6 Years of Experience with Nightly Home Hemodialysis Access
Abstract:Lynchburg Nephrology Dialysis Inc. started its nightly home hemodialysis (NHHD) program in September 1997. Purpose of study:
To evaluate episodes of exit site infections, catheter sepsis, safety, and longevity of accesses for patients doing NHHD. Methods:
If IJ catheter was chosen, patient was started on Coumadin 2 mg/day when catheter was placed. If catheter malfunctioned, it was locked with a thrombolytic agent and Coumadin was adjusted to meet a goal INR of 1.5–2.25. If the problem persisted, the catheter was exchanged. For catheters, the B-D InterLink device was used to prevent air emboli and infection, and a locking device was used to prevent disconnects. If AV fistula was used, 4 buttonholes were established using 16 gauge needles. If AV graft was used, patients were taught the ladder cannulation technique using 16 gauge needles. Results:
As of September 1, 2003, 45 patients have completed training and have performed 27,063 treatments at home. Total catheter time at home was 930 months. Total AV fistula and AV graft time at home was 190 and 20 months, respectively. Upon completion of training, 34 patients were using tunneled IJ catheters, 10 using AV fistulas, and 1 using an AV graft. The IJ catheter exit site and sepsis infection rate was 0.35 and 0.49 episodes/1000 patient days, respectively. Average catheter life was 8.5 months with the longest 66.7 months and the shortest 0.2 months. The AV fistula and graft exit site and sepsis infection rates were 0.16 and 0 episodes/1000 patient days, respectively. Catheter complications included 1 episode of disconnect due to patient's failure to use locking device, 1 episode of central stenosis, and 1 episode of intracranial hemorrhage, due to prolonged INR, with resolution of symptoms. Conclusion:
Data support that tunneled IJ catheters, AV fistulas, and AV grafts were effective and safe permanent accesses for patients on NHHD.
Document Type: Research Article
Affiliations: Lynchburg Nephrology Dialysis Inc., Lynchburg, VA, U.S.A.
Publication date: January 1, 2004