Home haemodialysis information pack

Transcription

1 Home haemodialysis information pack Information for you Follow us on Find us on Facebook at Visit our website: All our publications are available in other formats

2 Contents Home haemodialysis pack 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 2

3 Contact numbers Home haemodialysis pack Dr Elaine Spalding, Home Haemodialysis Consultant Renal Consultants: Dr R Wan Dr A Helps Dr M Macgregor Dr N Velasco Dr P McKenzie, Staff Grade Nephrologist Dr T Imtiaz, Staff Grade Nephrologist Nursing staff: Maire Henry, Home Haemodialysis Nurse mobile Renal Unit Charge Nurse Fiona McFadyen Renal Ward 2F Charge Nurse Susan Thomson Renal Dietitians: Lynn Thomson, Rhona Duncan Renal Pharmacists: Aileen Dunleavy, Permjit Singh Renal Technicians: John Wright, Eddie Woods, Michael Ramsay, Graham Baillie Renal Secretary: Linda Easton / Karen Rendall Estates at Crosshouse Hospital Switchboard Extension

4 Emergency telephone numbers Home haemodialysis pack If 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 Outside these hours ask switchboard at Crosshouse Hospital ( ) 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 Direct telephone number Renal Unit, Monday to Saturday 7am to 8pm on Outside these hours contact Renal Ward 2F on

5 Standard infection control precautions for home haemodialysis patients Hand hygiene Effective 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. Home haemodialysis pack Personal protective equipment Protective 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. 5

6 Home haemodialysis pack Spillages at home Clean any spillage of blood and other body fluids or substances thoroughly using household detergent and hot water. Cleanliness of the environment Making sure that the area around the equipment is properly cleaned will also help to prevent cross infection occurring. Safe disposal of clinical waste and sharps All 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. 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 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. 6

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 Removing too much fluid causing blood pressure to drop Symptoms: Feeling faint, dizzy, nauseous, hot Stop fluid removal Check blood pressure Follow actions for hypotension page 9 Re-assess target weight Air detector alarm This is a potentially serious alarm as air in the blood can be dangerous Common causes: Blood lines not connected securely 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 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 High the machine is removing too much fluid or the circuit is clotting Low the machine is removing too little fluid Check TMP alarm limits 7

8 Check UF rate Observe circuit for clotting Temperature alarm Machine problem 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 Machine problem Press spanner key and record code on display Reset machine by pressing Halt button at rear of machine Blood leak Home haemodialysis pack Ruptured membrane in dialyser Discontinue dialysis do not wash back blood Water failure Insufficient water supply to the machine Check water supply is on Check RO is on Check water inlet tube for kinks Call technician and discontinue dialysis Power failure Power failure to your house Power point turned off accidently Check above causes If power does not return, wash back and discontinue dialysis If machine spanners again contact technician 8

9 Home haemodialysis pack Clotted circuit, needle or dialyser Insufficient heparin/fragmin Heparin pump overload (if using heparin) Apply pressure until bleeding stops If still bleeding after thirty minutes contact unit for advice Reduce heparin on next dialysis Inform home dialysis nurse 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 Stop blood pump immediately You may need to discontinue dialysis. Seek advice Prolonged bleeding from fistula Too much heparin/fragmin used Clotting or fistula problem 9

10 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 Home haemodialysis pack If light headed or feeling nauseous If significant drop in BP If light headed and significant drop in blood pressure do the above plus: 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. 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. Give 200ml saline bolus Recheck blood pressure Assess patient Consider taking patient off machine Wash back safely Remember to seek advice for reassurance Air embolism An 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

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. 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. Graft 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. 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 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. 11

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 status Your 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 review You will be reviewed by the renal consultant one month after you go home to dialyse. Your renal nurse will then arrange follow up appointments. 12

13 Your dialysis supplies Home haemodialysis pack Baxter 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-ordinator Telephone Further information can be obtained from: The National Kidney Federation NHS Choices Useful Resources PatientView shows your latest test results, letters and medicines, plus info about diagnosis and treatment. 13

14 All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. 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 Tell 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 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 Last reviewed: November 2016 Leaflet reference: MIS GD PIL code: PIL