13.2 Home Setup, Monitoring and Emergency Readiness

Prepare the Space and Supplies

A home dialysis session begins before the blood pump starts. The learner prepares the clean area, performs hand hygiene, checks the prescription and selects the correct supplies. Inspect packaging, expiration dates, labels and connections. Confirm the prescribed dialyzer, bloodlines, needles or catheter supplies, anticoagulant and fluid. A supply that fits mechanically is not necessarily approved for the system or prescription.

Check the equipment's required self-tests and treatment readiness. For a water-based system, complete the water-quality and residual-disinfectant checks specified by the home program. For prepared-fluid systems, verify bag identity, integrity, storage and warming requirements. Do not assume that every home machine uses an RO loop or the same conductivity test. A failed check is a stop condition requiring the trained corrective or support process, not permission to bypass a safety feature.

Patient Assessment and Connection

Record weight, BP, pulse, symptoms and access assessment as instructed. Compare the weight with the current target and determine the ordered fluid goal using the trained calculation. Include fluid actually administered; discarded prime is not intake. Ask the home team about unexplained large weight differences or new symptoms rather than independently changing the prescription.

Inspect fistula or graft skin and feel for the usual thrill. Catheter users assess dressing and exit-site findings and follow the exact connection protocol. New absent flow, significant redness, drainage, fever or spontaneous bleeding requires advice or emergency action depending on severity. A home treatment should not proceed through an ulcerated access segment simply because the patient has used that site before.

Place needles or connect the catheter using the trained aseptic method. Secure lines so movement does not pull the access. Keep the access and venous connection visible throughout treatment; blankets and sleeping positions must not hide potential bleeding. Device alarms cannot reliably detect every venous-needle dislodgement. An alarm-free circuit is not proof that the connection remains secure.

Monitoring and Records

Record actual delivered treatment, UF, administered fluids, medications and significant events. Logs help the team interpret adequacy and identify recurring difficulties. Do not enter the planned time after an early stop or make up values to complete a required field. The home team must know when a substantial part of treatment was missed.

Termination, Cleaning and Disposal

Use the device-specific rinseback sequence and never return air or suspected hemolyzed blood. Remove needles and obtain hemostasis with focused nonocclusive pressure as taught. Recheck the access, symptoms and post-treatment weight before concluding the session. Catheter locks follow the prescribed agent, concentration and lumen volumes, with product-specific instructions for the next treatment.

Clean and disinfect equipment using the approved concentration, exposure and rinse process. Record completion when required. Household cleaning substitutions can damage equipment or leave unsafe residues. Dispose of sharps in approved containers and used supplies according to local arrangements. Keep clean supplies separate from contaminated material. Track inventory early enough to prevent unsafe substitution or missed treatment.

Emergency Decisions

The patient and partner rehearse how to stop the pump, clamp lines, call the home team and activate emergency services. Severe breathlessness, chest pain, altered consciousness, uncontrolled bleeding or collapse requires emergency help. A telephone troubleshooting queue is not an alternative to emergency services for a life-threatening event.

For access bleeding, use focused direct pressure and emergency calling. For a disconnected circuit, stop the pump and clamp according to training; do not casually reconnect contaminated ends. Air alarms require the device procedure and must never be disabled to finish treatment. The home plan distinguishes a correctable minor alarm from a situation in which blood return may be unsafe.

Utility and Caregiver Backup

Power interruption affects pumps and safety systems. Different machines have different backup and manual blood-return capabilities; practice only the approved method. Never rotate a pump or disconnect a line by guesswork. Loss or contamination of water prevents safe operation unless a validated alternative is available. Resume only after the home program confirms readiness and any required tests are satisfactory.

Keep an accessible list of contacts, medication information, access type and alternate dialysis arrangements. Care-partner absence, illness, housing changes or equipment failure may require a temporary in-center plan. Supplies stored for emergencies still require expiration and condition checks. The purpose of backup planning is continuity without improvisation.

Scenario

During a home session, a patient repeatedly silences a venous alarm and covers the access with a blanket. Training should identify both hazards: investigate the alarm through the approved procedure and keep the access visible. If the problem remains unresolved, stop safely and contact the home team. Completing every planned minute is not success if it depends on disabling protection or concealing a bleeding risk.

Sources: NIDDK home HD skills, CMS home support.