Home haemodialysis at QEHB.

1
Home haemodialysis at QEHB.
2
Overview of the programmeIntroduction of button
hole needling

• The future

3
There has been a home haemodialysis programme at
UHB since mid 1980s.

• To date we have 46 patients dialysing at home.
• Mixture of Gambro and fresenius machines.

4
Current UHB home haemodialysis programme.

• 46 patients at home to date (15 so far in this
  financial year)
• 86 AVFs, 14 lines
• 20 transplant listed and 4 suspended
• 4 patients on HDF
• Youngest 23yrs
• Eldest 83yrs
• Average training time 6 weeks (minimum 4
  sessions)

5
DATA

• 68 male. 32 female.
• Dialysis carers 4 mothers, 3 fathers, 2 son, 1
  carer and 35 partners

6
Current home haemodialysis dialysis schedules
7
Blood results.

• Average Hb 11.1
• Average Calcium 2.19
• Average Phosphate 1.59

8
Introduction of Buttonhole needling
9
Who can use it?

• Fistulas at present
• Limited needling opportunity i.e brachial fistula
• Difficult fistula
• Needle phobics
• Home haemo pts

10
Benefits

• Ease of cannulation, plus no need to assess for
  needle placement each time
• Reduced pain
• Reduced bleeding
• Less chance of aneurism formation

11
Disadvantages

• Higher infection risk
• Skin irritation from more frequent cleaning
• Need for staff commitment in tract formation
• De skills needlers
• Higher cost, currently blunt needles 3 times more
  expensive

12
Implementation within HHDX

• One off teaching session
• Ongoing support from HH team
• Written step by step instructions
• Ordering of consumables

13
Problem solving

• Develop pathway in case of skin irritation
• Develop pathway in case of suspected infection
• Ensure support in case of problems
• Ensure supply of sharp needles in case of problems

14
Current usage within home haemo team

• Over last 4 months
• 40 of AVF patients converted to technique
• 2 patients withdrew
• 92 use blunt needles
• 0 infections

15
Audit

• Invited 12 patients to participate in audit
• 11 responded
• 64 reported less pain on cannulation
• 100 reported easier cannulation
• 73 reported less bleeding after removal of
  needles.
• 100 preferred the technique compared to what
  they were doing previously
• 1 person reported that they thought their fistula
  had changed in appearance.

16
Future

• All home patients to be educated on BH
• Use of semi blunt needles
• Ongoing auditing
• Act as a resource to main unit and satellites

17
The Future and its challenges for HHDX at UHB
18
Data

• 24 pts on waiting list
• 21 waiting to be seen
• 34 have a training date
• 13 housing issues
• 26 waiting for a date
• 4 pre dialysis

19
Strategy for increasing numbers

• Engage with satellite and in centre dialysis
  units to develop self care
• Consider training from pre dx/failing tx/capd
  directly
• Solo dialysis
• Employed dialysis carers

20
Overcoming barriers

• Needling, offer button hole technique
• Carer concerns, offer information sessions, peer
  support
• Work commitments, offer flexible training, self
  care programme

21
Maintenance of the HHDX programme

• Carers ongoing support, training
• Efficient service, use of centrifuges etc,
  paperless
• Flexiblity of visits, clinics
• Quality service, continuity of care
• Psychological support
• Dietetics

22
Research and Development

• Quality of life
• Button hole technique
• Raise the profile of UHB