Concerned about Home Hemo

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Hi, everyone! I've been in hemodialysis for 12 years as staff nurse, charge nurse, facility administrator, and I've also done acutes. The company I work for has a brand new home hemo program. We are using the NxStage cycler and Pureflow dialysate. At first I was excited about this new challenge and my much more flexible job schedule. I am now 6 weeks into things and I see things much differently. Some people say I worry too much about my patients and try too much to be responsible for everything and everybody 24/7. I say I have integrity and I also have a nursing license that I want to keep. Even though I have taught my patients the concepts and the process, I keep thinking about the "what ifs". What if they do get an air embolism? What if they bleed to death? There are SO many things that could go wrong. This is dangerous and risky. I feel like I'm training my patients and their partners to be techs in a few short weeks. Techs on the treatment floor get more training and also have teammates for backup and support. My home pts can call me or NxStage anytime, but we aren't actually there with them to physically help out. My first patient doesn't even have a fistula. In three weeks I taught her to dialyze through a central venous catheter. There is no way in training that we could experience every single possible alarm or experience every possible scenario. I just feel like I will be held liable if anything detrimental occurs. Does anyone else feel this way or am I crazy?

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Specializes in Dialysis.

they can dialyze themselves thru their catheter? no way! I guess all our (3) pts have fistulas. wow! I would also worry about the same things you do, but if this program is so big and so awesome and important, you know they have researched and checked and balanced and troubleshot(?) as much as possible before going public with it. We currently have 2 home nurses. they are training 2 new couple right now. We have had one guy doing it himself for well over a year, no problems. It is ok to be scared, of course! But the point of this training is so that they get the basics drilled into them again and again and again, what to do if you break through bleed? what to do if your BP drops, what to do if you contaminate your field (caths?) etc. you have been through extensive training so that your new pts can also go through extensive training and everyone can be confident.

sorry, this is just coming from a tech who has seen all sides of in center hemo and PD and now some home hemo too. Hope this gives you a boost. I am sure you have done a wonderful job training.

but I do have a question, if they are doing this at home and something goes wrong, is it your license on the line? you mentioned something about your license.

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Yes, I worry that something could go wrong and my license could be in jeopardy. You know I do the best I can to drill the information in and they say they get it, but in the real world, in a true emergency would they respond appropriately? Let's face it, anything can happen at any time. I just want to know that I have done all that any human being could do. I feel like I could be facing a big lawsuit if a patient died. The family could say that they really didn't know what to do after all and blame me. Another issue with the home hemo that I have and my patients do also is this: It takes a good 45 min to 1 hour to set up the system, then they dialyze 2 1/2 to 3 hours six days a week, plus clean up time and add the time it takes to make the dialysate. Wouldn't it simpler to go a clinic 3 days a week for 4 hours and let someone else do the work for you and monitor your treatment? You know home hemo is a big undertaking for patient and partner. I just don't know if my nerves can take being responsible for these patients day in and day out. I realize that they sign a consent that states they are taking risks, but in a court of law who is actually responsible if something bad happens?

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Specializes in IM/Critical Care/Cardiology.

I'm sympathetic to your concerns, very valid. If it were ever to go to court YOUR nursing notes detailing the teaching and if patient sellf-demonstrated or verbalized understanding of said treatment is in there, I would think would be in your favor. Just a thought.

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Specializes in Dialysis.

i'm sad for you, what makes you all the sudden question your decision to go into home hemo? to even question yourself and your teachings?has something happened or have you read something?

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Ummm, I have never heard of hemo being done at home. That scares me. Wow!!

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Thanks for all your replies. I'm trying to convince myself that everything is going to work out okay. Maybe I'll develop more confidence as time goes by.

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Specializes in Hospice, Med/Surg, ICU, ER.

I know of several pts that do self-peritoneal dialysis.

This has been around for awhile.

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Home dialysis is quite common up here. And yes many of the patients have CVCs. Not every patient who applies to the programme is accepted. They have to be motivated, able to perform the dialysis process and strip down there machine. Never heard of a problem in the programme due to it being so selective of participants.

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I'm glad to hear that you have heard of no problems and I totally agree about the selection process. That is absolutely the key to success. The candidates must be intelligent, compliant, and possess the skills and drive to do this tx at home. My medical director is so agree to get this program going but I hope he won't just pick a patient, any patient. Thanks so much for your reply.

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Although not done in this area where I worked in a clinic for 5 years, home HD has been around for quite some time, although not with the NxStage system (which should actually be easier to use than regular machines!) From what I read on dialysis boards, patients absolutely love the freedom that it gives them and they also feel better than with 3 times/wk clinic dialysis. If you think about it, it requires less time than PD, but is of course more complex. However, the pts who do it don't seem to have any problems with it (from what I read).

As for your nursing license, I don't see how that could be threatened if you followed P&P and documented your teaching and the pt's demonstration. I am, I have to say, surprised that they let catheter pts do home hemo, but I was also surprised when my outpt company first allowed UAPs (PCTs) to access catheters; all the company had to do was document their training, and I never worried about my license because of it (personally, I think it's wrong to let PCTs access central lines - which we know would never happen in a hospital setting - it's all about saving $...)

Anyway, I don't think you need to worry about your liability regarding your NxStage pts.

DeLana

P.S. Also check out the Dialysis/Urology specialty forum on this site.

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Thanks so much for your input. I guess I just worry too much about the "what ifs". My cath pt has been home over a week now and seems to be doing great with the NxStage. I have documentation to cover my teaching and her skills demonstration, but in the back of my mind there's still that thought that something could go wrong. I don't have to have DaVita, but I do have to have my RN license!

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