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Home haemodialysis at QEHB.

Home haemodialysis at QEHB. Overview of the programme Introduction of button hole needling. The future. There has been a home haemodialysis programme at UHB since mid 1980’s. To date we have 46 patients dialysing at home. Mixture of Gambro and fresenius machines.

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Home haemodialysis at QEHB.

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  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 1980’s. 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% AVF’s, 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 it’s 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

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