1. ‘I Can’t needle myself!’ No Chance
Shared care and Home HD
‘I Can’t needle myself!’
No Chance

2. One of the biggest fears for the patient is putting the needles in and often is a reason why a patient will not consider home HD or be fully self-sufficient on the unit.
Shared care and Home HD

3. Shared care and Home HD Patient Nurses ‘I’m needle phobic’
‘I can’t go home because I could never put those in’
‘I’m right handed, how am I going to it with my left hand’
‘My fistula is too high up’
‘My hands shake too much’
‘I'm scared’
‘There is no way I’m putting those in’
‘What if I put it in the wrong place’
‘It will hurt too much’
‘I wouldn’t needle myself!’
‘What do you want to do that for?’
‘Not got time to teach you today so sit down so I can get you on’
‘You could damage your fistula best to let the experts do it for you’
‘DON’T DO IT LIKE THAT’ (spouse told off)
‘Let me do it for you’
‘I really don’t think you can do it’
‘No way that patient will be able to do it, have you seen how much his hands shake’
‘He will never go home, he can not even look at us when we put them in’
Shared care and Home HD

4. Nurses to the rescue
Shared care and Home HD

5. Shared care and Home HD Hints and tips
Build up a relationship with the patient, trust is key
Allow the patients to get a feel of the needles, putting tape on, getting flash back, checking the flow, connecting to the bloodlines (as soon as possible)
2nd 3rd session let the patient take their needles out
Shared care and Home HD Hints and tips

6. Shared care and Home HD Hints and tips
Keep it simple
Allow patient to feel for the fistula, explain what we are looking and feeling for
Every patient is different but most times I will not give them a date
May pop the tip of needle in and get the patient to guide the rest in
May just guide patient
Put one needle in and patient pops the other in
Encouragement
Shared care and Home HD Hints and tips

7. Shared care and Home HD Hints and tips
Education! How to look after the fistula, how to assess it
Praise, let others know of their achievements
Patients are very competitive!
Keep instructions simple
Avoid taking over
Give them space
Opportunity to speak to others
Shared care and Home HD Hints and tips

8. When should we start to teach ?
Shared care and Home HD

9. Shared care and Home HD ladder v buttonhole
Assess each patients access individually
Consider:
How old the avf is
What the access is
Has the patient had previous infections?
Eye sight
Skin issues
Bleeding
Pain
Access issues
Patient cleanliness
Shared care and Home HD ladder v buttonhole

10. Shared care and Home HD ladder v buttonhole
Allow the patient to track own site
If a patient is having to use sharps on numerous occasions consider new site or teach ladder
Make patients aware of risks
Refer if required!!!!
Shared care: need to assess access at regular intervals
Shared Care: at times patients will need our support
Rest bite
HHD: Plan; to have an annual review of access by the Access team
HHD: patients will plod along without raising issues
Shared care and Home HD ladder v buttonhole

11. Rewards Patients and Staff
Shared care and Home HD