6 Years of Experience with Nightly Home Hemodialysis Access
Bibliographic record
Abstract
Lynchburg Nephrology Dialysis Inc. started its nightly home hemodialysis (NHHD) program in September 1997. Purpose of study: To evaluate episodes of exit site infections, catheter sepsis, safety, and longevity of accesses for patients doing NHHD. Methods: If IJ catheter was chosen, patient was started on Coumadin 2 mg/day when catheter was placed. If catheter malfunctioned, it was locked with a thrombolytic agent and Coumadin was adjusted to meet a goal INR of 1.5–2.25. If the problem persisted, the catheter was exchanged. For catheters, the B‐D InterLink device was used to prevent air emboli and infection, and a locking device was used to prevent disconnects. If AV fistula was used, 4 buttonholes were established using 16 gauge needles. If AV graft was used, patients were taught the ladder cannulation technique using 16 gauge needles. Results: As of September 1, 2003, 45 patients have completed training and have performed 27,063 treatments at home. Total catheter time at home was 930 months. Total AV fistula and AV graft time at home was 190 and 20 months, respectively. Upon completion of training, 34 patients were using tunneled IJ catheters, 10 using AV fistulas, and 1 using an AV graft. The IJ catheter exit site and sepsis infection rate was 0.35 and 0.49 episodes/1000 patient days, respectively. Average catheter life was 8.5 months with the longest 66.7 months and the shortest 0.2 months. The AV fistula and graft exit site and sepsis infection rates were 0.16 and 0 episodes/1000 patient days, respectively. Catheter complications included 1 episode of disconnect due to patient's failure to use locking device, 1 episode of central stenosis, and 1 episode of intracranial hemorrhage, due to prolonged INR, with resolution of symptoms. Conclusion: Data support that tunneled IJ catheters, AV fistulas, and AV grafts were effective and safe permanent accesses for patients on NHHD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".