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As our parents get older, it will eventually become more difficult for them to move around and enjoy life as they once did. Arthritis can sometimes make it so we don’t even want to move around – it is incredibly painful, and as the joints lock up more, it is just going to become more difficult for you or your loved one to move around. The endocrine system is one of the bodya€™s main systems for communicating, controlling and coordinating the bodya€™s work. Patient Care & Health InfoQuality CareFind out why Mayo Clinic is the right place for your health care. Mayo Clinic's kidney transplant doctors and surgeons use proven innovations to successfully treat people with kidney failure and complications of diabetes and other diseases. Mayo Clinic surgeons perform more than 600 kidney transplants a year, including for people with very challenging kidney conditions who need special solutions and surgeries. Your care team works with you every step of the way, from preoperative testing through recovery. By working together, your surgeons, doctors, transplant nurses, pharmacists, social workers and others manage every aspect of your kidney transplant, from planning through post-surgical care. Mayo Clinic kidney doctors and surgeons also have expertise in many other areas of kidney transplantation. Every day the Transplant Research Center brings together specialist surgeons, diabetes doctors (endocrinologists), experts in human cell therapy and other experts many from other institutions — to collaborate.
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I was invited recently to present my PhD research project on dementia to a patient and public involvement (PPI) group. What if I told you there was a new treatment being used to relieve depression and anxiety, and its side effects include improved fitness, weight loss and social integration?
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Peripheral venous catheter-associated phlebitis is caused by inflammation to the vein at a cannula access site. Good practice when inserting a cannula, including appropriate choice of device and site, can help to prevent phlebitis.
There are two phlebitis scoring systems, which should be used in routine practice to identify and treat early signs of the inflammation.
Peripheral venous cannulation (PVC) is a common procedure carried out in hospital to allow rapid and accurate administration of medication (Endacott et al, 2009). Peripheral catheter-related phlebitis is caused by the inflammation of the tunica intima of a superficial vein.
It is estimated that in the UK 20-80% of patients with a PVC develop phlebitis (Pandero et al, 2002). It is essential for nurses to be able to identify patients who are at risk of developing phlebitis. The type of intravenous delivery device used depends on the type of fluid administered and the length of time intravenous therapy will last. Microorganisms gain access to new hosts via a variety of methods, with some microbes using more than one method of transmission.
Understanding these direct and indirect modes of transmission is essential for effective infection control (Box 1).
Clinical staff, especially those in close physical contact with patients, can act as a portal for disease-causing organisms, facilitating their spread between patients and the clinical environment.
Infection control measures are essential in the fight against disease-causing microbes, and in the delivery of a high-quality, effective healthcare service. Good staff hygiene, hand hygiene and adherence to universal precautions (Box 2) are fundamental nursing skills that have consistently been shown to reduce cross-infection, improve hospital hygiene and help combat nosocomial infections (Burke, 2003). In addition, aseptic technique can help prevent the transmission of micro-organisms to wounds and other susceptible sites (such as intravenous cannula ports), and reduce the risk of cross-infection (Hart, 2007).
An aseptic technique is necessary when performing any clinically invasive procedure, especially if the patient has an infectious disease.
Phlebitis has been linked with inappropriate catheter insertion sites and inappropriate catheter usage.
Mechanical phlebitis occurs where the movement of a foreign object (cannula) within a vein causes friction and subsequent venous inflammation (Stokowski et al, 2009) (Fig 1). It often occurs when the size of the cannula is too big for the selected vein (Martinho and Rodrigues, 2008).
This type of phlebitis can be avoided by selecting the smallest possible device for the largest vessel (although some studies such as Uslusoy and Mete (2008) have suggested that catheter size is not a significant causative factor). Consideration must also be given to the nature of the intended IV therapy and optimum cannula size for drug delivery. Antibiotics are reported to increase the incidence of chemical phlebitis due to their low pH (Macklin, 2003). Isotonic fluids have been found to lower rates of phlebitis, while hypertonic fluids increase the incidence of phlebitis by initiating the inflammatory response (Uslusoy and Mete, 2008).
TPN is hypertonic but its osmolarity can be adjusted without affecting the pharmacodynamics of the solution, which, alongside the addition of drugs such as heparin, has been shown to increase the life of a fine bore midline cannula (Catton et al, 2006). Poor practices during drug administration and a higher frequency of drug administration have been found to increase the risk of infective phlebitis (Uslusoy and Mete, 2008). Infective phlebitis can have significant ramifications for the patient due to the potential development of systemic sepsis. The commonest symptoms of any form of phlebitis are erythema and swelling along the venous track, leading to hardened, cord -like veins (Endacott et al, 2009). All patients with an intravenous access device should have the access site checked every shift for signs of phlebitis (LaRue and Peterson 2011; Gallant and Schultz, 2006).
The tool recommended by the Royal College of Nursing is the Visual Infusion Phlebitis scale first developed by Jackson in 1998 (Box 4).
These phlebitis assessment scales are used to inform clinical practice and decision making, indicating to clinicians the first stages of phlebitis and when intravenous cannulas should be replaced (Creed and Spears, 2010).
The clinician’s hands should be thoroughly washed, gloves worn and the patient’s skin adequately cleansed.
Good clinical practice must be observed when administering intravenous drugs, starting at the point of reconstituting and drawing up the drug. After insertion, the cannula should be dressed to minimise movement in the vein lumen, which could lead to mechanical phlebitis. Evidence suggests that the addition of drugs such as heparin and hydrocortisone can reduce the incidence of phlebitis (Ikeda et al, 2004); patients on intravenous steroid therapy have a lower incidence of phlebitis (Kohno et al, 2009).
To avoid chemical phlebitis, the possibility of bringing drug pH or osmolarity in line with physiological ranges should be explored (Kuwahara et al, 1999).


Similarly, TPN infusions have a high osmolarity, increasing the risk of chemical phlebitis (Kuwahara et al 1999) Adjusting the osmolarity of TPN solutions (if possible) can also help prevent phlebitis. Early phlebitis at an intravenous site usually resolves after a cannula is removed or resited (Rickard et al, 2010). Complications are rare but can occur; these include infection, thrombosis, and recurrent superficial thrombophlebitis (Loewenstein, 2011). One of the most serious complications – although fortunately rare – is septic thrombophlebitis, a condition characterised by venous thrombosis and inflammation in the presence of bacteraemia (Mermel et al, 2009). The treatment of phlebitis will depend to some extent on the severity of inflammation and presence of a thrombus. The initial treatment for any form of phlebitis is to stop the infusion and remove the PVC (Webster et al, 2010). An affected limb should be elevated to minimise inflammation and an anti-inflammatory cream or gel can be directly applied to the area (Reis et al, 2009). Anti-inflammatory analgesics can be prescribed to treat both the inflammation and the pain associated with phlebitis. Catton JA et al (2006) The effect of heparin in peripheral intravenous nutrition via a fine-bore midline: a randomised double-blind controlled trial. Dougherty L, Lister S (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures.
Gallant P, Schultz AA (2006) Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. Ikeda S et al (2004) Use of heparin to lower the incidence of phlebitis induced by anti-neoplastic agents used in ovarian cancer. Kohno E et al (2009) Effects of corticosteroids on phlebitis induced by intravenous infusion of antineoplastic agents in rabbits. Macklin D (2003) Phlebitis, a painful complication of peripheral IV catheterization that may be prevented.
Malach T et al (2006) Prospective surveillance of phlebitis associated with peripheral intravenous catheters. Martinho RFS, Rodrigues AB (2008) Occurrence of phlebitis in patients on intravenous amiodarione. Mermel LA et al (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: update by the Infectious Diseases Society of America. Pandero A et al (2002) A dedicated intravenous cannula for postoperative use: effect on incidence and severity of phlebitis.
Rickard CM et al (2010) Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial. Stokowski G et al (2009) The use of ultrasound to improve practice and reduce complication rates in peripherally inserted central catheter insertions: final report of investigation. Uslusoy E, Mete S (2008) Predisposing factors to phlebitis in patients with peripheral intravenous catheter: a descriptive study. Webster J et al (2010) Clinically-indicated replacement versus routine replacement of peripheral venous catheters.
If they have diseases like diabetes and arthritis (which sadly, sometimes go hand in hand), their mobility is definitely going to be more limited than it ever has been before. When you’ve got a chronic disease like arthritis, you can sometimes feel an excess of stress or feel as if you can’t keep everything under control in your life. Sometimes, in order to reduce pain, we have to make a couple adjustments to the way that we are doing things. There are tons of organizations out there that can help you stay “in the know” when it comes to arthritis treatment.
Like arthritis, it can be treated with exercise, but sometimes the struggles related to the disease make it hard for a person to really be able to get out there and do what they need to do. Even if you aren’t moving around a lot, you could have a lot of issues with your feet.
We mentioned these two things in the section on arthritis, but they are also absolutely vital for diabetics as well. As we mentioned above, research can be key in making sure that you’re up to date on everything going on in the world of medicine, and you can often find a ton of information that is related to whatever disorder that you are dealing with.
Now, of course, if you or your loved one is able to move around and exercise, that is always an amazing option, but we all know that there will be days, even weeks where that feels impossible. Mendoza provides expertise in the diagnosis and treatment of diabetes and health conditions related to hormone imbalances and thyroid disorders. Their experience in using minimally invasive surgery, new medicines to prevent organ rejection and specialized procedures makes Mayo Clinic a leader in transplant outcomes. And Mayo Clinic kidney transplant teams in Arizona, Florida and Minnesota are leaders in living donor kidney transplants.
Mayo Clinic's kidney transplant team is recognized nationally and internationally for its expertise in comprehensive specialty treatment for people with serious kidney conditions.
Mayo's kidney transplant specialists are focused on your needs and your family’s needs. Mayo Clinic doctors and surgeons use innovations and complex procedures available at only a select few institutions. For example, if paired donation isn't an option for you, they may talk with you about anti-HLA antibody, ABO incompatible or positive crossmatch transplants. Our scientists and physicians are involved in research that makes transplants safer and available to more people. They have expertise treating people in many areas of kidney transplantation, including those listed below. The development of a laparoscopic donor nephrectomy program in a de novo renal transplant program: Evolution of technique and results in over 200 cases. Combined heart and abdominal organ transplantation: Excellent outcomes gained from a unique experience.
Assessing the efficacy of kidney paired donation — Performance of an integrated three-site program. Positive crossmatch kidney transplant recipients treated with eculizumab: Outcomes beyond 1 year. Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy.
Reassessing preemptive kidney transplantation in the United States: Are we making progress? Decreased chronic cellular and antibody-mediated injury in the kidney following simultaneous liver-kidney transplantation. With 27 kidney specialists, 22 clinics and more than 40 dialysis centers across San Antonio and South Texas, you’ll never be far from trusted care. The ‘wonder drug’ in question is a smartphone game called Pokemon Go and you’re going to hear a lot about it.
Select 30+ subscriptions Our package is designed for organisations who want to purchase access and benefit from a group saving. However, the placement of an intravenous cannula can have undesirable effects, the most common of which is phlebitis.
The inflammation is due to irritation of the tunica intima by mechanical, chemical or bacterial sources. This broad range has also been reported in studies from other countries (Uslusoy and Mete, 2008) and suggests poor identification of phlebitis or poor reporting protocols. In turn, early recognition will enable prompt intervention, minimising disruption to treatment.


A significant number of patients admitted into hospital receive some form of intravenous therapy via PVC.
For example, peripheral venous cannulas are indicated for short-term use only (Dougherty and Lister, 2008).
Microorganisms are not able to move freely between hosts by themselves – they require either direct physical contact with a new host, or they use another person, animal or inanimate object, to gain access. An unhygienic environment can harbour micro-organisms and facilitate their contamination and spread (Randle et al, 2009).
It is, of course, indicated when delivering intravenous therapy, be it cannula insertion, intravenous drug or fluid administration (Randle et al, 2009). In addition, a poor standard of infection control has a part to play and infection control and hygiene standards are essential in the treatment and prevention of the condition (Uslusoy and Mete, 2008).
It has also been suggested that placement of a cannula near a joint or venous valve will increase the risk of mechanical phlebitis due to irritation of the vessel wall by the tip of the cannula (Macklin, 2003). For example, a large-bore cannula would be appropriate for rapid fluid resuscitation while a cannula with a smaller bore would suffice for sliding scale insulin therapy.
Factors such as pH and osmolarity of the substances have a significant effect on the incidence of phlebitis (Kohno et al, 2009) (Figs 2 and 3). With a large proportion of hospitalised patients receiving IV antibiotics, nurses need to be vigilant when administering this therapy. It may start as an inflammatory response to cannula insertion, allowing bacteria to colonise the “inflammatory debris” (Malach et al, 2006). Malach et al (2006) found the bacterial growth on removed cannula tips were those commonly associated with normal skin flora.
The area can feel warm and patients may experience pain or discomfort during drug administration (nurses should assess if this pain persists between administrations). Any exudate oozing from the insertion site would also be suggestive of phlebitis, in particular infective phlebitis (Macklin, 2003).
A number of phlebitis scales and assessment tools have been developed to assist this, and the two most commonly used in the UK are the Phlebitis Scale and the Visual Infusion Phlebitis (VIP) scale. The VIP scale has been shown to be a valid and reliable measure for determining when an intravenous catheter should be removed (Gallant and Schultz, 2006). This standard of practice must continue to the administration phase, with particular attention paid to cannula sites of patients on frequent intravenous therapy, as regular use of the cannula site increases the risk of bacterial phlebitis (Uslusoy and Mete, 2008). The site should also be carefully selected, to avoid any bony prominences, joints and venous valves that would cause the cannula to move within the vein lumen.
However, this applies only to the administration of antineoplastic drugs and so is limited to patients receiving cancer chemotherapy. For example, patients undergoing antibiotic or potassium therapy have a higher phlebitis risk due to the low pH of these solutions and neutralising such solutions may help prevent phlebitis (Kuwahara et al, 1999), although this is not usually done by nurses.
This should be done with consideration for the patient’s needs; if, for example, the patient is haemodynamically unstable, the PVC should only be removed once a new PVC has been sited.
In order for you to see this page as it is meant to appear, we ask that you please re-enable your Javascript! If you are overweight, you’re going to feel more strain on your body and your joints are going to be more difficult to move. By being involved with them and staying in touch with your specialist on a regular basis, you can stay informed and understand possible changes in your treatment.
One of the main reasons is because there is often nerve damage can play a significant role in what is going on in your body, making it uncomfortable and even painful for you to move around and do things. One drink once in awhile isn’t a big deal, but if you drink all of the time, the extra alcohol can make your sugar go nuts. Many diabetics will end up having nerve damage there, and if you don’t keep an eye on them, you could end up with some severe issues.
You want to make sure that you’re on a low fat, low sodium, low sugar diet and you want to be sure that you aren’t feeling stressed out all of the time. Talking with your specialist, reading news on the internet (from trusted sources of course) and being involved in organizations for your disorder can help keep you up to date. People who receive a kidney from a living donor usually have fewer complications than do those who receive a kidney from a deceased donor. They collaborate with you and a multidisciplinary team of doctors in endocrinology, infectious disease management and other specialties to provide the most appropriate treatment. And they have advanced the science and clinical practice of transplantation, including paired donation, multiorgan transplants, living-donor transplants and kidney transplant before dialysis is needed (preemptive transplant). At Mayo Clinic's campus in Arizona, doctors partner with Phoenix Children's Hospital to treat children who may need kidney transplants. Not all services are available at each of Mayo Clinic's three campuses, in Arizona, Florida and Minnesota. Click here for a map of our locations.Stay up to date with resources and education on kidney diseaseYour kidneys are key to your overall health. If left untreated, it can lead to infection or thrombus formation (Royal College of Nursing, 2010). If intravenous therapy is indicated for longer periods, central venous access will be required. Pyrexia and haemodynamic deterioration of an unknown origin should prompt investigation into cannula infection and potential systemic sepsis. A patient with phlebitis with a VIP score of 2 or more will require their cannula to be removed or resited.
So by watching what you eat and dropping weight, you can relieve some of the stress and strain. Stress is horrible for your body and it can make it even more difficult to move and enjoy life.
Smoking, of course, is bad in every case, so quitting is always an important and necessary option when dealing with your treatment of any disease, including diabetes. Soak them to relax them, clean them regularly, and make sure there isn’t anything odd about them (cracks, skin wearing away, ulcers, drainage, or swelling). Stress hormones can actually make it so that your sugars are out of control, and as a result it can make your sugars off balance as well. Empower yourself to live a healthier life, and team up with us to maintain and even enhance your quality of life.
Also, make sure that your diet does not have a lot of sugar or fat in it, as those things can make it harder for you to control the pain. Learn to relax, get enough sleep in a night, manage your relationships well, and make sure that you can talk out your feelings with someone you trust.
Slide instead of lifting when you can, and make sure to get up and move around if you’re used to sitting most of the time.
Click here to access our patient resources and educational materials.Trust your chronic kidney disease to the leaders in clinical researchThe goal of our Clinical Advancement Center is to provide patients suffering from renal disease and associated illnesses a little higher quality of life and a more promising future through our contributions to medical research. Click here to see how you can participate in clinical research for chronic kidney disease and other kidney-related research.



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