In the previous article (The Home Haemodialysis Assessment System; part 1), we discussed the assessment of patients for the use home haemodialysis (HHD), the qualifications of nephrologists and dialysis nurses; and the users of home haemodialysis devices (HHDDs) and patient training providers. In this article, we focus on the HHD training assessment system.
4 The HHD training assessment
Before patients receive any training, there are several conditions that need to be checked by dialysis nurses. These are related to the home environment and the patient. In the former case, the conditions include the adequacy electrical service and plumbing in the patient’s home; the amount of appropriate space for the device; and the cleanliness of the patient’s home environment. In the latter case, checks are made to ascertain whether the patient is able to use their hands without problems; and the patient is able to see and read (if they have sight or hearing impairment, they may have partners or care helpers who are willing to support and help them with their home treatment). If it is found that conditions are suitable for patients to carry out the treatment by themselves, as is the case when a patient’s home environment can store their HHD supplies, the water quality is good by test, and patients do not have major disabilities, then patients can get blood access.
For all types of any HHDDs, patients need to have an easy way to access their bloodstream. This is provided by a blood access, which is inserted during a small vascular surgery. There are three types of access: namely, fistula, graft, and catheter (Blagg, 2010). Fistula is the first and best choice for most patients, and it involves surgery to connect an artery and a nearby vein. Graft is the second-best access choice for patients. It surgically connects an artery and nearby vein with a piece of man-made vein. The least desirable access is a catheter, which is a plastic tube put into a large vein in a patient’s neck or chest. Catheters are more prone to infections compared to the other two accesses. After a patient’s access is ready to use, they will need training.
The patients themselves do not need to have a medical background to learn how to carry out the procedures safely at home. The duration of their training depends on the types of HHD, and can take several weeks up to a few months (depends on different types of HHDDs). According to individual’s unique and different needs, dialysis nurses will offer personalized training programs to help patients understand and learn how to perform their treatment. When patients begin their training, they will be given information regarding their particular device and how to set it up.
During the training, patients will learn all the skills and procedures that they need to perform treatment independently. The skills and procedural knowledge which are learnt include how to: prepare the device and supplies; test all of the alarms; take water samples to test the water safety; wash their hands properly; monitor and care for the blood access; place the needles in the access; set up the fluid removal goal (based on patients’ weight and blood pressure); monitor the treatment; check the blood pressure and pulse; keep treatment records; clean the water treatment system filter; order supplies; and spot and handle device emergencies that may occur. Among these skills, patients often have concerns regarding learning how to insert the needles. Actually, this is not as difficult as it may seem, and the dialysis nurses will help patients to learn how to do this. For example, when a patient is ready, a dialysis nurse will set up the device and insert the needles into the patient’s vascular access. In the following sessions, the dialysis nurse will be with the patient until they are comfortable to take over the entire process. During the whole HHD training process, patients will carefully follow demonstrations by their dialysis nurse, and they can feel free to ask any questions that they may have. As the HHD training moves on and patients start to become familiar with the treatment, they will slowly start to take over the set-up work. Once patients start to take over the set-up procedure, the dialysis nurse will always watch and help patients to make sure they are performing each task correctly. Before, patients are allowed to start self-treatment in their own home, they must pass the HHD training test by themselves, and the dialysis nurse must make sure patients are confident in performing each task safely. What is more, relevant clinics will be available to answer phone calls 24 hours a day to help patients deal with any problems.
Once the HHD training has been passed, home dialysis nurses will be with patients for their first time doing self-treatments at home. After that, some healthcare providers will have planned a routine visit to patients to make sure that they are still safe enough operating the device in their own home. Patients themselves will need to visit their dialysis centre around once a month to see the nephrologist, dialysis nurse, and kidney dietician to have some relevant checkups and tests (e.g., blood samples to check for anaemia, and also may receive some medication).
Blagg, C. (2010) The future of Home Hemodiaysis Dialysis and Transplantation, 39 (8), 335-337.