BACKGROUND Hemodialysis sessions frequently become unstable from complications such as intradialytic hypotension and untoward symptoms. Previous patient safety initiatives promote prevention of treatment complications; yet, they have placed little specific focus on avoidable session instability. A patient-centered definition of session instability grounded in patient experiences, and an understanding of patient perceptions of causes and solutions to instability, may enable such efforts. METHODS Twenty-five participants participated in three focus groups and/or a survey. They were purposively sampled for variation in region of residence, and sensitivity to patient well-being. Focus group recordings were analyzed using descriptive coding, in vivo coding, and thematic analysis. RESULTS Patients define unstable sessions ("bad runs") as those in which they experience severe discomfort or unanticipated events that interfere with their ability to receive therapy. Bad runs were characterized primarily by cramping, low blood pressure ("crashing"), cannulation-related difficulties ("bad sticks"), and clotting of the dialysis circuit or vascular access. Patients believed that cramping and crashing could be explained by both patient and clinician behavior: patient fluid consumption and providers' fluid removal goals. Patients felt that the responsibility for cannulation-related problems lay with dialysis staff, and they asked for different staff or self-cannulated as solutions. Clotting was viewed as an idiosyncratic issue with one's body, and perceived solutions were clinician-driven. Patients expressed concern about "bad runs" on their ability to achieve fluid balance. CONCLUSIONS Findings point to novel priorities for efforts to enhance hemodialysis session stability, and areas in which patients can be supported to become involved in such efforts.

中文翻译：

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抓取，撞击，插管和凝结：对患者对血液透析“不良反应”的定义的定性研究。

背景技术血液透析过程经常由于诸如透析内低血压和不良症状之类的并发症而变得不稳定。先前的患者安全措施可促进预防治疗并发症；但是，他们几乎没有将重点放在可避免的会话不稳定上。基于患者经验的以患者为中心的会话不稳定性定义，以及对患者对不稳定性原因和解决方案的理解的理解，可以促成这种努力。方法25名参与者参加了三个焦点小组和/或一项调查。目的是对他们进行抽样，以了解其居住区域的变化以及对患者健康的敏感性。使用描述性编码，体内编码和主题分析对焦点小组的记录进行了分析。结果患者定义了不稳定的疗程（“不良运行” ），因为他们经历了严重的不适或意料之外的事件，从而干扰了他们的治疗能力。不良运行主要表现为抽筋，血压低（“崩溃”），与插管相关的困难（“不良棍棒”）以及透析回路或血管通路凝结。患者认为痉挛和碰撞可以用患者和临床医生的行为来解释：患者的液体消耗和提供者的液体清除目标。患者感到透析相关问题的责任在于透析人员，因此他们要求其他人员或自行植入作为解决方案。凝结被认为是人体的特质问题，并且感知的解决方案是由临床医生驱动的。患者对“不良运行”表示担忧 他们实现流体平衡的能力。结论研究结果指出了提高血液透析疗程稳定性的新重点，以及可以支持患者参与此类工作的领域。