1. Advancements in home hd therapies

2. Objectives Describe the purpose of hemodialysis Discuss home treatment options including trends and improvements in therapy Summarize ethical considerations for patients

3. The Process … Arterial blood pulled Directed through filter Wastes/excess fluids removed Returned through venous system The Purpose : Cleansing of blood Chemical Stability Fluid balance Blood pressure control What is hemodialysis?

4. Change in Times… First dialysis machine 1940’s home dialysis first performed 1960’s Treatment times… 1960’s – 1970’s * dialyzed for 12hrs twice a week (coil dialyzer’s) 1980’s * 3 times a week for 8hrs 2000 to the present….typical home regimens include: * 1.5 – 4 hrs five to seven times per week * 8.0 –10hrs three to six nights per week

5. From 1960’s to the present Dialysis “Dinosaur” Travel ready

6. For the clinician Then… Now… Special plumbing/wiring Cumbersome Estimated (pressure based) Lengthy treatment times Mechanical system Few opportunities r/t cost & unpredictability Standard outlets Portability Precise (volume based) Convenience for lifestyle Human technology interface User friendly

7. Benefits of home hd Patient involvement in care Fewer dietary restrictions Better blood pressure control Decreased need for meds Improved sleep Fewer fistula problems Decreased hospitalization Increased survival rates Minimal travel time Overall more positive outcomes

8. challenges Need specific documentation from MD Requires compliant /knowledgeable pts Training of 3-8 weeks required Need for “helper” Risk for complications: Air embolus Uncontrolled bleeding BP control

9. Ethical Considerations Unequal and limited access to home technology Quality of care Assignment of responsibilities Freedom of choice privacy

10. Trend Review Clinical Information/ Special Purpose Used by Nurses and Trained Individuals Dialysis Point of Care / Stand Alone Configuration

11. Competencies required Familiarity w/ materials set-up Ability to program patient specific data Evaluation of integrity of system Knowledge of potential complications and troubleshooting measures

12. responsibilities Communication w/ MD r/t goals of treatment Management of treatment for pt including set-up through finish of treatment Documentation of accomplished treatment and pt response Monitoring for complications / perform troubleshooting measures Evaluation for future treatments Pt education about their role (may include supporting pt if they are actually performing for themselves)

13. recommendations Designed for in home use Human technology interface permits training for non- medical individuals Increases home care possibilities/ patient independence Promotes professional outreach

14. summary More home therapy options : Increase in number of pts Improved quality of life Improved compliance Superior quality of care/outcomes Necessitates: Increase in trained staff Availability of support for pts Need to maximize pt accessibility

15. references Assessing the efficiacy and safety of medical technologieshttp://www.princeton.edu/~ota/disk3/1978/7805/780503.PDF Blagg, C. (2006). The early history of dialysis. AJKD, 49(3), 482-496. Hopme dialysis information. (n.d.). Retrieved from http://www.davita.com/home- dialysis/home-hemodialysis/a/1541 Medical design online. (n.d.). Retrieved from http://www.medicaldesignonline.com/article.mvc/Xcorporeal-Inc-Announces-The- XCR-Dialysis-0001?VNETCOOKIE=NO (n.d.). Retrieved from http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis picture. (n.d.). Retrieved from http://www.alibaba.com/showroom/hemodialysis- machines.html Schermer, M. (2004). Advanced home care technology: moral issues surrounding a new healthcare practice. Retrieved from http://www.rvz.net/data/download/CEG2.pdf Twardowski, Z.J. (2010). Daily dialysis.. is this a reasonable option for the new millenium. Oxford Journals, 16(7), 1321-1324. Twardowski, Z.J. (n.d.). Phd: the technological solution for daily hemodialysis. Retrieved from http://ndt.oxfordjournals.org/content/18/1/19.full.pdf+html