Your Guide to Home Hemodialysis Module 1: Introduction

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1 Your Guide to Home Hemodialysis Module 1: in Your Guide to Home Hemodialysis Module 1:

2 This manual was created by the Ontario Renal Network in collaboration with dialysis training programs in Ontario to help guide you through Home Hemodialysis (HHD). It will explain the basics related to your care, help you understand how hemodialysis works, and guide you on how to safely and effectively perform your treatment in the comfort of your own home. Convenience and control over when your treatment takes place allows you to fit dialysis more easily into your life. This manual is not meant to replace any already existing training materials you have received, but rather complement them as required by your clinic. You will be given specific information related to the operation of the equipment your clinic uses. You are encouraged to seek more information or clarification from your healthcare team as needed. Your Healthcare Team While all members of the healthcare team play a key role in the management of your care, we believe that you and your family are the most important. Remember to keep a positive attitude and don t hesitate to ask questions of your team who are there to help and support you. They will provide the training and support you need to safely do your dialysis at home. Your healthcare team may consist of: Dialysis Nurses Manage your care and provide training and ongoing support. Nephrologists Doctors who are kidney specialists and will assess and prescribe the best treatment for you. They will see you regularly at clinic, monitor your health and make changes to your treatment as needed. Nurse Practitioners Nurses with special skills and education who work with the nephrologist to manage your care. Social Workers Assist with any social needs you may have. They may provide counselling to help you adjust to dialysis at home and provide information and resources in your community. Pharmacists Review and provide information you need regarding your medications. Your Guide to Home Hemodialysis Module 1:

3 Dietitians Teach you about the diet specific to your dialysis prescription. They will work with you to maintain proper nutrition and eating habits. Support Staff Assist with scheduling appointments, keeping your personal information updated and directing your inquiries to the appropriate staff. Biomedical Technologists Provide ongoing equipment maintenance and repair as needed in your home. They may also provide monitoring of your water quality as determined by your specific clinic. Family Doctors Continue to be involved in those areas of your care which do not require the nephrology team. It is important to maintain an ongoing relationship with your family doctor. Other Members There may be other members of your healthcare team such as a chiropodist, physiotherapist or psychiatrist. Ask your clinic if these services are available should you need them. Why Choose Home Hemodialysis? Performing your dialysis treatments in your home has many benefits: You decide when you dialyze which allows you more independence and control of your life. Travel time is eliminated other than for clinic visits. You have the opportunity to dialyze longer and more often which will allow you to feel better and may reduce dietary restrictions and complications. The training period provides you with the knowledge and confidence necessary to assist you in the management of your disease. You are able to dialyze in the comfort of your own home. Your Guide to Home Hemodialysis Module 1:

4 Treatment Options- The More Dialysis The Better There are many options for home hemodialysis. Option Description Benefits Drawbacks Conventional Dialysis Three times per week, usually four hours, anytime, may be able to do overnight as well Intermittent Dialysis Every other day - usually four hours or overnight Less weekly time commitment No two day lapse in treatment as with conventional dialysis, feel better, increased waste clearance More likely to have dialysis side effects - low blood pressure, cramping, extended recovery time, more fluid and diet restrictions, increased utility costs Increased utility costs Short Hour Daily Dialysis 6-7 times per week, 2-3 hours during awake time Feel better, more energy, less dietary and fluid restrictions, possibly less medications, rare dialysis side effects, minimal recovery time, increased waste clearance Takes up more free time, increased utility costs Frequent Nocturnal Dialysis 5-7 times per week 6-9 hours (sleep time) Feel almost normal, more energy, less medication, liberal diet and fluid intake, rare dialysis side effects, no recovery time, easier on your heart and body, the most waste clearance possible, days are free Increased utility costs. Having to make all these decisions may seem overwhelming at first but as you gain more confidence during your training and speak with your healthcare team they will assist you in deciding which option is best for you by looking at your lab values, blood pressure, prescription needs and, last but not least, your lifestyle. Your Guide to Home Hemodialysis Module 1:

5 Testimonials From Patients Since switching to HHD a great weight has been lifted from my shoulders, no more scheduled dialysis, driving in winter storms. I feel free, whole and in control of my life. For me, HHD meant more control. I decide when to dialyze and for how long. I m in the comfort of my own house with few distractions. Frequent dialysis has given me an increased level of mental and physical confidence in myself. I ve been reborn as a better functioning human being, instead of a burden on everyone important in my life. The machine can be overwhelming at first but then it becomes your friend. You feel independent and in control of your life again. You become very aware and educated about your disease. Questions You May Have How do I know if my home is okay for Hemodialysis? Once you have met with the Home Hemodialysis team and together have decided that this is the direction you will take, your home will be assessed to determine if the machine and water requirements can be met. If you do not own your home, this may mean obtaining written permission for the installation to take place. If you use a well for your water supply, having good quality and suffcient supply will be necessary. Do I have to pay for the installation, supplies and training? No, the cost of the equipment and its installation is covered by your Ontario Health Insurance Plan, as is the training and supplies. You are responsible for utility charges which will increase due to operation of the equipment. Your Guide to Home Hemodialysis Module 1:

6 Your Guide to Home Hemodialysis Module 1: What else do I need? You will need: A phone with an answering machine to allow you to communicate in emergency situations and for the clinic to organize appointments, etc. It is important to return calls in a timely manner. Adequate space to store supplies Good lighting, flashlight Reclining chair or bed An interpreter - if there is a language barrier - who will need to be present during training and dialysis once you are at home What does the clinic expect of me once I am at home? Your clinic will expect you to: Perform your scheduled treatments in a safe manner as instructed, keep records Maintain equipment Order supplies Communicate concerns to the clinic Attend clinic appointments Draw blood samples as requested What about training? You will be provided with training which will allow you to safely manage your treatment at home. The training period is an opportunity for you and your healthcare team to determine if home hemodialysis is for you. The training period usually takes place over six to eight weeks and is tailored to your specific needs. During this period, the nurse will check your skills to make sure you are able to do your treatment correctly and safely. If a caregiver is required, they must also attend the training sessions. At the completion of training you will be able to: Understand hemodialysis and how your hemodialysis machine works Understand how dialysis, diet and medications work together to keep you well Perform proper hand hygiene and understand no touch technique Take your blood pressure, weight, temperature and pulse and understand their significance Correctly prepare your dialysis machine Manage your dialysis access correctly and be able to safely initiate and terminate treatment Monitor and record your treatment and make adjustments as required Know when you should call for assistance/guidance Correctly administer dialysis medications

7 Troubleshoot machine/dialysis problems Use safety devices properly Order and properly store supplies Maintain and disinfect your hemodialysis machine and water system Properly dispose of wastes including sharps Follow-Up Care It is the goal of your clinic to provide you with the same level of care you would receive if you were dialyzing in a hospital or community clinic. Many clinics provide 24 hour on-call nursing support as well as regular home visits. These home visits are usually done during your first treatment after you have completed training, as well as routinely one to two times per year. Frequency of clinic visits and lab tests will be determined by your nephrologist. The purpose of the clinic visits is to provide you with an opportunity to meet your healthcare team and make adjustments in your care to assist you in being the best that you can be. Routine equipment maintenance as well as water testing will also be done to ensure that your equipment is operating safely and properly. Remember You Are Not Alone There are many people with kidney disease who are managing their hemodialysis treatments in their home. Your healthcare team is here to help you. You will not do your treatment at home until both you and your nurse are confident that you can safely manage your care on your own or with the help of a caregiver. Your healthcare team is experienced in helping people with HHD. If you have any questions or concerns, do not hesitate to contact them. You may also wish to connect with other people receiving HHD whom you meet at your clinic or through the Kidney Foundation of Canada you can often help each other. Your Guide to Home Hemodialysis Module 1:

8 Important Contact Information Your clinic phone After-hours phone Primary Nurse Primary Nephrologist Nurse Practitioner Social Worker Pharmacist Dietitian Biomedical Technologist Supply Company Notes Your Guide to Home Hemodialysis Module 1:

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