Understanding the Complex Nature of End-Stage Renal Disease (ESRD) in the IR Setting 

Sunday, June 12, 2022

1:20pm - 2:20pm ET

When the kidneys lose the ability to adequately filter wastes and excess fluids from the body, which can occur from a variety of causes, the patient is considered to have End-Stage Renal Disease (ESRD). Patients with ESRD require the assistance of tunneled catheters or the creation of a fistula to receive dialysis treatments so that the blood can be filtered properly. Interventional Radiology (IR) plays a significant role in the placement of these lines, the mapping of the vessels for fistula creation, and the management and treatment of the complications associated with arteriovenous fistulas. Understanding the complex nature of ESRD, the co-morbidities these patients often have, and the serious risks and negative outcomes that can occur from fistula interventions are essential for IR nurses.  Analyzing and preparing for each ESRD patient’s individual medical needs and planned interventions allows for better patient outcomes.

This virtual presentation will discuss the pathophysiology of ESRD, the co-morbidities often associated with the disease, and the factors to consider when protocoling these patients for nursing sedation versus anesthesia-level care. Venograms, tunneled hemodialysis line placements, fistulograms, angioplasty, stenting, and de-clotting procedures will all be discussed. Complications and risks related to these procedures will be addressed utilizing case studies. Pictures of before and after images and video clips of upper extremity angiograms will be used to demonstrate altered perfusion and reperfusion. Nursing care considerations, medication administration, thrombolysis management, and potential complications will all be reviewed.  

Melissa Mullen, MSN, RN

Nursing Practice Specialist

Massachusetts General Hospital

Melissa Mullen earned her BSN from Boston College (BC) in 1996 and began her career at Massachusetts General Hospital (MGH) working on a surgical floor. After a few years, she transferred to the Emergency Department where she spent the next 15 years of her career. Eventually she began to focus on staff certification and continuing education which led her to get her Master’s in Nursing Education from Framingham State University in 2014. While the ED would always be her first love, it was time to move on to a new adventure. She began teaching clinically for BC for the undergraduate and master’s programs and switched to the interventional radiology (IR) department at MGH. After 4 years in IR, she took on the shared role of Nursing Practice Specialist for the Department of Radiology where she oversees the orientation and continuing education of the IR and Imaging staff. Simulation is a passion for Melissa, as she teaches interdisciplinary Contrast Emergency Management Sim every week and writes, runs, and debriefs virtual sims for the school of nursing at Endicott College. She is also a contributing author and editor for the Journal of Radiology Nursing and has spent much of the past 2 years working as a nurse educator in two pop-up COVID-19 surge-ICUs.