HOME HAEMODIALYSIS

9.0 Education & Training

Introduction

Training for Home Haemodialysis has historically been a lengthy process, taking up to 3 months of three sessions a week. However, with the development of machines designed specifically for Home Haemodialysis, this process can be much quicker and easier. Whatever machine you use there is no pressure to train quickly, you will only go home once you are safe to do so¹.

9.1 Am I suitable for Home Haemodialysis?

• Once you have been referred for home training the nurse will assess you for suitability to perform dialysis at home. You will be assessed for any condition which may prevent you from carrying out your own treatment, i.e. poor eyesight, arthritis etc. If so, your helper may be trained to carry out extra procedures².
• You and your helper must be able to understand and remember information and instructions given.
• You should be aware of the potential changes in lifestyle.
• You should be willing to consider short daily dialysis, a minimum of 5 days a week, 3 hour sessions, or dialysis overnight.
• You need a good functioning fistula or another type of access that works well.
• You should be physically stable on dialysis.

9.1.1 Do I need a dialysis partner?

Depending on your needs and home circumstances you can learn to perform dialysis independently or with the help of a partner. The partner can be anyone reliable and committed but is usually spouse or close relative. If a partner isn’t available it may still be possible to undertake dialysis at home.

9.1.2 Is my home suitable?

You should have a suitable room which is large enough to house the dialysis machine and other equipment required for haemodialysis, and has suitable service points including plumbing and electricity, for the dialysis machine (if required). Plumbing and electricity changes can be arranged by the dialysis centre.

9.2 Training

9.2.1 Cannulation / Access training

Some people learn to put in their needles prior to machine training. This will allow you to concentrate on machine skills during Home Haemodialysis training.

It is also possible for patients with long-term central venous catheters to go home, but it is usually necessary for a partner to learn how to help with connection and disconnection.

9.2.2 Training schedule

Training on the machine itself can be achieved as quickly as in a two week period, It will take longer to learn to put in your own needles. However, the time taken depends on how quickly you learn, and how many times a week you train. Some units can offer a schedule where you attend for up to 5 sessions per week for a two week training period and have dialysis on the in a designated training area.

Training on different machines will take different periods of time. The nurses can advise how long your training is likely to take.

9.2.3 Training location

Depending on the distance of your home to the hospital and whether, a designated training area is available in the hospital, and nurse availability, this might be done at home or in centre. You may feel more comfortable and concentrate more in your home environment or may feel safer initially doing this in the hospital.

9.2.4 Training support materials

• A training pack with all written information should be available, with quick guides and pictorial guides.
• Demonstration videos are also useful for you to watch on portable devices during training if these are available.
• During training you can often practice on a demonstration machine.
• During training all competencies for machine and other skills will need to be signed off by yourself and your allocated nurse.

9.3 Going home and follow up

In the final week of your machine training you should be at home with support from your allocated community nurse, for at least 3-4 dialysis sessions. During these sessions the nurse should be present the whole time.

Once you and your nurse feel safe and confident you can be left to undertake the sessions independently. You will still have phone back-up and possibly video conferencing if you have any questions or need support.

9.3.1 Ongoing follow up

Once settled at home you should have a routine monthly visit from your nurse for bloods, access monitoring, and general checks.

References

1. Borman N, Nair S, Goffin E. More Frequent Haemodialysis Improved Outcomes: The Wish Comes True at Home. European Medical Journal 2017;5 (1): 36-42
2. Rioux J.P, Marshall M, Faratro R, Hakim R, Simmonds R, Chan C. Patient Selection and Training for Home Haemodilaysis. International Society for Haemodialysis 2016