health systems
ST . JOSEPH ’ SHEALTH A BETTER WAY TO PREPARE DIALYSIS PATIENTS
The good news : With the help of modern medicine , chronically unwell patients are living longer than ever before . Instead ofsuccumbing to illnesses like kidney disease , they can return to the hospital for years of life-sustaining treatment .
The bad news : Patients who need procedures such as dialysis on aregular basis are stuck so often with needles that the integrity oftheir veins can be imperiled , and steps need tobetaken to preserve them .
It is in this context — and the need to free up operating rooms where dialysis patients have traditionally been catheterized — that Matt Ostroff , a nurse practitioner at St . Joseph ’ s Health , came to lead ateam that places tunneled dialysis catheters in patients right at their bedsides , usually in the neck area . Not having to relocate patients to operating rooms to insert the tunneled catheters — IV tubes that go under the skin — eliminates the time interventional radiologists and vascular surgeons are tied up doing the procedure , and allows Ostroff ’ s
NP MATT OSTROFF WITH A PATIENT
team to comfort and sometimes translate for the patients . Ostroff says heisaware ofonly one other nurse practitioner inthe world doing what he ’ s doing , and that individual works in Australia . Ostroff performed the first bedside tunnel dialysis in September 2022 . He has been innovating ways to efficiently and painlessly thread dialysis catheters , though , since 2015 , when he helped developed away toinsert them in the mid-thigh ; this method , he notes , sticks to National Kidney Foundation guidelines to preserve veins in the arms , wrists and hands , even if the patient hasn ’ t started hemodialysis yet .
“ Dr . Sam Rae ( anephrologist with St . Joseph ’ s Health ) approached me one day and asked me to consider placing tunneled dialysis catheters , which used to only be performed with fluoroscopy ( a continuous X-ray ),” hesays . “ Atfirst Isaid no , but then Iread apaper by avascular surgeon inPhiladelphia about having to do bedside tunnel dialysis because he couldn ’ t bring patients down to surgery during COVID . Idid aton of research , and came up with aprotocol and plan .”
The plan , hesays , involves minimal sedation with asmall dose ofVersed and topical lidocaine , and inserting avery small needle into the jugular vein on the right side of the neck guided by ultrasound ; then , he tunnels acatheter underneath the skin from the chest to the neck . Once out , the catheter is placed and ready for use after anX-ray .
The practice is innovative enough that it won the team aMagnet Innovation Award from the American Nurses Credentialing Center inOctober 2022 . In December , Ostroff published abook on the subject , Ultrasound GuidedVascular Access : Practical Solutions to Bedside Clinical Challenges . And he is currently working on apaper about the hospital ’ s bedside vascular program , which he believes will be the first paper published in the U . S . on this subject .
VALLEY HEALTH RESIDENCY PROGRAM IN THE WORKS
Fully opening a Paramus campus to the public won ’ t be the only development Valley Health plans to kick off in 2024 . On July 1 of next year , Valley will welcome its first class of medical residents — 12tobe trained in internal medicine in each of three years for atotal of 36 , and three to be trained in obstetrics / gynecology DR . REHAM in each of four years for a SHAABAN total of 12 . The programs have received initial accreditation , and recruiting ofmedical school graduates in the two specialties will begin this fall . The new graduate medical programs are being led by Dr . Reham Shaaban , who has more than 15 years ofexperience leading internal medicineresidency programs . She will lead Valley ’ s internal medicine program , while Dr . Kajal Angras will head up the ob / gyn program .
“ It ’ sexciting to start something new and build from the ground up ,” says Shaaban . “ When these doctors graduate , they can work in inpatient or outpatient settings or pursue a specialty through a fellowship .” The students will be supervised and guided by physicians within the Valley Health system using resources developed by the Icahn School ofMedicine at Mount Sinai , Valley ’ sacademic sponsor . Some training sessions will be virtual , while others will be held in person , says Shaaban . Plans are currently in the works to launch asurgery residency over the next few years , possibly followed by specialties such as palliative care , oncology and hematology .
PATIENT : COURTESY OFST . JOSEPH ’ S HEALTH ; HEADSHOT : COURTESY OF VALLEY HEALTH
8 2023 EDITION ( 201 ) HEALTH