Nurses trained in dialysis for pandemic response

Four nurses in Samoa’s coronavirus preparation unit at the national hospital have graduated from an intensive training in acute dialysis.

The National Kidney Foundation (N.K.F.) has extended its training service to the Tupua Tamasese Meaole Hospital staff in anticipation of an outbreak of COVID-19, which has been shown to attack the kidneys.

Research on cases around the world has shown rates of between 15 to 20 per cent of COVID-19 patients suffer an acute kidney injury and require lifesaving dialysis. 

Evelyn Seuoti, from the intensive care unit, Albert Tuilaepa Bell, from the operating theatre and Semu Iesiva and Tuifiti Charles Roache from the Acute 8 Department where chosen to undergo the dialysis training.

They are among 40 nurses selected to prepare for COVID-19 through online Massey University courses and some specialist training in acute care and emergency care.

The team are also mentally and emotionally preparing to have to isolate from their families and friends should an outbreak of COVID-19 enter the hospital as if it does, they may not be allowed to go home.

I.C.U. nurse, Evelyn Seuoti, said she was proud to take on the opportunity to be among the first public health nurses trained in acute dialysis treatment for intensive care. 

“For all of us, it’s scary. In other countries, most of the health professionals are the frontliners and some health professionals sacrifice their lives,” she said.

Ms. Seuoti has been a practising nurse for five years, and is 27-years-old. As well as dialysis training she has been practicing “donning and doffing” the layers of personal protective equipment she might need if the highly infectious COVID-19 enters the hospital. 

“We do simulations every two weeks to practice, just in case we might have a suspected or maybe a confirmed case.”

In the I.C.U. there 20 registered nurses which is not quite enough if the unit was become full. 

They will be responsible for eight beds, 10 ventilated patients and two dialysis machines for patients who require it. 

“If there are eight patients a day there is not enough staff to cater to them, with eight staff per shift for three shifts a day. Right now we can do five per shift.”

Acute kidney injury has proven to be both a severe complication of COVID-19, and one that significantly increases the mortality rate of its victims.

A preprint of research published in medRxiv reports that out of 85 patients studied, 23 per cent had an acute kidney injury. Among high risk patients it was 60 per cent. 


National Kidney Foundation Renal Services Manager Christina Poloai-To’afa ran the four week intensive training and will continue to host the four nurses for the coming months to keep up their skills.

They will spend one shift a week at the N.F.K. delivering dialysis to the patients there for at least the next four months. 

As well as providing the skills to the national hospital nurses, N.K.F. is also handing over two dialysis machines and two water filtration machines to be installed in the I.C.U. department for potential COVID-19 use, which is worth about $100,000. 

N.F.K. Clinical Director Leituala Ben Matalavea said it takes at least four people to work a dialysis machine – three nurses to cover a 24 hour shift and a biomedical engineer. If an outbreak were to affect the hospital, he doubted the kidney services would get those four people back to regular N.F.K patients.

“It is best we provide the treatment that is appropriate for the patient at the point of contact, meaning if someone with COVID arrives at the hospital and they need dialysis we need to train people there to provide that service.”

Currently, N.K.F. staff are called into the hospital at all hours of the day to help dialyse victims of disease or accident that damage the kidneys, because they are the only ones with the knowledge. The newly graduated nurses will be able to fulfil this role from now on.

The small team of 22 dialysis practitioners manage 140 patients between them and deliver outreach programmes to screen for pre-diabetes or kidney disease in the community. 

N.F.K. Chair Papalii Samuelu Petaia said his organisation has been trying to train public service nurses in dialysis treatment for a long time, and that the threat of COVID-19 finally pushed them to make it happen.

It means the 140 patients currently requiring dialysis at the N.K.F. site won’t be left understaffed if demand surges in the hospital, which even without the pandemic can happen sometimes. 

If the Ministry of Health wants it, N.K.F. will offer more training for nurses to learn how to deliver dialysis treatment, Papalii said. 

Acute 8 nurse, 22-year-old Tuifiti has been working for a year. 

“I am so proud to be on this team, it’s the first time I received a call from our leaders and it is a good opportunity for us to participate,” he said.

“I just rely on God to help us and protect us and pray for the COVID not to enter Samoa.”

Tuifiti said he and his family have discussed the scenario where he may not be sleeping at home if Samoa is responding to the pandemic.

“The first time I asked my mum for permission to join this team, it was not easy for her to release me,” he said.

“But now they are so proud of me to have this new experience and new knowledge on acute dialysis.”

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