Home haemodialysis information pack

Information for you

Visit our website: www.nhsaaa.net

All our publications are available in other formats

Find us on Facebook at www.facebook.com/nhsaaa

Follow us on Twitter @NHSaaa

2

Home haemodialysis pack

Contents

Contact numbers Page 3

Standard infection control precautions Page 5

Trouble shooting Page 7

Hypotension on dialysis Page 10

Air embolism Page 10

Care of your access Page 11

Your dialysis supplies Page 13

3

Home haemodialysis pack

Contact numbers

Dr Elaine Spalding, Home Haemodialysis Consultant 01563 825176

Renal Consultants:

Dr R WanDr A HelpsDr M MacgregorDr N VelascoDr P McKenzie, Staff Grade NephrologistDr T Imtiaz, Staff Grade Nephrologist

Nursing staff:

Maire Henry, Home Haemodialysis Nurse mobile 07833 095270 01563 827492Renal Unit Charge Nurse Fiona McFadyen 01563 827492Renal Ward 2F Charge Nurse Susan Thomson 01563 827918

Renal Dietitians:

Lynn Thomson, Rhona Duncan 01563 825007

Renal Pharmacists:

Aileen Dunleavy, Permjit Singh 01563 827154

Renal Technicians:

John Wright, Eddie Woods, Michael Ramsay, Graham Baillie 01563 827495

Renal Secretary:

Linda Easton / Karen Rendall 01563 827491

Estates at Crosshouse Hospital Switchboard – 01563 521133 Extension 27340

4

Home haemodialysis pack

Emergency telephone numbersIf you have any problems with the dialysis machine, RO machine or wall filters, you should contact the Renal Technician - Monday to Friday from 9am to 5pm on 01563 827495.

Outside these hours ask switchboard at Crosshouse Hospital (01563 521133) to contact the Renal Technician on-call.

Renal technicians provide a 24 hour telephone service for home haemodialysis patients. They will make home visits between Monday and Friday from 9am to 5pm.

Please note that if you are having dialysis outside renal unit hours it will be necessary to wait until the renal unit is open to arrange an alternative dialysis session.

If you have any other problems you should contact nursing staff:

• Maire Henry, Home Haemodialysis Nurse

• Monday to Friday 8am to 5pm

• Mobile number – 07833 095270

• Direct telephone number - 01563 827492

• Renal Unit, Monday to Saturday 7am to 8pm on 01563 827492

Outside these hours contact Renal Ward 2F on 01563 827918

5

Home haemodialysis pack

Standard infection control precautions for home haemodialysis patients

Hand hygieneEffective hand hygiene is the single most important way of preventing the spread of infection.

The essential five key moments for hand hygiene are:

• Before patient contact or care

• Before an aseptic task

• After exposure to body fluid

• After patient contact

• After contact with patient surroundings

Before washing your hands remove watches and jewelry and make sure your wrists and forearms are not covered.

Social hand washing using soap and water and a good technique removes most of the bacteria from soiled hands.

An alcohol hand rub applied to socially clean hands is now the preferred method of antiseptic hand hygiene in most clinical settings.

See leaflet on how to wash your hands properly.

Personal protective equipmentProtective clothing is worn to:

• Prevent the user and the user’s clothing becoming contaminated with blood, body fluids, secretions and excretions

• Prevent the direct transfer of potentially harmful germs from the user to the patient and from the patient to the user

• Protect the user from chemical contamination - for example, disinfectants

• Prevent the user’s clothing or uniform being soiled, moistened or stained

Types of protective clothing:

• Gloves

• Waterproof dressings

• Disposable plastic aprons

• Face and eye protection

Cleaning equipment in your home Effective cleaning of each piece of equipment kept in your house will reduce any risk of infection to those who come into contact with the equipment. It will also help to keep the equipment in good working order.

The use of household detergent (washing up liquid) and hot water is enough for cleaning the outside of the dialysis machine, the RO machine and the dialysis chair.

6

Home haemodialysis pack

Spillages at homeClean any spillage of blood and other body fluids or substances thoroughly using household detergent and hot water.

Cleanliness of the environmentMaking sure that the area around the equipment is properly cleaned will also help to prevent cross infection occurring.

Safe disposal of clinical waste and sharpsAll dialysis waste is clinical waste. Clinical waste should be placed in an orange bag then placed in another orange bag (double bagged). Then place it in a grey lockable bin and it will be collected by a hospital porter. Only clinical waste should be placed in your grey locking bin.

It is the responsibility of the individual using the sharps to ensure safe practice and disposal.

Used sharps pose a serious health risk to the general public. Please be very careful when handling or disposing of them.

Needles must not be recapped.

Needles and syringes should be disposed of as one unit.

All your sharps should be disposed of in a yellow sharps box with an orange lid. Each container should be assembled properly and should not be filled above the fill line, that is, no more than two thirds full. Your sealed sharp bin will be collected from your lockable grey bin with your clinical waste.

Instructions for correct usage of sharps containers• Only sharps to be placed inside

container

• Do not place hands inside the container

• Do not retrieve items dropped in the container

• Observe maximum fill limits

• Securely seal container when fill limit reached

7

Home haemodialysis pack

Trouble-shooting

Alarms:Attention button (hand symbol) – this alerts you to a problem

Continuous alarm – this alerts you to a problem that you need to rectify

Intermittent alarm – this is a prompt rather than an alarm

Hypotension (low blood pressure) on dialysis

Causes:Removing too much fluid causing blood pressure to drop

Symptoms:Feeling faint, dizzy, nauseous, hot

Actions:• Stop fluid removal

• Check blood pressure

• Follow actions for hypotension – page 9

• Re-assess target weight

Air detector alarmThis is a potentially serious alarm as air in the blood can be dangerous

Common causes:Blood lines not connected securely

Actions:• Check blood lines for evidence of air

bubbles

• If no air is visible reset air detector

• Check all connections are secure

Arterial and venous pressure alarms

Common causes:• Needle needs re-positioning

• Blood line occluded (blocked)

• Clotting

• Fistula or catheter problem

Actions:• Reduce blood pump speed

• Check needles and re-position if necessary (you may need help to do this)

• Check for obstructions in blood lines

• Check lines and dialyser for signs of clotting (you may need to adjust your heparin dose if clotting visible)

• Rectify problem and slowly increase blood pump

TMP alarm

Causes:• High – the machine is removing too

much fluid or the circuit is clotting

• Low – the machine is removing too little fluid

Actions:• Check TMP alarm limits

8

Home haemodialysis pack

• Check UF rate

• Observe circuit for clotting

Temperature alarm

Causes:• Machine problem

Actions:• Call technician

Conductivity alarm

Common causes:• Machine not picking up the correct

amount of dialysis fluid/bicarbonate, often caused by loose connections

Action• Check connections

• Check dialysis fluid/bicarbonate containers are not low/empty

Spanner

Causes:• Machine problem

Actions:• Press spanner key and record code on

display

• Reset machine by pressing ‘Halt’ button at rear of machine

• If machine spanners again contact technician

Blood leak

Causes:• Ruptured membrane in dialyser

Actions:• Discontinue dialysis – do not ‘wash

back’ blood

Water failure

Causes:• Insufficient water supply to the

machine

Actions:• Check water supply is on

• Check RO is on

• Check water inlet tube for kinks

• Call technician and discontinue dialysis

Power failure

Causes:• Power failure to your house

• Power point turned off accidently

Actions:• Check above causes

• If power does not return, ‘wash back’ and discontinue dialysis

9

Home haemodialysis pack

Clotted circuit, needle or dialyser

Causes:• Insufficient heparin/fragmin

• Heparin pump overload (if using heparin)

Actions:• Check heparin pump for clamps or

kinks and check pump is not empty

• If clots are visible you may need to change the circuit

‘Blown needle’Recognised by arterial or venous pressure alarm, pain at needle site and signs of a small ‘balloon’ at needle site

Actions:• Stop blood pump immediately

• You may need to discontinue dialysis.

• Seek advice

Prolonged bleeding from fistula

Causes:• Too much heparin/fragmin used

• Clotting or fistula problem

Actions:• Apply pressure until bleeding stops

• If still bleeding after thirty minutes contact unit for advice

• Reduce heparin on next dialysis

• Inform home dialysis nurse

10

Home haemodialysis pack

Hypotension on dialysis• Decrease in blood pressure BP

• Patient may feel light headed

• Patient may sweat

• Patient may feel nauseous and feel the need to go to the toilet

Actions:

If light headed or feeling nauseous

Switch off UF (light will flash). Elevate feet and check BP. Reassess and check BP in five minutes. Reassess UF volume. If patient feels well and BP is within their normal limits then press UF back on to resume fluid removal. Leave feet up and recheck BP after 10 minutes.

If significant drop in BP

Switch off UF, put feet up and give 100mls bolus of saline check BP in 2-3 minutes. Leave feet up and recheck BP after 5 minutes. Reassess UF volume. If patient feels well and BP is within their normal limits then press UF on to resume ultra-filtration.

If light headed and significant drop in blood pressure do the above plus:

• Give 200ml saline bolus

• Recheck blood pressure

• Assess patient

• Consider taking patient off machine

• Wash back safely

• Remember to seek advice for reassurance

Air embolismAn embolism is an obstruction of the circulatory system caused by air.

Make sure you are very careful during the priming procedure and when connecting the patient to the machine. Make sure that all air is out of the lines and that the air detector is activated before initiating dialysis. Close the clamps while connecting the patient. All connections should be tight.

In the event that you suspect that the patient has received an air embolism, you should:

• Stop dialysis immediately – do not wash back

• Lay the patient with their head down and feet up on their left hand side

• Dial 999

11

Home haemodialysis pack

Care of your dialysis access A vascular access is the point on your body where the blood required to do a dialysis treatment is removed from you and returned to you. While the blood is out of your body (less than a cup is removed at a time), it is pumped by the dialysis machine through the dialyser (or artificial kidney) to be cleaned and have extra fluid removed. The vascular access must be able to take blood moving at a large enough rate to allow for adequate haemodialysis treatment in a relatively short period of time.

There are three types of haemodialysis access:

• A-V Fistula

• Graft

• Catheter

An AV fistula is a connection, made by a vascular surgeon, of an artery to a vein.

An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels

A graft is a piece of artificial tubing that is connected at one end to an artery and at the other end to a vein, usually in your arm.

Take good care of your fistula or graft:• Do not wear tight clothing, handbags

or wallet straps, or tight jewellery around your access.

• Do not sleep on your access arm.

• Be careful not to hit or cut your access arm.

• Do not carry heavy loads over your access (groceries, firewood).

• Do not let anyone take blood from or put IVs into your access arm. Also, do not take blood pressure on your access arm.

• Do not scratch or pick at the skin of your access arm.

• Keep the access arm clean and the skin moist and pliable. Use a skin moisturiser every day.

• Be aware of the blood flow direction of your access. Make sure your needles are placed properly.

• Low blood pressure and being below your target weight should be avoided to discourage the access from ‘clotting off’.

Graft

12

Home haemodialysis pack

Check your graft or fistula every day! • Look at the access. Are there any signs

of infection?

• Redness?

• Swelling ?

• Bleeding?

• Drainage?

• Feel the access with your fingertips. Is anything different from yesterday?

• Is there a pulse?

• Any hardness or swelling?

• Any pain?

• Hot to touch?

• Numbness in arm or fingers?

Call your dialysis unit immediately if you notice anything out of the ordinary.

The Catheter is usually a temporary (short-term) access. Most often catheters are used while the fistula or graft are healing from surgery and ‘maturing’ (becoming useable).

Always be on the lookout for signs and symptoms of infection:

• Redness

• Swelling

• Pain, numbness

• Drainage (pus) or bleeding

• Increased temperature (at the exit)

• Fever with chills

• Clotted catheter

If any of the above are present, your nurse or your nephrologist need to be notified immediately.

Monthly blood samples and assessment of fluid statusYour home dialysis nurse will arrange to collect blood samples. This will either be done at home or arranged in the renal unit.

Your nurse will organise for you to visit the renal unit for assessment of your dry weight every three months.

Medical reviewYou will be reviewed by the renal consultant one month after you go home to dialyse. Your renal nurse will then arrange follow up appointments.

13

Home haemodialysis pack

Your dialysis suppliesBaxter Healthcare organises the delivery of your dialysis supplies. You will be contacted by a Baxter representative who will advise you of how much dialysis consumables you will need to order for one month.

If you have any problems with the delivery of supplies contact your Baxter representative who will be able to help you.

Baxter Healthcare co-ordinatorTelephone – 0800 652 1378

Further information can be obtained from:• The National Kidney Federation www.kidney.org.uk

• NHS Choices www.nhs.uk

Useful ResourcesPatientView shows your latest test results, letters and medicines, plus info about diagnosis and treatment. www.patientview.org

Last reviewed: November 2016Leaflet reference: MIS10-289-GDPIL code: PIL16-0203

All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your

choice.

0800 169 1441Tell us what you think...If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, Crosshouse Hospital, Crosshouse KA2 0BB. You can also email us at: comms@aaaht.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response.

Name ______________________________________________________

Address ______________________________________________________

______________________________________________________

Comment ______________________________________________________

______________________________________________________

Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh.