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Understanding Home Hemodialysis
Utopia Health Career Center
www.utopiahcc.com
Magda Castaneda, RN, BSN, CNN, HTC Coordinator/Instructor
BONENT Approved Program Florida Board of Nursing CE Provider # 50-16333
Goals
• Provide guidance to dialysis and non-dialysis personnel in understanding the Home Hemodialysis process. A well informed staff member can help educate patients and therefore help them make an informed decision when choosing a dialysis treatment modality.
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Objectives
The Student will:
• Define Hemodialysis and Home Hemodialysis.
• Describe the Home Hemodialysis patient selection process.
• Identify the steps of the patient training.
• Describe different types of vascular accesses used in Home Hemodialysis.
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• Describe what a buttonhole track is and who can use it.
• Indicate methods for Home Hemo patient monitoring.
• Indicate methods for water monitoring at home.
• Describe clinic visits and schedule.
• Describe lab draw process and schedule.
• Describe flowsheet documentation and deliver to the Home unit.
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Hemodialysis and Home Hemodialysis
• Hemodialysis:
Done for people that have kidney failure.
The blood is cleaned using a filter on a machine.
Fluid and wastes (solutes) are removed from the blood.
Conventional: in-center. 3 times a week. Time varies by patient.
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Home Hemodialysis (HHD) • Modality in which the patient is trained to
perform hemodialysis at home.
The blood is cleaned using a filter on a machine.
Fluid and wastes (solutes) are removed from the blood.
• Done up to 6 times a week at home.
• Treatment is gentle and patient is less time on the machine each day.
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Home Hemodialysis (HHD)
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• In order to perform Hemodialysis at home, patient and partner have to go through a 3 – 5 week training program. • Once training is done patient receives the equipment and supplies at home. • A partner has to be with them at all times during treatment. • Clinic visit once a month.
Benefits
• Reduces LVH (Left Ventricular Hypertrophy)
• Reduces Amyloidosis (Waxy Protein build up – Carpal tunnel)
• Can help reduce PO4
• Better fluid management
• Better clearance
(short daily – Kt/v = 2.0)
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Benefits
• Quality of life
• Independence
• Travel
• Flexible Treatment Schedule
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Hemodialysis and Home Hemodialysis
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Fresenius Baby - K Nxstage Cycler One
Process • Patient’s referral • Patient’s phone interview • Patient’s physical interview • Home visit • Training arrangements • Training starts ( 3 – 5 weeks) • When ready treatments start at home • Patient is monitored • Clinic visit
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Patient Referral
• Who is a candidate for HHD?
Any patient and/or partner that is motivated to perform hemodialysis within their home.
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Patient Referral • Contraindications
Non compliant hemodialysis patient.
Behavioral issues.
No cleanliness.
No support at home.
Physical limitations (blind, paralysis, hearing issues, etc…)
Illiterate
Hx of abusive or aggressive behavior
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Patient Referral Access cannulation issues
Renting a home
Limited space for supplies
Bedridden or on ventilator
Dementia or short term memory
Homeless
Hx of uncontrolled seizures
Drug or alcohol use/abuse
Uncontrolled psycological disorders (Alzheimer, Bipolar, Schizophrenia)
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Patient Referral Has no phone communication
Does not have access to water and electricity
Language barrier which prevents communication with training nurse and /or support team
* Patient can be referred by Physician, Social Worker, another staff member, another patient or self referred. (Md order is needed)
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Phone Interview
• Training nurse has a phone conversation with the patient for
initial screening.
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Physical Interview
• Patient selection tool is used
• Cognitive test performed
• Dexterity test performed
• Color vision test performed
• Labs are evaluated
• Patient must come with partner. If no partner, a Physician order must be present.
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Color Vision Test Plate
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Home Visit
• Training Nurse visits patient’s home:
Cleanliness
Storage Space
Hazards
Patient & partner relations
Idea of where the machine will be (<40 feet from a drain).
Depending on which machines is used home modifications may be needed.
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Equipment & Supplies
• Once the suitability of patient is established then the equipment and supplies are ordered. (MD order)
Machine
Supplies
Acillaries
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Equipment & Supplies
• Dialysate
• Time
• Vascular Access
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Schedule
• Training
• At Home
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Training
• Patient and Partner have to be present.
• Principles of dialysis
- When kidneys fail
(Diet, medication and dialysis).
- Osmosis
- Diffusion
- Ultrafiltration
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Basic Chemistry of the Body
• Solution: homogeneous mixture of dissolved particles (solute) and a liquid (solvent).
Example: water and sugar mix.
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Solute
• Which one is a solute:
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Stones Sugar
Solute
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Rice
Cocoa
Osmosis
• Movement of fluid from an area of low concentration of solutes to an area of high concentration.
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Osmosis
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Diffusion
• Movement of solutes from an area of higher concentration of solutes to an lower concentration of solutes so that both sides are equal.
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Diffusion
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Diffusion
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Ultrafiltration
• Extra squeeze in order to remove fluid.
• Fluid removal goal.
• Set up on the machine.
• HHD - ≤ 3 kgs.
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Training
• Infection Control
Clean
Sterile
Dirty
PPE
Hand wash (Gel soap)
Handling blood specimens at home
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Infection control
Medication vials, syringe disposal
Access hygiene
Cleaning work surfaces
Machine disinfection
Supplies disposal
Sharp containers (3/4ths full)
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Dialysis Machine
• Baby –K
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Dialysis Machine
• Nxstage
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Nxstage
• Watch video setup
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Water Treatment
• AAMI
• Cultures – Dialysate
• Chlorine & Chlorimine test
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Training
• Access Care
AV Fistulas
AV Grafts
CVC (Central Vein Catheters)
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Training
• Buttonhole Technique
http://www.nxstage.com/medisystems/mediacenter/constant-site-cannulation
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Training
• Monitoring Treatment
Flowsheet
Flowsheet documentation
Delivery of the Flowsheet
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Training
• Diet and Fluid
Diet is more flexible
Fluid control
PO4 binders
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Training
• Medications
Oral medications
PO4 binders
Epogen
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Laboratory
• Lab training
• IATA (Internation air transport Association)
• Centrifuge
• Lab boxes
• Fed ex
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Training
• Complications and Emergencies
• 24 hr On call
Technical support
Clinical support
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Training
• Coping
Social Worker
Support groups (physical & online)
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Training
• Ordering supplies
• Monthly follow up (clinic visit & doctor’s appointments)
• Exercise and activities
• Overall health
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Training
• Other modalities
- Nocturnal
- In-center
- PD
- Transplant
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Conclusion
• Home Hemodialysis is an option for the dialysis patients. It gives them freedom and independence. Patients are able to decide when during the day they will dialyze and which days of the week they will do it. Overall, patient in HHD tend to be more happy and have a better quality of life.
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