Foot Assessment in the Dialysis Unit

Abstract

            A major complication in the end stage renal disease (ESRD) population is lower extremity amputation from vascular complications and nonhealing wounds.  The incidence of nontraumatic lower extremity amputation among the end stage renal disease population in the United States is ten times higher when compared to the general public. Mortality rates for ESRD patients following amputation are elevated with less than 50% surviving two years postoperatively.  Increased vascular complications force many amputees to undergo revisions to an amputated site, revascularization, or additional limb removal. Despite the increased mortality risk there is no lower extremity assessment guideline for ESRD patients. 

            The purpose of this study was to analyze and synthesize current research regarding amputation risks in the ESRD population and implement a lower extremity assessment tool that can easily be performed in the hemodialysis unit.  Following staff education, the quick assessment tool was placed into use at a dialysis unit in Greenville, SC.  The professional nurses performed lower extremity assessments based on evidence based protocol for a period of three months on all dialysis patients with diabetes or over the age of 65 years.  Vascular irregularities were noted on the assessment tool and referrals were made to wound management, vascular surgery, and podiatry as needed.

            The objective of the project was to determine if a dedicated lower extremity assessment tool used monthly in a hemodialysis unit could decrease the incidence of lower extremity amputations.  Findings demonstrated eleven new referrals were made to specialists in the three month period.  These findings resulted in early recognition of complications including the need for a great toe amputation from osteomyelitis, a revascularization, and nine referrals for follow up care for potential complications.