16 May Six Steps to Understanding the “Move” from In-Center to Home Dialysis
Has anyone ever talked to you about trying home dialysis as a treatment option for kidney failure? You may have tuned them out, thinking “that’s not for me.”
But, home dialysis IS a preferred alternative to in-center hemodialysis treatment for many people.
Sarah Wuellner, RN, home dialysis manager and chronic kidney disease (CKD) educator at DCI Sedalia, Missouri, said that most of her home dialysis patients state their quality of life is better when compared to that of in-center therapy.
“We have several patients who’ve said they would not return to in-center treatment; they feel that much better. I think a big part of it is that they don’t feel like their life is centered on a dialysis schedule. They don’t live for dialysis, dialysis lets them live,” she said.
So, we asked Sarah to break down the move for us. What are the six steps to understanding the transition from in-center to home dialysis? Here’s what she said:
1. The patient has the right to choose the best treatment for his or her lifestyle.
Before treatment begins, all patients are provided education concerning the advantages and disadvantages of each treatment offered for kidney failure. The options include in-center hemodialysis (90% of the adult US population uses this option), home hemodialysis, peritoneal dialysis, transplant and medical management without dialysis.
“We recognize that patients are individuals with unique hopes, dream and goals. They should choose a treatment option that best fits their needs,” Sarah said. “As a dialysis team we want to help patients achieve their goals without their treatment getting in their way.”
2. Home visits help determine the needs when considering home dialysis.
Home nurses provide an at-home visit prior to training. This is to assist the patient in learning how to successfully plan for his or her dialysis sessions at home. The home team will ensure each of their patients’ homes is a safe place to complete dialysis treatments.
3. Self-care is the first step to going home.
For patients interested in home hemodialysis, they will be taught self-care prior to their formal training. This includes learning to weigh, check blood pressure, how to insert their needles and properly document each treatment.
4. Surgery may be required for a new access.
For patients interested in peritoneal dialysis (PD), the home nurse will set up an appointment with a vascular access surgeon for a PD catheter placement. After the catheter is placed, the home nurse will keep close communication with the patient to answer any questions or concerns. Appointments are made weekly, usually before or after hemodialysis treatments, to flush the PD catheter and perform dressing changes.
5. Complete training and full support are available.
For several weeks, each patient and his or her caretaker are taught the ins and outs of home dialysis. After training is complete, the home nurses remain available 24/7 for questions, concerns, or assistance.
6. Follow up with the care team ensures good health.
When receiving care in the home setting, patients are still seen by medical professionals. Each patient will continue to be monitored closely by the home nurse to ensure treatment is going well. Also, all patients will continue to be seen monthly in the clinic to monitor their lab work and to ensure they are receiving quality care.