Home hemodialysis (HHD) is a therapeutic nephrology procedure that uses extracorporeal blood purification to detoxify the blood. However, the peculiarity of home hemodialysis is that this dialysis procedure is not performed in a specialized dialysis center, as is usually the case, but in the renal insufficient patient’s own household. As a result of performing hemodialysis in the patient’s own household, there are various advantages. Particularly noteworthy is the fact that home hemodialysis allows for more flexible scheduling. This means that every dialysis patient who is dialyzed at home is independent of the dialysis center’s schedule. For many patients, this gain in flexibility makes it possible to pursue a profession without massive restrictions. It should also be mentioned that every patient has to assume a greater degree of personal responsibility as a result of treatment at home and is usually happy to do so. In various studies it could be determined that this personal responsibility leads to a significant improvement of the patient’s satisfaction with a given therapy success. This has the further consequence that both the well-being and the quality of life of the patient and his partner can be increased. In addition to these factors, it can be concluded from various studies that the complication rate is reduced to a relevant extent. This is also reflected in the discernible reduction in mortality resulting from the use of home hemodialysis. However, many patients no longer see the need to perform hemodialysis treatment at home, as there is now a comprehensive network of outpatient dialysis centers and clinic dialyses, and learning how to perform hemodialysis correctly is judged to be relatively difficult. In recent years, the importance of home treatment has declined, particularly because the age of patients requiring dialysis has shifted upward. With increasing age, the willingness to acquire a sound knowledge of the necessary parameters of dialysis treatment generally decreases. In order for hemodialysis to be used by the patient at home, proof of eligibility for home hemodialysis must be provided. It is also a basic requirement that hemodialysis can be performed without complications and that the vascular access can be easily punctured either by the dialysis patient himself or by his partner. Prerequisites for home hemodialysis treatment
Theoretical organization
- Any patient requiring dialysis who wishes to receive home hemodialysis treatment must meet certain quality criteria to be eligible for this treatment option. These criteria relate to both the individual’s willingness and ability to acquire the necessary knowledge of how the system works and necessary measures to maintain a consistent quality of therapy.
- In addition to these personal factors, spatial conditions, respectively, the equipment with a defined furniture are also relevant to the suitability of patients.
Practical organization
- In order for home hemodialysis to be practiced with an equivalent or possibly even improved therapeutic success, the condition of having both a very well trained nursing team and a specially trained medical staff must be met. Based on this, the patient should, as far as possible, ensure that the treating nephrologist attends various training courses at certain intervals.
- Although home dialysis patients must perform a special five-step training and are tested in each section, it is still essential that the dialysis center staff is available for continuous care. In order to minimize the risk of complications, the first task of the staff in a home dialysis unit must be to provide the individual patient with a sound knowledge of the treatment.
- To improve compliance (cooperative behavior of patients), it should be aimed that at the beginning of treatment an exchange of information between an already experienced home dialysis patient and the dialysis patient in the preparation phase can take place.Once this step is taken, in addition to training the patient, the staff should also ensure the ordering of materials and the delivery of the necessary components. The first home dialysis performed independently must also be monitored by the dialysis center staff in the patient’s home. In addition, outpatient follow-up appointments should be scheduled at certain intervals.
Space requirements and necessary technical equipment
- To prevent bacterial contamination of the dialysis machine and the shunt used, respectively, reduce the risk, home hemodialysis should take place in a separate room.
- Since this form of dialysis requires special conditions for water access, a specialized company must make the necessary changes. So that an accurate assessment of the water quality is possible, it should be tested using a sample of the water on site. Since tap water can not meet these special requirements in principle, a mobile reverse osmosis is normally used, which is coupled with a softener, so that the water quality can be adjusted to the demand.
- In addition to the changes in water access, the electrical equipment must also be properly connected and placed. To ensure that the responsible personnel can be contacted quickly in case of need, a cell phone must be placed at each location where dialysis treatment is provided. It is also necessary to provide sufficient space for storage of dialysis materials. Furthermore, there should also be a suitable storage room to store the materials to be disposed of.
