraisal-tools
Sharif A, Borrows R. Delayed graft function after kidney transplantation: the clinical perspective. American Journal of Kidney Diseases. 2013;62(1):150–8.
Lubetzky M, Tantisattamo E, Molnar MZ, Lentine KL, Basu A, Parsons RF, et al. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients. Am J Transplant. 2021;21(9):2937–49.
Lafranca JA, IJermans JNM, Betjes MGH, Dor FJMF. Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med. 2015;13:1–18.
Amer A, Scuffell C, Dowen F, Wilson CH, Manas DM. A national survey on enhanced recovery for renal transplant recipients: current practices and trends in the UK. Ann R Coll Surg Engl. 2023;105(2):166–72.
Schmid S, Jungwirth B. Anaesthesia for renal transplant surgery: an update. Eur J Anaesthesioly. 2012;29(12):552–8.
Kolodzie K, Cakmakkaya OS, Boparai ES, Tavakol M, Feiner JR, Kim MO, et al. Perioperative normal saline administration and delayed graft function in patients undergoing kidney transplantation: A retrospective cohort study. Anesthesiology. 2021;135(4):621–32.
Lukaszewski M, Kosiorowska K, Banasik M, Koscielska-Kasprzak K, Krajewska M. Assessment of hemoglobin levels in patients qualified for kidney transplantation in the perioperative period and its impact on the occurrence of delayed graft function. In: Transplant Proc. Elsevier; 2020. p. 2059–61.
Udomkarnjananun S, Townamchai N, Iampenkhae K, Petchlorlian A, Srisawat N, Katavetin P, et al. Furosemide stress test as a predicting biomarker for delayed graft function in kidney transplantation. Nephron. 2019;141(4):236–48.
Seo CH, Ju J Il, Kim MH, Jun KW, Ahn SH, Hwang JK, et al. Risk factors and long-term outcomes of delayed graft function in deceased donor renal transplantation. Ann Surg Treat Res. 2015;89(4):208-24.
Premasathian N, Avihingsanon Y, Ingsathit A, Pongskul C, Jittiganont S, Sumethkul V. Risk factors and outcome of delayed graft function after cadaveric kidney transplantation: a report from the Thai Transplant Registry. Transplant Proc. 2010;42(10):4017–20.
Larpparisuth N, Cheungpasitporn W, Lumpaopong A. Global perspective on kidney transplantation: Thailand. Kidney360. 2021;2(7):1163–5.
Ingsathit A, Avihingsanon Y, Rattanasiri S, Premasathian N, Pongskul C, Jittikanont S, et al. Different etiologies of graft loss and death in Asian kidney transplant recipients: a report from Thai Transplant Registry. In: Transplant Proc. Elsevier; 2010. p. 4014–6.
Newstead C. Management of the peri-operative and critically ill renal transplant patient. Curr Anaesth Crit Care. 2010;21(2):75–7.
Consortium ANS. Appraisal of Guidelines for Research & Evaluation (AGREE) II Instrument [Internet]. 2017 [cited 2025 Mar 16]. Available from: http://www.agreetrust.org
Medical Research and Technology Assessment Institute, Department of Medical Services, Ministry of Public Health. Tool for Quality Assessment of Guidelines for Research and Evaluation (Appraisal of Guidelines for Research & Evaluation II; AGREE II) [Internet]. 2013 [cited 2025 Mar 13]. Available from: https://www.agreetrust.org/wp-content/uploads/2013/09/Thai-AGREE-II.pdf
Sukyai S, Kamying W, Wongyutthajak J, Websoongnoen C. The effects of clinical nursing practice guideline development on nursing outcomes in patients with traumatic brain injury. Journal of Health and Nursing Education. 2022;28(2);1-18. (in Thai).
Yamrattanakul W, Jiraphan A. Clinical practice guidelines for the management of anxiety and depression in patients with stroke: a systematic review. Journal of Mental Health of Thailand. 2021;29(2):161-76. (in Thai).
University of Edinburgh. Edinburgh Renal Unit. 2024 [cited 2025 Mar 11]. Transplant assessment – edren.org. Available from: https://edren.org/ren/handbook/transplant-handbook/transplant-assessment/
Prachanphanit P. Study on the Outcomes of Kidney Transplant Surgery from Brain-Dead Donors and Post-Surgical Complications in Udonthani Hospital. Udonthani Hospital Medical Journal. 2020;28(2):212–9. (in Thai).
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