NUTRITION

10.0 Safety at Home

Introduction

Home Haemodialysis (HHD) today, is generally very safe. This will be because you have been carefully assessed before starting home therapy and because you will initially spend many weeks learning the technical aspect of self-managing the dialysis procedure¹.

There have also been advances in machine technology that have reduced technical complications and longer and more frequent treatments have reduced the risk of dialysis related complications such as low blood pressure².

Traditional Haemodialysis patient safety is given by health care professionals when you dialyse in center. Safety in Home Haemodialysis involves working with yourself, your care partner and health care professionals³.

One big important part of safety is to make sure that you are aware of the risks involved in performing your dialysis at home so that you can make an informed choice as to whether this is the correct therapy for you.

10.1 Education

Serious adverse events during Home Haemodialysis are rare and this is due to the fact that you will be taught all the safety procedures that are needed when dialyzing at home, these will include troubleshooting machine alarms and responding to emergency situations, including power outage and accidental disconnection^2,3. You will be taught how to look after your access and what to do if you have bleeding problems and how to avoid infection.
If you have a care partner they will be trained in all these aspects of your care³.

10.1.1 Patient Risk Assessment

Patients using Home Haemodialysis have gone through extensive training and many units will ask you to sign a liability form and or provide certification of competency with Home Haemodialysis. To ensure that you maintain your skills and do not take unnecessary risks, a risk assessment should be performed regularly. An example of this is shown below.

10.2 Contacts

Clinical and technical assistance for you and your care partner should be easily accessible 24 hours/day. You will be made aware of how to contact emergency medical services and know the location and contact details for their nearest hospital emergency department.

10.3 Potential risks /complications of Home Haemodialysis

Performing Dialysis in a home setting can generate the same complications as in center. In addition, there can be complications because you do not have a nurse immediately present to help with machine and water maintenance and in trouble-shooting. However following procedures carefully that you are taught reduces this risk considerably.

Complications can be divided into three areas:

10.3.1 Technical safety

Home Haemodialysis machine safety requirements are the came as from center based machines and they must meet international and national safety standards in order to reduce risk. The safety mechanisms include:

• Pre-dialysis safety check.
• Recommended priming procedures (include ways to minimize infection risks).
• Dialysate conductivity alarms.
• Ultrafiltration monitoring.
• Blood flow pressure alarms.
• Blood leak alarms.
• Safety limits that can be pre-determined.
• Air detector mechanisms (to prevent air embolism).
• Sterilisation procedures to ensure good water quality.
• Safety cutout mechanisms for electrical risks.

You will be taught to follow procedures that maintain this safety and also how to contact technical support if alarms occur related to machine functioning. 

Regular servicing of machines and water treatment equipment as per manufacturers recommendations is critical. Servicing can be done at home or by machine swaps to the technical department.

Regular water testing is also a key part of technical safety.

10.3.2 Medical complications

The medical complications can be similar to those when in center

• More frequent dialysis can mean that the vascular access has a higher risk of problems such as infections and bleeding⁴.
• Cardiovascular problems such as low blood pressure or overload of fluids can occur but are usually seen less frequently than in in center dialysis.
• Malnutrition can occur due to “overdialysis” with loss of nutrients^1,2.
• Side-effects of drugs and gastrointestinal complications can occur^1,2.

Regular check-ups, blood tests and technique checks can reduce the risk of medical complications.

10.3.3 Psychosocial

Many people on dialysis do experience psychosocial affects such a; anxiety and depression, family/carer fatigue, exacerbation of pre-existing psychiatric conditions and difficulty in coping with managing all aspects of dialysis². It is important to talk to your health care team if you feel that you experience any of the above concerns.

Patient and Caregiver burden – Home Haemodialysis usually increases the number of days per week that you are having dialysis treatment. This may increase the burden of dialysis on you and your care partner. Choosing the dialysis routine that suits your lifestyle should help to minimize the risk of burden.