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Medical pathway for home dialysis introduced at Merlin Park Hospital

 Eight clinical staff members wearing medical uniforms in a clinical setting.

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. It is one of the treatments used for 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,” according to Dr Paul O'Hara, Consultant General Physician 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, explained that with this new technique, waiting times for peritoneal dialysis catheter insertion will be reduced: “This will mean a reduction in 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. Patients then attend a clinic every 2 to 3 months for medical review between their home reviews. Home therapies are 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.”

The home therapy service will be offered to patients from kidney centres in Galway, Mayo, Sligo and Letterkenny.

Clinical benefits that have been identified with home therapies include increased person-control over treatment and reduced reliance on additional medicine, with one study finding that 26% of home-dialysis patients rely less on medication overall when compared to in-centre haemodialysis. It involves an average of one hour of recovery time compared to eight hours for in-centre dialysis. As it results in better health levels, patients on frequent home therapies have an increased chance of receiving a kidney transplant.