Twenty-seven-year-old William Tackie is now able to spend more time following his passion for music while managing his own dialysis treatment at St Pancras Hospital

Published: 15 May, 2015
by TOM FOOT

NHS patients are being shown how to treat themselves in a new “self care” dialysis unit in St Pancras Hospital.

The kidney and diabetes treatment centre, which is run by the Royal Free Foundation Trust, was set up to improve treatment times for patients who can waste hours waiting to be hooked up to life-saving machines.

Eventually 72 patients will be given “intensive training” on how to use the new system which could save wasted time by “reducing reliance on nursing assistance”, according to the Royal Free. 

Dialysis is a form of treatment where a machine replicates the kidney’s function. Typically, the blood is transferred out of the body into a machine, which filters out the waste products and excess fluids. The filtered blood is then passed back into the body. Patients usually undergo three sessions a week, each lasting four hours. 

William Tackie, 27, who has had dialysis for eight years, said: “The thought of doing it yourself at first is daunting, but you begin to realise that it is actually not as hard as you thought it was going to be. The more time you spend getting into it, the easier it becomes. Instead of waiting for a nurse who might be busy to get you set up, and then help you off when it’s finished, you can get started on your own and take yourself off. 

“By the time someone would be there to help you off the machine you have already left.”

He added: “It’s really liberating being able to do it myself. It’s also kind of impressive and really satisfying doing it myself. I have even shown other patients what to do and given them advice.”

Mr Tackie suffered permanent kidney damage as a young child and now uses his dialysis time to work on his music.

Diane Walker, home and supported self-care dialysis specialist sister, said: “It’s not just the treatment. They have to have the background knowledge about their diet and medication, blood results, how to look after the access line and infection control.

“People surprise you. You might get a lady in here who is 70 years old who wants to do everything for herself, and if you try and help, she says ‘no, I will do it’.”

Ms Walker said that the training and skills required to administer self-care helped many patients to escape the feeling of helplessness often associated with dialysis.

She said: “You have patients who are struggling to come to terms with their condition, but by learning about their dialysis and doing it for themselves they get a buzz out of it and a sense of achievement.

“Patients have more flexibility as they can come in at a time that suits them. We don’t have to consider whether there is a nurse there who can help them get set up.

“It’s all about making the patient’s life easier and giving them more flexibility without putting a machine in their home.”

Ms Walker added that the different structure had helped to foster a more communal atmosphere.

She added: “We get patients who are more advanced in their learning who see patients struggling, and they will intervene and give them advice, and then they have a natter and introduce themselves.”

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About peritoneal dialysis

Peritoneal dialysis is a needle-free treatment and can be performed either by a patient or with the help of a care partner. It is used to remove waste products and extra fluid from the body during the issue with kidney functions. Peritoneal dialysis differs from hemodialysis as in this treatment the blood is not taken from the body to treat the patient. In peritoneal dialysis, a tube called PD catheter is placed in the belly of the patient, and the dialysis is carried out by sterile fluid flowing through the lining of the belly called the peritoneum. This helps the blood flow into and out of the peritoneal space and the blood is cleansed inside the body.

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Technavio's analysts forecast the global peritoneal dialysis market to grow at a CAGR of 4.40% over the period 2014-2019.

Covered in this report

This report covers the present scenario and the growth prospects of the global peritoneal dialysis market for the period 2014-2019. The report considers the following segments of the market:

Peritoneal dialysis products
Peritoneal dialysis services

The global peritoneal dialysis market is categorized based on the type of application:

Continuous ambulatory peritoneal dialysis (CAPD)
Automated peritoneal dialysis (APD)

Technavio's report, the Global Peritoneal Dialysis Market 2015-2019, has been prepared based on an in-depth market analysis with inputs from industry experts. It covers the global peritoneal dialysis market landscape and its growth prospects in the coming years. The report includes a discussion of the key vendors operating in this market.

Key regions

Americas
APAC
EMEA

Key vendors

B. Braun Melsungen
Baxter International
DaVita Healthcare Partners
Fresenius Medical Care

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Other prominent vendor

Covidien
Dialysis Clinic
Diversified Specialty Institute Holdings
Huaren Pharmaceutical
Medical Components
NephroPlus
Nipro
Northwest Kidney Centers
NxStage Medical
Renal Services
Sandor
Satellite Healthcare
Sichuan Kelun Pharmaceutical
U.S. Renal Care

Market driver

Growing aging population
For a full, detailed list, view our report

Market challenge

Associated risks and after-effects of peritoneal dialysis treatment
For a full, detailed list, view our report

Market trend

Emerging markets
For a full, detailed list, view our report

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Key questions answered in this report

What will the market size be in 2019 and what will the growth rate be?
What are the key market trends?
What is driving this market?
What are the challenges to market growth?
Who are the key vendors in this market space?
What are the market opportunities and threats faced by the key vendors?
What are the strengths and weaknesses of the key vendors?

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Nonprofit dialysis provider Northwest Kidney Centers has received Qualis Health’s 2015 Washington Award of Excellence in Healthcare Quality for Outpatient Services in recognition of its multiyear initiative to foster kidney transplants.

Northwest Kidney Centers was one of seven organizations from across the state honored for improving health care quality and outcomes. Qualis Health is a population health management organization. 

Read also:  Collaboration, focus drive transplant success rate at Northwest Kidney Centers

To better help patients seeking transplantation, Northwest Kidney Centers launched a focused initiative in 2009. It aimed to:

• Address patients’ needs before, during and after transplant
• Educate patients about transplantation
• Track each patient’s transplant status
• Remove barriers to transplantation and collaborate with local hospital transplant programs.

The program has been so successful that in 2014, Northwest Kidney Centers’ transplant rate was 80% better than the national average. The number of its dialysis patients who received a kidney transplant increased by 14% in 2014 compared to 2013, while the national average declined by 16 percent.

The award recipients were recognized during Qualis Health’s 2015 Northwest Patient Safety Conference on May 13 in Lynnwood, Wash.

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After receiving several complaints form home hemodialysis patients about difficulty using the Nipro BioHole Needle with CAPICK Scab Remover, Home Dialyzors United sent a letter to the FDA, asking the agency to revoke its approval of the needle.The needle has been on the market since its approval in March 2010.

"We believe that this device is not 'substantially equivalent' to the predicate devices cited in the approval letter of March 17, 2010, and that the differences pose significant risks to the health and safety of patients receiving dialysis for End-Stage Renal Disease (ESRD). We are requesting full review of the safety of this device," Home Dialyzors United said in the letter.

Home Dialyzors United (HDU), an advocacy and support group devoted to home dialysis patients, told NN&I that they had received complaints via two closed Facebook groups for HDU and Home Dialysis Central. At Nipro's request, HDU also solicited anonymous comments from group members, and submitted them to the company.

Concerns about needle design
HDU highlighted specific concerns regarding the safety of the needle, and allowed NN&I to view some of the anonymous patient comments. Nipro has responded to HDU's concerns in a letter. The specific concerns, and Nipro's responses, are included below.

Length of needle
In their letter, HDU said the Nipro needle is a ¼ inch longer than most predicate devices. This added length, HDU said, makes it easier for patients to puncture their fistula. Some patients have reported punctures and subsequent infecitons, and some said they had to use extreme caution because the "extra ¼ inch ends up against the back wall of the fistula."

Nipro response: The BioHole Needle has an exposed needle length of 1” or 1 ¼” as indicated on the device label and meets all Kidney Disease Outcomes Quality Initiative (KDOQI) and Fistula- first guidelines. The depth of cannulation is dependent on the cannulator and the patient’s access as written per clinic protocol as well as how the tunnel track was physically developed. This process is defined by national standards, not device manufacturers.

Infection risk
HDU and many patients also expressed concern about infection risk, because the CAPICK scab remover, which resembles the removable cap of a ballpoint pen, is included in the same package as the needle, rather than being packaged separately. "This means that as soon as the package for the needle is opened, the CAPICK can be exposed to non-sterile conditions, risking infection in the access site."

Nipro response: The CAPICK is an accessory to the BioHole Needle – packaged together for ease of use to the patient or clinician, just as the predicate device (Medisystems ButtonHole Needle with Steripick) is packaged. Packaging the CAPICK independently of the BioHole Needle would increase the manufacture cost, in turn increasing patient treatment costs as well as waste due to unnecessary packaging materials. The device would still be exposed to non-sterile conditions as soon as the package is opened, which is common for many medical devices, including the predicate. The device label advises not to use the device if the packaging is damaged (which would compromise the sterility), and the Instructions for Use (IFU) state to remove the CAPICK from the needle cap using aseptic technique. It is also stated in the IFU that a second skin disinfection is recommended, after the scab pick has been used, before cannulation.

Ease of use
HDU said "the tube is ½-inch shorter than other buttonhole needles. The scab picker is not shaped to remove the scab easily and completely for access to the fistula, and may, in fact, push pieces of the scab back into the fistula." Most of the patient complaints sent to NN&I involved the inability to pick the buttonhole scab with the CAPICK.

Nipro response: The BioHole Needle tubing is 12? long, as indicated on the device label. The CAPICK was designed as a dull plastic needle with large finger grips to prevent the skin from being cut during use and with a bevel on each side of its point. It is for skin contact only and not to be used inside the tunnel track. 

Air embolism risk
Many patients expressed concern about the frosted needle, which they say makes it hard to ensure the line is bubble free. "The NIPRO needles with CAPICK are frosted, rather than clear, making it more difficult to determine if the line has been adequately cleared of bubbles before use," HDU said.

Nipro response: The risk of micro air bubbles has many factors including needle entry angle cannulation and depth of the patients tunnel track. An AVF needle with a back-eye can also contribute to the micro air condition. These elements are independent of the tubing materials and coloring. The clarity of the needle tubing is comparable to the predicate tubing, which is also slightly frosted in color.

"We believe our device has proven substantial equivalence to the predicate device." Nipro said in the letter. "The issues that you have outlined in your letter can be significantly reduced with training provided by the Nipro Clinical team through the Nipro Connect Educational Program."

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