ESPN 50th Annual Meeting

ESPN 2017


 
Running a successful paediatric Home Haemodialysis service: Overcoming treatment risks at home
LOUISE PITTENDRIGH 1 KATE SINNOTT 2 ZOE DICKSON 1 LYNSEY STRONACH 2 DALJIT HOTHI 2 DEEPA ATHAVALE 1

1- ROYAL HOSPITAL FOR CHILDREN, GLASGOW
2- GREAT ORMOND STREET HOSPITAL
 
Introduction:

Home haemodialysis (HHD) has clear advantages, including reduced cardiovascular morbidity, liberalisation of fluid and dietary restrictions and improved quality of life compared to conventional in-centre dialysis. However, haemodialysis is not a risk free treatment and managing these risks at home along with addressing carer burden are essential for a successful HHD service. We describe the measures instituted in 2 paediatric centres to address the potential risks of HHD treatment.

Material and methods:

A review of treatment complications as well as measures implemented to minimise these risks at both centres was undertaken.

Results:

To date, a total number of 34 patients have participated in the HHD service at both centres. Treatment complications have been minimal with 2 cases of line sepsis in the past 3 years; 2 cases of suspected air embolism, 2 thrombophlebitis episodes and no line dislodgements or other fistula related complications or deaths. 3 patients have returned to in-centre haemodialysis. 14 dialysis machines have required replacement, due to equipment failure, in the past 3 years. A robust HHD plan with parameters to seek medical help and emergency procedures along with basic life support training is given in every case. Due to proximity of local hospitals to patient homes, each patient has community children’s nursing support, a named consultant with an open access policy and provision of emergency protocols at a local hospital. Ambulance services are now routinely notified with a medialert alarm system being incorporated in some homes.

Conclusions:

Whilst HHD has clear benefits for patients and families, treatment risks are real and a robust training programme with supportive and emergency measures must be in place to ensure patient safety and minimise carer burden. Risks of treatment at home can thus be outweighed allowing a successful and sustainable paediatric HHD service.