I write this as a caregiver for my father. For a few months, he was on home hemodialysis modality and it gave him a great amount of freedom to move his dialysis sessions around but he unexpectedly had to go back to in-center recently due to us running into issues at home. We’re not sure if he will ever go back to home hemo but I want to leave a few tips to help people looking to be successful on home hemo. I honestly wish our clinic gave us these pointers before we had to figure out the hard way on our own.
- Absolutely follow aseptic technique. Make sure BOTH patient and caregiver are wearing masks and clean gloves throughout the session, especially when cannulating and connecting to the machine. Make sure you wash your hands or use hand sanitizer each time before you wear new gloves.
- Ensure the aseptic cleaning fluid you are using has not expired. Check expiration date on Chlorhexidine bottles or whatever you use to clean the access area. In our case it was Exsept Plus. When you open the bottle write the date it was opened on the bottle in sharpie. In the case of Exsept the shelf life of the solution is 180 days from opening, so be sure to discard after 180 days is up and do not use if expired.
- If you do make a mistake (dirty tape, dirty gloves, etc) make note of it and tell your nephrologist. This could easily lead to infections without you being aware of it. Your dialysis clinic can schedule a septic screening and put you on antibiotics to treat the infection.
- When checking temperature, make sure to use an oral thermometer as that is more accurate reading than a temperature gun.
- Monitor temperature changes at end of dialysis session. If there is a fever (99-100F) immediately call an ambulance. More likely than not, the fever was caused by the dialysis session and it could be a sign of blood stream infection.
- At the end of a session, make sure you stop the bleeding from the access site (if you have a graft/fistula) and tape up before you go through the process of breaking down equipment and disposing trash. Going back and forth will mess up the sterile environment and easily lead to infection. Ideally, return the blood, stop bleeding and tape up in that order. Have the patient leave the room. Then you can start disposing of trash.