# Patient who is a quad and trached needs training for inhome HD **URL:** \ **Category:** Ask Our Experts\ **Created:** [September 20, 2019, 12:41pm UTC](https://forums.homedialysis.org/t/patient-who-is-a-quad-and-trached-needs-training-for-inhome-hd/7263 "2019-09-20T12:41:46Z")\ **Posts on this page:** 3\ **Page:** 1
**Author:** ![a24416](https://forumcdn.homedialysis.org/letter_avatar_proxy/v4/letter/a/b3f665/32.png) [@a24416](https://forums.homedialysis.org/u/a24416)\ **Post date:** [September 20, 2019, 12:41pm UTC](https://forums.homedialysis.org/t/patient-who-is-a-quad-and-trached-needs-training-for-inhome-hd/7263/1 "2019-09-20T12:41:46Z")
We are having difficulty finding a HD center willing to train our patient’s wife to perform in home HD due to his open trach. Any thoughts on how we can get this family trained without going to a HD center? ---
**Author:** ![Beth\_Witten\_MSW](https://forumcdn.homedialysis.org/user_avatar/forums.homedialysis.org/beth_witten_msw/32/541_2.png) [@Beth\_Witten\_MSW](https://forums.homedialysis.org/u/Beth_Witten_MSW)\ **Post date:** [September 20, 2019, 3:49pm UTC](https://forums.homedialysis.org/t/patient-who-is-a-quad-and-trached-needs-training-for-inhome-hd/7263/2 "2019-09-20T15:49:39Z")
I have found when I get calls or emails like this that dialysis clinics are often unwilling to accept patients with trachs. I have communicated and advocated with DaVita and Fresenius about this issue. DaVita leadership told me they’re certifying some of their clinics to work with trach patients. They and Fresenius and DCI may admit patients to their in-center or home programs on a case-by-case basis based on the patient’s status. Here’s a KidneyViews blog I wrote about this challenge. > **[Who Will Dialyze “Complex Patients”?](https://homedialysis.org/news-and-research/blog/311-who-will-dialyze-complex-patients)** > > For years, I’ve received an occasional call or email from a hospital case manager or a patient’s loved one who was having a hard time finding a dialysis clinic that would admit someone with a trach with or without a vent. A company that offers staff-assisted dialysis in nursing homes has given me a list of the nursing homes where they do dialysis, some of which accept patients with trachs in case the patient/family might consider placement in a nursing home that offers hemodialysis. Has anyone assessed the patient’s candidacy for peritoneal dialysis? Some patients with trachs have been able to do PD successfully. Training for PD is much faster than training for HD and the patient may be able to do PD while sleeping. Here are a couple of KidneyViews blogs from the Home Dialysis Central about this topic. > **[Dialysis with a Trach or Vent](https://www.homedialysis.org/life-at-home/articles/dialysis-with-a-trach-or-vent)** > > Do you or a loved one have a tracheostomy (known as a > trach, > an opening in the neck) or use a ventilator (vent) to breathe and need dialysis? Some patients who are quadriplegics and who have trachs are stable and have a decent quality of life. Others are so debilitated that they have poor quality of life. In some cases, conservative management without dialysis may be less burdensome. Here’s another KidneyViews blog on conservative management. > **[Conservative Management in End-stage Renal Disease: A Tale of Two Countries](https://homedialysis.org/news-and-research/blog/295-conservative-management-in-end-stage-renal-disease-a-tale-of-two-countries)** > > A recent study showed that healthcare providers have limited understanding of what patients want from a conservative kidney management (CKM) program ---
**Author:** ![Stuart\_Mott](https://forumcdn.homedialysis.org/user_avatar/forums.homedialysis.org/stuart_mott/32/183_2.png) [@Stuart\_Mott](https://forums.homedialysis.org/u/Stuart_Mott)\ **Post date:** [September 22, 2019, 1:54pm UTC](https://forums.homedialysis.org/t/patient-who-is-a-quad-and-trached-needs-training-for-inhome-hd/7263/3 "2019-09-22T13:54:35Z")
What town do you live in