Self‐cannulation of the vascular access in home hemodialysis: Overcoming patient‐level barriers

• Published in: Seminars in dialysis 2018-09, Vol.31 (5), p.449-454
• Main Authors: Ward, Frank L., Faratro, Rose, McQuillan, Rory F.
• Format: Article
• Language: English
• Subjects: Arteriovenous Shunt, Surgical - adverse effects; Arteriovenous Shunt, Surgical - methods; Catheterization - methods; Central Venous Catheters - adverse effects; Hemodialysis, Home - methods; Humans; Kidney Failure, Chronic - therapy; Patient Education as Topic - methods; Self-Management - methods
• ISSN: 0894-0959; 1525-139X
• DOI: 10.1111/sdi.12708

Patients with end‐stage kidney disease who are considering home hemodialysis (HHD) face the challenge of learning to self‐cannulate their arteriovenous access. Current practice discourages the use of tunneled central venous catheters, with recent indications that self‐cannulating patients have superior outcomes. Patient‐level barriers do not appear to preclude a successful HHD program and should not be viewed as insurmountable by healthcare staff or patients. The healthcare team must address patient fears while instructing the patient to perform self‐cannulation safely. Identification and understanding of the barriers perceived by the patient will allow the patient and healthcare team work collaboratively, toward the goal of independence with self‐cannulation both during initial training and follow‐up care. The aim of this review was to provide a practical resource to aid in the identification and resolution of these patient‐level barriers, with the overall goal of improving the patient experience and medical outcomes in home hemodialysis programs.