ESPN 50th Annual Meeting

ESPN 2017


 
Assisted Home Haemodialysis
DALJIT HOTHI DALJIT HOTHI 1 KATE SINNOTT 1 LYNSEY STRONACH 1

1- GREAT ORMOND STREET HOSPITAL FOR CHILDREN
 
Introduction:

 Introduction

In the UK 13 haemodialysis (HD) centres serve the paediatric population. Consequently some children travel large distances for their dialysis but at a significant cost to their schooling, psychosocial health and family dynamics. Home HD offers an obvious solution but it is not suitable for every family.

Material and methods:

 Objective

We report the case of a 8 year old girl with complex medical needs whose HD was carefully transitioned to East Anglia Childrens hospice close to her home.

Results:

 Results

Patient K with VACTERL has a tracheostomy, colostomy, poor vascular access and renal failure. She travelled up to 3 hrs each way for in-centre HD and had repeated, frequent admissions to hospital with acute, often infective, respiratory symptoms. . Peritoneal dialysis was not an option. Home HD was medically optimal but not possible at home. Therefore we approached the hospice familiar to the family that was providing respite care and proposed a package of care that eventually transitioned Patient K’s dialysis care to them. They agreed in principle. Funding was secured from the local council. The NxStage TM dialysis system was chosen as it required no water conversion and was mobile. A robust 3 month training programme was designed and executed for 4 hospice nurses to learn to provide HD in the hospice 4 times/week.  A risk assessment and symptoms care plan was written for the patient’s specific needs. We secured the hospice local medical support from her local General Paediatric consultant and a honorary contract was put in place which enabled the hospice nurses to dialyse patient K at the local hospital during admissions.  

 

The impact has been extremely positive. Patient K is free of dietary and fluid restrictions and is growing. She has made excellent progress at school with improved social skills with children her own age and for the first time mum has worked. The change in the quality of life for Patient K has been dramatic. 

Conclusions:

 Conclusion

We present the first reported case of assisted home HD that has been successful in improving a child’s health outcomes and rehabilitating them back into school, social and family life. Mum- “She sings on the way to the hospice and says it’s where she goes for a holiday –it’s such a relief for me”.