Mary S. Wheeler

A salvage technique for continuous ambulatory peritoneal dialysis catheters with exit-site infections

Catheter infection is a major complication of continuous ambulatory peritoneal dialysis (CAPD) therapy for end-stage renal disease. Catheter exist-site infections were treated with a new surgical technique consisting of dissection and removal of the existing catheter in the subcutaneous layer, insertion of a catheter connector and new catheter piece, and creation of a new subcutaneous tunnel. The new surgery can be performed on an outpatient basis and allows for the continuation of CAPD, thereby avoiding the cost associated with inpatient admission and interim hemodialysis.

Pain assessment and management in the patient with mild to moderate cognitive impairment.

The gold standard for pain screening and assessment is the patient report. Research shows that many patients with mild to moderate cognitive impairment retain the ability to report pain. All patients should be given the opportunity to self-report their pain using valid and reliable tools.

Interviews with patients who have cancer and their family members provide insight for clinicians.

The words of patients with cancer about pain management are powerful learning tools. Questions were posed about the meaning of pain for patients and families, effective pain management strategies, and professional caregivers’ roles to three patients and families. This article details their responses about pain, pain management, and the barriers they encountered. Clinicians are urged to read these case reports to “hear” the importance of effective pain management to individuals and act appropriately.

Managing noncardiac pain in heart failure patients.

Both acute and chronic pain are common coexisting problems in patients with heart failure. Because nonsteroidal anti-inflammatory drugs and corticosteroids are contraindicated in heart failure, traditional pain management algorithms require modification. This article reviews pertinent pain management principles, including pain vocabulary, barriers to pain management, and general pain assessment and treatment measures. Issues unique to the heart failure patient are discussed and specific interventions for the heart failure patient with acute or chronic pain are then delineated.