Haemodialysis is a procedure used to maintain patients with end stage renal failure by using an artificial kidney machine (dialysis machine) to replace the excretory function of the failed kidneys. Blood from the patient is pumped from the body through special tubing to the dialysis machine, where it travels through the dialyser, cleaned then returned to the patient.
For home haemodialysis, patients are trained to conduct their haemodialysis at home. Patients choose their dialysis hours and times to suit their lifestyle. Patients dialyse for to five to eight hours, seven times per fortnight during daytime hours. Alternatively, they can conduct the haemodialysis overnight (nocturnal haemodialysis), while sleeping. Patients then dialyse for up to ten hours either every second night or six times per week.
A 24 hour home haemodialysis nurse on-call service is provided for all patients, so patients are never alone.
Prior to starting home haemodialysis training, patients are interviewed by a nurse from the home haemodialysis team and the social worker. The requirements for home haemodialysis are explained and all questions answered. A hygienic area at the patient’s home is required, as well as storage space for dialysis supplies and the dialysis machine. All supplies are delivered monthly to the patient’s home at no cost.
Training is conducted according to each patient’s pace by expert renal nurses to enable the patient to dialyse in the comfort and privacy of their own home. Most patients attend the training unit daily for 5 to 10 days, until they are competent and confident to dialyse themselves at home. Training generally takes between six to eight weeks.
A Monash Health dialysis technician visits the patient at home to ensure the water supply and water quality are at required standards. Some plumbing modifications may be required in the room where the haemodialysis will be conducted. The cost to do this is paid by Monash Health.
The technicians also deliver the haemodialysis machine and arrange for servicing when required. The haemodialysis machine is made available at no charge.
Home haemodialysis does not suit all patients and there are some drawbacks to consider:
Holidays can be arranged easily when the dialysis machine can be taken with the patients.
In peritoneal dialysis, the dialysing fluid is inserted into the peritoneal (abdominal) cavity at regular intervals, and the waste products diffuse into it. The peritoneum is the membrane that lines the abdominal cavity and it is across this membrane that the chemical exchange between the blood capillaries and the dialysing fluid takes place. After a period of time, the dialysing fluid is drained from the cavity and replaced with clean fluid.
There are two forms of peritoneal dialysis:
CAPD takes place inside the body using the natural lining of the abdomen, the peritoneum. The peritoneum acts as the dialysis membrane. Patients dialyse at their own home, usually four times every day. It takes less than 30 minutes each time and is a very simple and painless procedure.
All the equipment required for dialysis is delivered to the patient’s home at no cost, including the dialysis bags which are delivered in boxes. As such, storage room is required at home to stack these goods. A dry garage, spare room or an outbuilding is ideal.
A small machine regulates the movement of fluid into and out of the peritoneal cavity. The patient is attached to the machine at night before going to sleep, and while they sleep the machine performs six to eight exchanges. During the day, the fluid solution remains in the peritoneal cavity so that dialysis can still occur slowly. APD is designed to be simple – children have always been dialysed this way and the machines are simple and easy to use.
The peritoneal dialysis units in Dandenong and Traralgon (La Trobe Regional Hospital), ward 34 South and renal registrars are always available for oncall assistance when patients dialyse at home.
Each patient is interviewed by a nurse from the peritoneal dialysis team. As there are now two locations (Clayton and Traralgon), you can choose the one closer to your home. The requirements for home dialysis and training will be explained and all questions answered. A hygienic area at the patient’s home is required, as well as storage space for dialysis supplies and the dialysis machine. All supplies are delivered monthly to the patient’s home at no cost.
Training is conducted according to each patient’s pace by expert renal nurses to enable patients to dialyse in the comfort and privacy of your own home. Training can occur at either Clayton or Traralgon, it is your choice. Most patients attend the training unit daily for 5 to 10 days, until they are competent and confident to dialyse at home themselves.
There are now two units to assist patients located in south-east Melbourne and south-east Victoria
Patients have a few options when looking to take a holiday:
Short holidays like long weekends are as easy as packing the equipment patients require for dialysis and setting off. Medium to longer-term holidays are still very easy but will take a bit more planning.
Dialysis fluid can be delivered anywhere in Australia at no cost to the patient however the supplier will require extra time to make the arrangements. It is recommended that the fluids are delivered to a patient’s before they go on holiday, and for someone to personally accept the delivery. Most accommodation services will do this if requested in advance.
A medical letter and a dialysis letter should also be arranged so that in case of an emergency, another medical facility will have information about the patient’s renal failure. The letters will contain contact names to gain further information if required.
The patient will be given the address of the hospital nearest to their holiday destination that deals with peritoneal dialysis so that they have contact names and telephone numbers if required.
Overseas holidays are more involved and more time is required to organise supplies. This should be planned at least three months in advance and the freight charge to the overseas destination will be payable by the patient. An estimate of that cost will be given prior to delivery.
Overnight cycler machines cannot go overseas due to varying arrangements for maintenance in different countries, so fluid for manual exchanges is the only fluid that can be authorised for overseas delivery and use. Six weeks is normally the maximum period that fluid can be authorised in advance for any one year.
With proper planning, patients can take holidays whilst on haemodialysis. It is recommended that patients:
The key is to plan ahead, well in advance, particularly for school and end of year holidays.
The patient’s ‘home’ haemodialysis unit will send the patient’s haemodialysis treatment details to the destination holiday satellite unit, usually one month before departure.
There are 242 haemodialysis units across Australia covering all states and territories. Most are associated with public hospitals and are provided free of charge. Some are private facilities and may charge the patient a fee for each treatment.
Please note that despite these facilities being available, holiday spots can be difficult to obtain due to local demand and limited resources. As such, it is suggested that patients do not pay for travel or accommodation until a haemodialysis site for the holiday is confirmed.
Satellite haemodialysis, again subject to availability, can be free of charge where reciprocal arrangements exist between the Australian Government and other countries. Currently, Australia has arrangements with Belgium, Finland, Italy, Malta, New Zealand, Norway, Sweden, The Republic of Ireland, The United Kingdom and The Netherlands. For details, telephone Medicare on 13 20 11.
For countries not listed above, arrangements for free haemodialysis service do not generally exist, and the overseas unit will charge the patient a fee.
All Monash Health dialysis units are at capacity with permanent patients, and holiday spaces are rare. We do apologise in advance if we cannot accommodate you, and this is most likely what will occur.
Please contact our Dialysis Co-ordinator to determine if any spaces are available in one of our seven satellite haemodialysis units located at Berwick, Cranbourne, Dandenong, Moorabbin, Traralgon, Warragul and Wonthaggi.
Haemodialysis is a procedure used to maintain a patient with end stage renal failure by using an artificial kidney machine (dialysis machine) to replace the excretory function of the failed kidneys. Blood from the patient is pumped from the body through special tubing to the dialysis machine, where it travels through the dialyser, cleaned then returned to the patient.
The unit is an acute eight chair facility with an additional two chairs located in a separate isolation room where patients who have been diagnosed with VRE, (vancomycin resistant enterococci), dialyse.
The unit provides acute healthcare needs for a wide range of patient conditions including: