What is Home Dialysis
Home dialysis means that you dialyse in your own home, rather than travelling to your dialysis centre.
You can dialyse at home whether you are undergoing Haemodialysis or Peritoneal Dialysis and if Haemodialysis; using a Fistula or Neck Line.
You will be given your own dialysis machine and the necessary training so that you or a partner can set up the machine, do your own needling, respond to machine alarms and safely end your treatment sessions.
After discussing this option with you, a home dialysis nurse and renal technician from your dialysis centre will visit your home to make sure you have enough space for the equipment and the necessary supplies
It will mean that your home will become your ‘Treatment Centre’, so you will need to keep your home clean and safe.
Dialysis machines do come on wheels but they are not portable. They need a water supply and drainage connection, so some adaptions to your home will be necessary to accommodate the equipment.
Once ‘installed’ the machine will become a fixture in your home, so careful consideration should be given to where you want to dialyse; in your lounge, your main bedroom or a spare room.
All of the above will be discussed in detail with you by the home dialysis team at your dialysis centre.
The Benefits of Home Dialysis
The benefits of dialysing at home are well documented and numerous. They include:-
No-longer having to travel to and from your local (and sometimes not so local), dialysis centre three or four times a week.
Have much more time and energy to spend at home, with your family, pursuing a hobby or working.
Giving you more choice and control to change your dialysis regime to suit your lifestyle, by dialysing more often (but for shorter periods) or more slowly i.e. when you sleep at night.
Home comforts; it is far more comfortable to dialyse at home, choosing to lay in bed and rest or put your feet up read or watch TV in your lounge.
Health benefits, many of which are well documented by NICE and other NHS bodies They show that home dialysis will improve your mental health and general well-being, and with more frequent less intensive dialysis sessions, recovery times and your energy levels are increased
Being able to undergo more frequent and gentler therapy that will result in reduced dietary and fluid restrictions and less medication.
What Equipment and Adaptions are Required in your home
You will be aware from you time in the dialysis centre that dialysis machines are not small items! These machines, made by the likes of Fresenius, Nipro, Nikkiso or Braun are known as free-standing, and it is very likely that you will be given one of these for your home.
However, some Trusts are now using the smaller desktop size, NxStage machines for home use, so it is possible that you will be offered one of these.
Depending on the dialysis machine being offered, you should think about where you would like it positioned. The larger free-standing machine does require more plumbing, its own filters and will take up more floor space, whereas the smaller desktop machine will sit on a cabinet or small table and be far less intrusive. But both require a water feed and drainage connection so you should assume that both will be permanent fixtures; not portable.
The type of dialysis machine being offered to you will depend on the machines available to the Trust and your Consultants’ preference. Both machines offer dialysis in different ways and your Consultant and nursing team will advise you accordingly.
Free-Standing Machine Installation
The free-standing machine requires a filtered cold water supply and drainage connection. Two filters, each approx. 20” tall will be affixed to a ‘Plumbing Board’ mounted on a wall adjacent to the dialysis machine.
The Plumbing Board will be approx. 1M square in size and along with the filters will include some other plumbing components and accessories all to ensure a safe supply of purified water to the machine.
In front of the Plumbing Board and on the floor, will sit a large PVC floor tray approx. 1M x 1.5M in size. On here will sit the dialysis machine, the RO** and possibly a water softener **. The tray is there to protect your floor in the event of any drips or leakages.
** The RO (Reverse Osmosis) machine purifies your tap water so that it can be used for your dialysis.
*** A water softener may or may not be required depending on where you live and the water hardness and the make of RO being used.
Alongside the Plumbing Board we will plumb a drainage connection consisting of a white 40mm diameter pipe that we will be connected to a nearby drainage system or run directly to an outside drain. In exceptional circumstances we will install a waste pump, but this would be a last resort as these pumps are noisy and intrusive and certainly not something you would want if you were nocturnal dialysing.
Two no. double 240V switched RCD electrical sockets will also be fitted above the Plumbing Board giving the machine, RO and softener their own electrical supply
With your agreement and permission, our professional installers will install the necessary equipment as clean, tidy and sympathetically as possible. We realise that this is your home, so we will work with you every step of the way.
Desktop size (NxStage) Installation
These smaller NxStage machines are designed to be portable, but in practice they are not. They require a cold water supply, a drainage connection and a 240V electrical supply similar to the free-standing machines, but do not require the filters nor Plumbing Board. This is called NxStage PureFlow.
The water supply and drainage hose pipes supplied with the machjne are quite small (approx. 10mm in diameter), and are 30’ in length, so you could move the machine around your room while connected to the water supply and drain. But these hoses do need secure connections and must be protected against damage or kinking, so it is not advisable to move your machine around on an ad hoc basis; rather keep it stationed in the one place.
The NxStage machine can also run in PureFlow Lactate Solution mode. This is where the fluid required is provided in pre-mixed dialysate bags rather than from a cold water supply. In this mode the machine will not require a water supply or drainage connection and the dialysate bags will have to be disposed of afterwards. Pureflow Lactate Solution mode is very specialised and quit rare, so it is highly unlikely that you will be offered this dialysis option
Unless you contact us directly, we usually work on referrals from NHS and privately run dialysis centres and NHS Trusts. Home dialysis is not new. In 2008 NICE recommended that all dialysis patients should be given the choice to dialyse at home if they wished and in 2019, NHS England launched a ten year plan to get more patients dialysing at home. So, feel free to speak to your nursing or technical support team if you wish to be considered for home dialysis.
If dialysing from home is a real possibility, a member of the Home Nursing Team and possibly a Renal Technician will visit your home with you to check for themselves that you have the space for the machine and supplies. They will also discuss the Training required so that you can manage your own dialysis.
If you are in rented accommodation your Landlord will be contacted and asked to give their permission first, but this not usually a problem, save for the time it takes. So, once all is agreed, we will get the call from the Trust and be given your contact details.
A member of our team will then contact you and arrange for our plumber and electrician to visit your home to discuss with you where you would like the installation. Our plumber will check the proximity of the cold water supply and the waste pipe system. He’ll also check the mains cold water pressure. Our electrician will be looking at your consumer unit and the general state of your electrics.
We will report back to the Trust and await their go-ahead. Approval and scheduling of the installation can take a few weeks and will depend on a number of factors such as your training schedule and the availability of equipment.
But once approval is given, we will liaise with you on an installation date/s. Depending on the size of the job the plumber and electrician may come on the same day or different days. This will depend on the amount of work each has to complete.
Once we are done, the Trust will arrive with the dialysis machine, RO and Softener and connect up. They’ll take a couple a water samples and once the results are back away you go.
The above process is very much based on us installing a free standing machine. With the desktop sized NxStage machine, the approval process is very similar but there is less plumbing to install and water samples aren’t required, the installation process could move along a little quicker.
Who will carry out the Installation - our team
A Qualified plumber will carry out all the plumbing works, free standing and desk top machines.
A Qualified electrician will carry out the electrical works. An electrician is not required for a NxStage machine.
All Operatives are experienced home dialysis installers and are CRB checked
The whole process will be managed by a member of our team and you will be kept informed at every stage of the works
All our work is guaranteed for 12 months, but of course we will be on hand to support you for as long as you are dialysing at home.
Typical Plumbing and Electrical Adaptations Required
The following is a guide to what is required for a large free standing Fresenius, Nipro, Nikkiso or Braun dialysis machine.
Mains cold water feed min 1.5Bar pressure
Mains stop cock, double check valve, pressure regulator valve
Mains emergency water shut off valve
2 x water filters (1 x Particle and 1 x Carbon block cartridges)
Water sample tap
40mm waste upstand connected to waste pipe system or if required a waste pump
2 x double 13A switched RCD sockets, switched spur if a waste pump is required
All the above to be mounted on the back board approx. 1M x 1M in front of the floor tray
Floor tray approx. 1M x 1.5M in size; white PVC with 20mm lip. This will collect any water from leaks or drips. The probe from the emergency water shut off valve will detect any water in the tray and shut off the water supply.
You will be required to store all the necessary supplies and consumables in your home. The amount stored at any one time will vary on the amount of storage space you have, the frequency of the delivery (can be every 2 – 8 weeks) and the machine being used. Typically you will be asked to store:-
Dialysis fluid concentrate solution
What other services do we provide
Along with your home dialysis installation, we can provide:-
Emergency repairs to your home installation
Home dialysis upgrades and alterations
Home dialysis removals
What else can we provide
Along with the basic plumbing and electrical requirements to ensure everything works, we can provide any number of sundry items (subject to the Trust’s approval), such as:-
A bespoke dialysis chair
Stacking drawer tidies
Shelves for supplies
Two-way audio monitors
Extra telephone connection
Floor trays to any size
Home Dialysis Installations Ltd (HDIL), is based in Hampshire, but we carry out home dialysis installations across the UK working in partnership with several NHS Trusts and some Private Providers.
All the installations are managed by HDIL staff from beginning to end providing you with a single point of contact.
However, the actual plumbing and electrical works are carried out by independent qualified and local tradesmen, each of whom has been checked and vetted by us and is tasked with completing their work safely in your home.
Each is experienced and trustworthy and by using local tradesmen we are able to respond quickly and efficiently in whichever part of the country we are required.
Our promise to you
We understand that being on dialysis is not easy, and we realise that having a dialysis machine and all its related equipment in your home is not ideal. We know that the machine is cumbersome and intrusive and ‘sometimes Clinical’, but we make this promise to you. We will always :-
Try our best to put the installation where you want it. If required, we can move the radiator or your TV to make way for the installation; indeed anything within reason and with your permission
Work in a clean, caring and considerate manner, conscious that we are in your home.
Fit the installation as close to a mains water supply or waste pipe system to keep the length of exposed visible pipes to a minimum. As much as we would like to, often NHS budgets do not stretch to channelling walls or pulling up floorboards to hide our plumbing. All necessary pipework will be surface mounted and sometime visible
Work with you to try to avoid the need for a waste water pump that can be noisy and can clog up if not maintained.
Aim to ensure your dialysis machine works in its new location with the appropriate infrastructure around it, but that your home does not feel like a dialysis unit.