Quiz 1 (Module 2)
Lets troubleshoot some of the barriers with home hemodialysis (HHD) and get our patient started on HHD.
Mr. A has been on home hemodialysis for 6 months. His wife accompanies him for monthly clinic visit and reports “I can no longer support his dialysis. I am tired of the dialysis at home”. Mr. A is tearful and wants to switch to in-center hemodialysis.
This is a case of caregiver fatigue. Mr. A can be supported by a dedicated home hemodialysis team with few in-center sessions for break.
Ms. B is CKD stage 5 and will soon require dialysis. She received detailed education regarding various renal replacement therapies . She is interested in home hemodialysis but feels anxious and worried how she would do everything alone. She thinks her husband can help her but she needs to know how her partner’s support will entail.
It is important to set clear expectations prior to start of home hemodialysis. An initial meeting with home unit can be arranged for debriefing to help reduce anxiety. Partner Agreement on Tasks for Home Dialysis (PATH-D) tool is available to help set routine and clear expectation for division of work.
Schatell D. Introducing the new Partner Agreement on Tasks for Home Dialysis (PATH-D) tools—comments welcome [Blog]! Home Dialysis Central. May 7, 2015.
Schatell D. Introducing the new Partner Agreement on Tasks for Home Dialysis (PATH-D) tools—comments welcome [Blog]! Home Dialysis Central. May 7, 2015.
Ms C is soon expected to transition to HHD. However, you notice that he has contraindication to anticoagulants and are worried about clotting?.
If there is high risk of clotting, consider blood pump speed more than 300 ml/min.
Mr D is interested in home hemodialysis, however during training period, it is found that the water has low pressure and poor quality.
If water pressure is low, can consider lower dialysate flow rate or premixed dialysate. If water quality is poor, consider alternative water purification equipment or premixed dialysate.
Mr. E is currently in-center hemodialysis patient and often missed hemodialysis sessions. He is enquiring about home dialysis options.
It is important to find out reason for missing in-center dialysis sessions. Often, it can be related to transportation issues, wait time, dependence on hemodialysis staff, loss of autonomy and lack of flexibility with schedule. Appropriately selected candidates usually do well with home therapies and non-adherence may improve when patients regains their autonomy.
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