New medical pathway for home dialysis introduced at Merlin Park University Hospital

Merlin Park University Hospital has introduced a new pathway offering some dialysis patients an alternative to surgery for the insertion of catheters.

The new option will reduce waiting times and allow more people to avail of treatment at home following the implanting of peritoneal dialysis catheters.

Traditionally these catheters required surgery under general anaesthesia, however, selected patients who meet the criteria will now be offered the procedure as a day case using ultrasound guidance under a local anaesthetic.

The new process will improve the patients' overall experience and allow them to carry out their own treatment at home without having to come to hospital on a regular basis. 

Peritoneal dialysis is a process of removing excess fluid and waste products from the body by running fluids in and out through the peritoneal catheter and is it is one of the treatments used in kidney failure.

"This procedure was developed in order to meet the predicted demands for peritoneal dialysis as a home therapy option of choice for our patients,” said Dr Paul O'Hara, Consultant General Physician and Nephrologist and lead Nephrologist delivering this intervention for the Home Therapies Service.

“I trained at Beaumont Hospital under the guidance of Dr Mark Denton, Consultant Nephrologist to get the expertise needed to bring this procedure to the Saolta Group for the first time. Surgical insertion will still be required for patients who are not candidates for medical insertion, but it will increase the number of patients who can access this service locally and give them the option of having the catheter inserted under ultrasound guidance with conscious sedation or local anaesthesia.

“Peritoneal dialysis for the management of end stage kidney disease offers improved patient involvement in the management of their care, better patient experience, autonomy and quality of life with treatment schedules that can be adapted to peoples’ lives, reducing the frequency of hospital attendance,” he added.

Lorna Durack, Clinical Nurse Manager for Home Therapies who is leading out on the service said, "With this new technique, waiting times for peritoneal dialysis catheter insertion will be reduced, reducing the number of patients who will need to come to a renal dialysis centre for haemodialysis, which is currently exceeding demand.  When dialysis is necessary, this option allows patients to choose their preferred renal replacement therapy. Home dialysis is more cost effective and is in line with the fundamental Sláintecare vision of treating people as close to home as possible.

"We provide our patients with home dialysis training and once training is complete, we are with them in their home to review how they perform their first dialysis session.  We continue then to review the patient at home every 6 to 12 months and patients attend a clinic every 2-3 months for medical review between their home reviews.

“Home therapies is transforming the lives of patients with chronic kidney disease. Dialysis at home keeps people more independent. It fits in with their lifestyles, their work, their social activities, and it enables them to travel as well. It gives them a lot more flexibility,” added Lorna.

The Home therapy service will incorporate patients from kidney centres in Galway, Mayo, Sligo and Letterkenny, and it is a key pillar of the home service's development.

One priority of the HSE National Renal Office is the continued development of home therapies in Ireland.

Clinical benefits that have been identified with home therapies include:

· Increased person control over treatment

· Reduced reliance on additional medicine, with one study finding that 26% of HHD patients rely less on medication overall when compared to in-centre haemodialysis

· An average of one hour recovery time compared to eight for in-centre dialysis

· Due to better health levels, patients on frequent home therapies have an increased chance of receiving a kidney transplant

Photo caption:
From left, Fiona Moloney Staff Nurse Interventional Radiology, MPUH; Nodlaig McDermott, Clinical Nurse Manager 2 Interventional Radiology, MPUH; Dr Mark Denton, Consultant Nephrologist, Beaumont Hospital; Dr Paul O Hara, Consultant General Physician and Nephrologist, Galway University Hospitals/Portiuncula University Hospital;  Lorna Durack, Candidate Advanced Nurse Practitioner, Home Dialysis; Fidelma Gubbins, Clinical Nurse Manager 2, Hospital 1, MPUH; Imelda Mathews, Assistant Director of Nursing, MPUH and Mansu Mathew, Staff Nurse Interventional Radiology, MPUH.